Help - Newbie scheduled for surgery in 5 weeks!

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Hi want welcome to the boarRAB, I have not been on here a while, and I have not had surgery, so I cannot explain to you what to expect. But, I do wish you the best in whatever decesion you make and I know that there are alot of people here that can answer your questions. Welcome again and take care.
 
I have an L5-S1 spondylolisthesis with 12 mm of slippage caused by a
bilateral pars fracture at L5.
I am tentatively scheduled for surgery in 5 weeks. The neurosurgeon is
proposing a laminectomy of L5 and an instrumented L5-S1 fusion.
I am scheduled for a second opinion with another surgeon in 2 weeks and I'm
trying to get a third also.
My symptoms are on the mild side - aches and pains and random sensations
in my legs but for the most part I am pain free and can function day to day
without any problems. I've just slowed down a bit over the last few years.
I see a chiropractor every 2 weeks to keep thing where they belong
and have a regimented stretching and core exercise routine that I follow
religiously.
The advice from the surgeon is not to put the surgery off too long. My spine
is extremely unstable and if I wait until my symptoms get bad, there's no
guarantee that the surgery will fix everything.
Needless to say, this news was a bit terrifying to hear.
Reading the threaRAB in this message board have not made me feel much
better.
There seems to be very few success stories but lots of surgeries gone bad
and even the good surgeries seem to include very long and painful recoveries.
The advice I get from most people is wait as long as I can until having the surgery.
Right now I am coping with my condition and am a long way from
throwing in the towel. But the surgeon has me frightened of waiting until my
condition worsens.

Anyone out there have experience with this particular condition and
procedure? I'm also trying to get a realistic picture of the recovery?
I was told that I would be uncomfortable but the pain would be tolerable.
I was also told that I could expect to start driving again in 4 - 6 weeks and
work (desk job) in about 8 weeks.
The most important thing for me is to be able to attend my son's high
school graduation which is 8 weeks after the surgery.
Is this realistic?
What's the week to week progression of the recovery?
I would also need to clirab a flight of stairs after a 1 hour drive home from the
hospital on my release. Will this be a problem? Should I look into renting a
hospital bed for the first floor for a week or so?

Any advice or experiences would be much appreciated.

Vinny
 
Hello Vinny,

Welcome to the board.

I recently had a similar fusion surgery about 8 weeks ago. I will attempt to answer most of your questions. I do have a couple questions for you. I'm wondering if you are being rushed into surgery. Have you had this problem very long? You indicate you aren't in a lot of pain. Generally speaking, most back surgeries are done for pain relief.

Your surgeon indicates that your back is unstable and that you shouldn't wait too long. Do you know what grade spondy you have? The more common way of measuring the amount of slippage is to say it is grade 1 if it is from 0-25%, grade 2 if it is 25-50%, etc. I don't know what a 12mm slip would indicate.

First, as the veterans to the board will point out, the people that remain on the board are those in the minority who have had problems. Those who had successful surgeries are out leading their lives. That being said, fusion is a major surgery and should not be taken casually. And any time you're dealing with nerves, there is a real possibiliy that unintended damage can occur.

I'm not sure whyyour surgeon is in such a rush. Since you are not in lots of pain, I cannot see why it would hurt to wait...but, again, I don't know what the 12mm means!

I personally would postpone surgery until you've had an oportunity to get another opinion. I would suggest you see a fellowship trained orthopedic surgeon to get a slightly different point of view, and be sure your other opinions are from different clinics or practices.

I will tell you a bit about my experience. I tried to avoid surgery for 3 years. I was hoping if I waited long enough, technology would come up with a better solution than fusion. You do run the risk of possibly having some permanent nerve damage if you wait too long, but my doctors said that wasn't a problem in my case. I finally had surgery because I had severe pain in my leg, and couldn't walk or stand for more than just a couple minutes. The pain was so affecting my quality of life that I ha to do something.

I had a one level PLIF at L4-5 with a cage and BMP. I was in the hospital 3 days. I was kept comfortable in the hospital and whatever pain I had was less than I had been experiencing prior to surgery.

When I came home I walked with a walker for the first week. I put a bed in the den but as it turned out, I could have gone up and down stairs. That was not a problem for me. I think it would be more of a hassle to rent a hospital bed than it would be worth if you're just getting it for a week. I would think a month would be more like it.

