I am so confused and need help desperately!

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Jeff2263

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Hello All,

I am brand new here and have an issue and I don't know what to do. I use to play golf for a living and I am 37 years old. I have back problems. I had MRI's done 2 years ago and found out the problem and did nothing with my back at that time. I just had MRI's done again last week because of pain in my lower back. Results were L4-L5 herniation with deg. disc disease. I went to a NeuroSurgeon and he is rec. PLIF.

My pain is not all that bad all the time. I mean I can feel the pain in my lower back from sitting at my desk but I don't take pain killers of any kind. Sometimes I cannot stand and sing at church for very long. That actually might be a good thing!:) I have a lot of pain when I am bent over for awhile or when I cut firewood or do manual labor. There is not fluid left in L4&L5 so I would assume its not going to magically get better.

This is a crappy question, but what do I do? Should I let him do the PLIF? Will my back continue to get worse? Should I do the procedure while I am kinda young? I smoke, and cannot see myself quitting anytime soon. What happens if I do nothing. Will the disc that is pushing in on my spinal canal create more damage? I am SO CONFUSED. My wife thinks I should think long term and get the procedure done. I have great insurance so the cost would not hurt my family. Can someone please HELP ME!??

Thank-you,

Jeff
 
Hi Jeff,

The thing that jumped out at me is the smoking. If you aren't willing to quit smoking, there is no good reason to go through with the PLIF because chances are good that you will not get a fusion.

No one can make this decision for you, but I'll try to answer a couple of your questions. I too have issues at L4-5 and just had surgery, a one level PLIF two weeks ago. I had severe sciatic pain and could not walk or stand for more than a couple minutes. However as soon as I sat down, I was no longer in pain. So I couldn't justify surgery. I was afraid it might make things worse, and then where would I be? I tried every alternative method available to me. Nothing worked. My only option for pain relief was to try surgery.

I would suggest before doing anything you get at least another opinion from a fellowship trained doctor who specialized in the spine. You might want to try a fellowship-trained orthopedic spinal surgeon to see if there is any difference in his recommendations.

You are right that this situation will not magically improve. But you might be able to find exercises and some alternative treatments that would lessen the pain. I would advise you to do more homework...and find out what all your choices are before making a decision.
 
Marlo,

You made comments on my situation but you never told me how your surgery went. How do you feel? Are you confident you did the right thing?

I forgot to add that my doctor I seen that rec. the fusion was a neurosurgeon and suppose to be the best around. His name is Isa Canavanti and he took a long time with me and was very polite and I really felt comfortable with him. But you are absolutely correct on the whole smoking thing. I think its about time to quit anyway.

Please let me know how your surgery went and your recovery is going!

Jeff
 
Hi Jeff,
My name is Pam. I'm quite a bit older than you........like 17 years....! But, I'm thin , in good shape and pretty active. I had a PLIF. He fused L5 and S1. He did a dynamic stabilization on 4 and 5. That means he didn't fuse it. He just stabilized it with hardware. I was in the hospital 4 days. I'm also a nurse. I don't smoke. The smoking is a big factor. I think it can actually interfere with how the fusion takes. My pain did not usually go down my legs. It was like a huge big toothache. It felt like somebody was chipping away at my spine. I put up with it for 13 months. Within the 13 months I had Physical Therapy, a caudal block, and epidural block, a facet joint block. I had traction for 2 weeks. I then went to a tens unit. I got to the point where I figured I had to do it. I'm 16 weeks out now. I don't want to be negative, because I have no idea what direction I'm going with this, but my pain is probably worse now than before surgery. I'm very discouraged. They act like I am a bit behind on recovery, but hopefully they are not giving up on me. Just make sure you've tried everything before you do it. He told me the failed fusion rate varies from 10-40%. Pretty big spread there...... So do your homework and think about it. I had also had a previous laminectomy when I was only 19. Keep reading, and do all the conservative things first! Good luck.
 
Hi Jeff, I had a posterior fusion done over 21+ months ago at l4/l5.

Obviously your disc is torn. Since you've had this issue for awhile now, I think you are past the timeframe in which it would heal on it's own. So, at some point.. that disc eventually breakdown and will no longer offer your spine any stability at all there and you risk your spine collapsing at that level there if it's not repaired surgically. It is likely a matter of when, not if.

My disc there was also badly torn and it went undiscovered by 3+ years of MRIs. A discogram finally found the problem. There was no fluid left in mine and it was amazing it was holding up like it was. I was fused a few weeks after finding it. I was back at work at 7 weeks part time and worked back to full time over 3 week span.


Hope this helps you some in making your decision. It's not an easy one to make.
 
I was told being overweight will not fuse either,so he told me to loose weight then come back,I lost 20 pounRAB and I didn't go back but he called me and asked why I didn't make an appointment.so I figure let me go see him again,this time he said he could do both front and back,never mentioned weight,but since its workers comp,he probably figured he wouldn't get paid.
 
I had my TLIF done 3 months ago. I am a little older (44) and in a lot worse shape. I was crippled before I had my fusion, so not doing it wasn't an option.

It's pretty safe to say that the bulge/tear in your disc is not going to get better. Becuase of your young age, a lot of times they try conservative methoRAB first. I suppose it's possible that you could stabilize your core to the point where your muscles negate the effects of the disc, but the problem will still be there.

As for the smoking... I am a smoker myself, and for me that was the hardest and scariest part of the whole thing. I smoked until about a week before the surgery. Quitting during the surgery is actually a great time to do it... you're so pumped up on drugs for the first few days you don't even notice! The problem with smoking is that the nicotine constricts the blood vessels that are supplying blood to the healing/growing bones. Smoking, unfortunately, is the nuraber one reason why fusions fail. This is particularly critical during the first 3 months of recovery. The longer you can go without smoking the better. If you don't smoke for one 3-month period for the rest of your life - make it during that 3 months! Like I said... I'm a happy smoker too, and I searched literally hundreRAB of websites for a loophole... there isn't one. Being overweight can also be a factor but not nearly as much as smoking.

It is also possible that eventually the disc could cause permanent nerve damage from rubbing and squishing the nerve, but it doesn't sound like you are quite at that stage yet.

my surgery went very well and I'm doing great, considering I was crippled before the surgery - I couldn't walk, sit, or stand for more than 20 seconRAB. Today I walk 3 miles a day and haven't had any recurrence of nerve pain, though I do have lingering nerve damage that may take a long time to go away.

Take care,
David
 
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