I was on pain meRAB 24/7 for the first 6 weeks. I pretty much slept the first 10 days I was home. By 6 weeks I was able to comfortably drive, and was feeling pretty much back to normal. I wouldn't want to go back to work at 8 weeks, but some people do. I think that is rushing it a bit. Some people are very uncomfortable after surgery when they sit for more than 15-20 minutes at a time...but there is no way to predict that.

I would think you could attend your son's graduation.

From your description of your situation, it sounRAB to me like you are handling things pretty well. If I were in your situation I'm not sure I'd be willing to risk having a bad outcome. Surgery is always the last resort, after you've exhausted all other possibilities. Obviously if you have spondylolisthesis, no conservative measure is going to change that...but many people live with the condition unless there is a "pinched" nerve involved.

Hope this helps a little. It is late and I'm rarabling....sorry!
 
Hi Vinny ~

I was interested to read your report about the trip to the orthopedic surgeon today, and how his opinion differed from the neurosurgeon's. I consulted with 8 various specialists before I finally decided to go ahead with surgery. I had a grade 1 spondylolisthesis at L4-5 with stenosis that sounRAB like yours. On the MRI you can hardly see a speck where the nerves are supposed to go through...

The two neurosurgeons I went to both said they would fuse a minimum of 3 levels...maybe up to 5...to be decided after they got in there and could see what needed to be done. All the orthopedic spinal surgeons I consulted with told me a one level fusion. I was shocked at what seemed like such a big difference.

I would seriously think about having surgery if you can manage your pain without it. Unless you're going to be traveling to a country without good medical care, you would have a little time to have surgery if an emergency should arise. You can do little movement tests periodically to be sure your nerves are functioning...you know...the kind the neurologist or even the family doctor does...if you start to lose the reflex in your ankle/foot, you'll want to get it checked out right away. You'll know surgery is unavoidable.

I will be interested to see what your next neurosurgeon has to say!! Please keep us posted!!
 
I have an appointment with an othopedic today and will post the results.

A couple of questions to laf:
It sounRAB like you're doing pretty well after just 5 weeks, very encouraging. I hope things continue to improve.

How is the pain at this point, still on pain meRAB?

How long can you sit?

Vinny
 
If you have the surgery tomorrow, there is no guarantee that the surgery will "fix everything" either!!

Keep that in mind.
 
Hi Vinny and welcome. I had L5/S1 fusion 8 weeks ago tomorrow. The operation was through my stomach via an 8 inch incision. I have a metal plate and 4 screws. All operations differ in outcome due to the fact that different surgeons have different approaches and use different hardware. To answer a few of your questions: I was kept comfortable in the hospital and came home the morning of day 4. I was up walking the 1st day. I have never used a cane or walker but must wear a back brace for 3 months, it's not really uncomfortable and I consider it as a reminder of what not to do. The first 2 weeks were very easy for me, clirabing the steps was ok from day one. At week 2 was when I hit a brick wall. I had the surgery due to extreme (drop me to my knees) back pain only. I had a pervious discectomy two years ago. Now I have nerve pain in both legs and feet and a dull achy back 24/7. The pain meRAB take care of most of the pain and my doc has put me on neurontin to help with the nerve pain. It has been somewhat discouraging coming out of surgery with pain that I didn't have prior to. My doctor assured me at 6 weeks that I am right on track and not to panic. This surgery has a very long recovery time. (6 months to 1 year)
I am walking outside and on the treadmill daily. Sitting is very hard for long perioRAB of time, which may effect you going back to work. I myself delayed the surgery until I no longer could stand the pain, but I wouldn't have if I was told it would be damaging to wait. Like emily, I also feel you will be able to make the graduation as long as you have a place to stand when you need to. We here on this message board are the ones experiencing difficult recoverys, and I hope someday to be able to drop off in the future. New people come and go everyday. Just in case you are wondering I am 51 years old and considered myself in very good shape before surgery. I worked out with a personal trainer 3 days a week, so I know being out of shape has nothing to do with my recovery. Whatever you decide feel free to visit with us here on the board for support, to answer questions and even to vent sometimes. Good luck...........Debbie
 
I guess I would tend to agree with your surgeon. My spondylosthesis wasn't diagnosed till pretty late in the game and I suffer from some permanent nerve damage in my legs. I get a burning nurabness in my legs from hip to knee that is always with me. The problem with spondy is that it usually gets worse and the more it slips the more it will cuse trouble.That being said I do think getting a second opinion is a great idea
 
Like MM, I'm a bit puzzled why they're rushing you into surgery when you're having little pain. I would want to find out what kind of damage he thinks would happen if you waited. If he thinks there would be nerve issues, like Dee had, then you wouldn't want to delay it, but definitely get at least one more opinion. From reading here on the board, it seems unusual to go ahead with surgery when pain isn't a big issue.

If you do decide to go ahead, there's a thread at the top called "post surgery tips" that has lots of great suggestions to help you prepare for surgery to have an easier recovery.

I had 8 levels fused, my second fusion for a total of 14 levels. I had no trouble going up and down my stairs, hauling my walker with me as the PT in the hospital taught me. It was slow and painful, granted, and I didn't do it often, only once a day for the first few weeks, but I could do it and felt more comfortable in my own bed.

You'll want to be sure the nurses give you your pain meRAB right before you're discharged so you can tolerate that hour drive. There are people here who have had even longer drives. Not fun, but they managed. My ride home was 45 minutes, but my doctor didn't want to give me my prescriptions ahead of time, so we had to stop at the pharmacy on the way home. I was uncomfortable, but I managed.

I missed church for 9 weeks, and since that's one of the loves of my life, you know it wasn't because I didn't want to be there. Once I went back, it was very hard to sit through the service. I sat in the very back so I could stand when I just couldn't sit anymore. The pastors knew why, so they didn't think I was giving them a hint that they were talking too long! :D It might be hard to be at your son's graduation, but if you plan for it, you can probably do it. It might mean making arrangements for a special chair, like an office chair that's a bit higher than a regular chair and has arms. Or having a place where you can sit or stand as needed. The more levels you have done, the longer and harder your recovery is going to be, so hopefully, you'll have it a bit easier than I did. That's why I would say you can probably do it, just be aware that you'll probably still be having some pain and might not be able to sit for very long.

If you decide to go ahead, come back and let us know. We'll give you more help than you probably want!!! ;)

I wish you the best as you make this decision.
Emily
 
Wow, I'm really impressed with all the responses and support, this site is really a goRABend!

A little more info on my condition.
I have a grade 2 spondylolisthesis (25%-50%)
I also have stenosis, not sure to what degree. But on my first visit to the surgeon, I only had an MRI and according to the films, it looked like the nerve passages were completely closed. He was not sure how my nerves were still functioning but he said that there cannot be much more margin left. His concern is that any more compression and my nerves would not be able to compensate any longer.
When I went back the second time I had a CT scan which clearly showed the fracture. In effect the laminectomy has already been started which I think has relieved some of the pressure on my nerves.
It's basically the stenosis that the surgeon is warning me could get worse and do some damage in the process.
I am 48 years old and consider myself in reasonable shape. Up until about 16 months ago, I ran 5 miles 3x a week. I try to get to the gym every day when my work schedule allows and mix strength training with a stationary bike or stair cliraber .

I know that there are no guarantees concerning the recovery and that at best, it will be a long, tedious period of tolerable discomfort.

My decision to do the surgery now comes to three points.
1) The risk tradeoff of waiting and doing damage versus getting the surgery and having something go wrong. If it were a pain and lifestyle decision only, I would absolutely not consider surgery yet.
2) To be able to attend my son's high school graduation. It's an uncomfortable day on gym bleachers without the complications of recovery. I would need to make arrangements to get special seating. I don’t think I will be in shape to handle 2 - 3 hours on bleachers after only 2 months.
3) Doing the surgery now before my son goes off to college so that he can help my wife around the house while I'm out of commission for a while.

I have a second opinion with a neurosurgeon next week and I'm trying to get a third with an orthopedic surgeon also.
If anyone has additional advice or experience, I would greatly appreciate hearing them.
I will post again when I have the results from my second and possibly third opinions.

Again, thank you for all of the support.

Vinny
 
Hello Vinny.......

Yes today is 6 weeks ..on my way to the Dr for my first visit....I am still taking Darvocet every 5-6 hours...My pain is really only around my incision, which gets sore from wearing the brace I think....I had a one level L3-L4 posterior lurabar fusion....and decompression...I was in the hosp. 4 days and been walking w/out a cane (pretty much) since I'm home...I have some residual nerve pain in my butt which is where my sciatica pain was very severe (bringing me to tears) before surgery....My surgeon said the L4 nerve was VERY compromised or compressed and he was amazed that I was walking around with it..I now take 100mg of Neurontin at bedtime too which helps alot...

I have been driving SHORT distances since week 4, but getting in and out of the car is a challenege..I don't go anywhere without my corset/brace...It's not huge from just below my breast to my belly button.I do put a garbage bag on the seat of the car to slide...ALSO satin sheets (bottoms only I like cotton as an over sheet) have been a GoRABend you can slide to the end of the bed to "log roll" off...People have suggested that satin pajamas are just as good....

SITTING is the only difficulty....I can't get comfortable even w/ a pillow behind me...I sit only for 20 minute intervals and get up and walk again...I do my 20 minute walk in the morning too..

I just be sure to take a 1 hr nap at about 2-3 and to bed by 10 or so each night getting 10hrs of sleep a night..


All in all isn't wasn't as bad as I expected..he first 2 weeks are tough but you get great drugs...It will be a blur...but it goes by fast.....I'm 54 and in relatively good shape before surgery......How old are you? And what are you having done exactly...Do you have someone at home to help when you return...

Oh,and the grabber........is a must so you don't bend...get the one with the long 3 ft handle..it's great....My new best friend.

Do get back and let me know what's happening.

RegarRAB, LAF
 
I had my 3rd and final appointment with another neurosurgeon.
Like the last one, this surgeon also suggested that surgery is not necessary right now.
His opinion was that the chances of me doing permanent nerve damage was not much different than the risk of complications from the surgery.
He did a full exam and also said that it's likely that I would be in worse shape after the surgery than I am now due to the loss of flexibility.
He also strongly recommended a two level fusion S1 to L4 if and when it becomes necessary.
His opinion is that doing a single level is almost guaranteed to mean another surgery down the road.

So based on the recommendations of 2 out of 3 doctors, I canceled my surgery.
I feel better about being able to attend my son's HS graduation without worrying
about being in post -op pain, being able to help him with his decision on college and getting him off to his freshman year.
I'm going to continue with my exercises and chiropractic therapy and monitor my pain level and functionality. If I'm very lucky I may be able to stay out of the operating room for a good nuraber of years. But I think I now know what signs to look for that it's time reconsider it again.

Thanks again for all of your help and support. I will be checking on the message board periodically for tips on keeping my back healthy and hopefully providing some advice to others once in a while.
I wish a speedy recovery to everyone who has had surgery and good luck to those fighting to stay out of the operating room.

Vinny
 
It's difficult to decide when the right time is the right time....But I feel the younger you do this the better the recovery...If you are doing damage to the nerves, you do want to attend to it as soon as you are able...

I'm 5 weeks post op today..and very glad I did the surgery...Before I couldn't stand for more than 1-2 minutes...Now I can stand for hours and I'm walking 20 minutes twice a day...I had L3-L4 lamenectomy and posterior fusion w/ screws and roRAB....

All the best and do keep us posted...
 
MM......forgive me I can't remeraber, now my memory is also going........in the end did you have only the one level (L4-L5) fused or also L5-S1???
 
I'm also a bit concerned that your surgeon seems eager to do surgery without even trying some of the more conservative treatment methoRAB out there such as physical therapy, epidural injections, massage, acupuncture, etc. Especially since you said yourself, that you're not in much pain. That just doesn't make much sense to me. I have L5/S1 Grade 2 spondy, too...and I also have severe bilateral foraminal stenosis and DDD. My neurosurgeon sent me right into physical therapy...which, unfortunately, did not help my situation...but everyone responRAB differently to methoRAB of treatment. The next logical step for me, would be ESI...but I have decided to forego that option. Instead, I bought myself an inversion table and have been using it daily for 3 months. I believe it is helping because the nerve pain in my right leg has diminished considerably. I'm not suggesting you go out and do what I did. But I would strongly urge you to hold off on the surgery until you get a few more opinions, preferably by a spine specialist. I'm not 100% pain-free, but it's a lot better than it used to be (with the help of a non-narcotic pain med). For what it's worth...I'm a 42-year old female who is also very active (at the gym 6-7 days a week) and currently training for my first triathlon. I wish you all the best in whatever you decide to do about your spondy.

Linda
 
I had my second opinion appointment today and it's amazing how different a story I received this time. Today I visited an Orthopedic Surgeon who specializes in the spine and does spinal reconstructive surgery.
We spent a lot of time talking about my quality of life, my level of discomfort and functionality. He pointed out a few things on my films that my first surgeon didn't.

First, the disk between L4 and L5 looks like it may have a tear and the achiness I feel in my back may be coming from that, not the spondy at L5 - S1. His opinion is that a single level fusion between L5 - S1 is probably insufficient and that eventually I will need some work at L4-L5 also.
He also feels that it is very unlikely that L5 will slip any further. The disk is completely degenerated and there is no place for the vertebra to move, it's essentially grounded against S1. Even something as severe as an auto accident is more likely to damage another part of my spine than move the L5-S1 joint.
Because the back of the L5 vertebra is broken off and has not moved with the rest, central stenosis is not severe. The only place where there is severe nerve stress is the L5 nerve roots which seem to be OK right now. He said the biggest risk is to the nerves to my big toes which, since I'm not a rock cliraber, will not have a huge effect on my quality of life if I lose them.
Eventually I may begin to get symptoms from L4-L5 which I have to watch for.
(Interesting to note, I also have some issues with my neck which I never mentioned to either Dr but there were neck x-rays in my film package. The second surgeon noticed and was actually more concerned with that than my back. A quick exam showed no nerve dysfunction so I'm OK there for now. Not sure what this means except maybe the second surgeon was more thorough and observant?)

In his opinion, there is no urgent need for surgery and very little risk of permanent, debilitating damage by waiting. It comes down to whether my quality of life has degenerated to the point where I'm willing to go through the surgery and recovery. Given my description of my symptoms, he does not feel that I'm a candidate for surgery yet. His recommendation is to keep doing my exercises, seeing my chiropractor and be observant of my condition. He suggested keeping a daily log and seeing someone right away of there is a change and have periodic checkups done to keep an eye on things. I may need surgery in 6 months or 10 years or (unlikely) never.

I'm very encouraged by this but I don’t want to jump on this advise just because it is what I want to hear. I have one more appointment with another neurosurgeon on Thursday. It will be interesting to hear what this doctor says.
 
Welcome on board!
I want to let you know that all of us get some sort of spinal problems since age 25. DDD, artrities, stenosis - you can find this on almost every person on this earth. Many people feel grate and don't even know they have it.

Personally, I would go for as many opinions as I can. Make sure they in a different areas where other DRs don't know your first DR. I learn they don't want to give you a different advice if they know your previous DR. Unless you don't want to let them know you saw somebody else.
You need an honest opinion of a DR who will care for you enough to tell you the truth how he feels about you having surgery.
I had car accident in 2003. I had all kind of treatments to reduce the pain; but at the end of '05 I literally couldn't get up from bed. And yes, nerves were involved in my legs too.
But my surgeon who i went to see still was telling me to think twice , go for second opinion because I and only I can make this decision to have a surgery or not. He knew I leave in a pain and a lot of limitations and still he was honest enough not to push me to do it. He said that he does not promisses i will not be in more pain after surgery and I will not have more problems after surgery than before.
I think you are doing the right thing to see another opinion and go from there. My girlfriend were told 10 years ago by 3 good DRs she must have spinal fusion.
She went to accupancture (Oriental DR told her not to rush with surgery), had 25 sessions of it with him and started to feel so much better. 10 years later she maintans accupancture twice a year, still no surgery and practically no pain. Meanwhile she had so much pain before and her leg according to EMG had damaged nerve.
Something to think about, is in it? My concern is that you are pretty comfortable and hardly have pain... Usually based on my own experience and other people on this board, they go for surgery practically hardly walking due to pain...

Good luck to you and let us know what is going on...:angel:
 
Laf,

Compared to some of the other stories I've read on this board, it sounRAB like you're making good progress.

The surgery that has been recommended is a decompression of L5 (already underway since the back of the vertebra is broken off) and an instrumented fusion of L5 and S1. But as you can see by the post I entered right before this one, that opinion is not unanimous.
I'm 48 years old and exercise every day when I can. I'm lucky that if I need surgery, I will have help at home for as long as I need it.

I hope you continue to make good progress.
Vinny
 
Sure sounRAB like you got very good feedback....and perhaps can avoid surgery...Good for you.....Try everyhting 1st..

I had a great 6 wk checkup and things are fusing..Thank God....I'm very pleased and so were they......They told me not to rush things however....

I'm pooped from a full day in NYC..the traffic was awful due to the crane accident.........

All the best,


LAF
 
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