Question regarding lumbar fusion and discogram

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caliecat

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Hi all,

Need your opinions about upcoming lurabar fusion. A little info first:

Been thru all conservative treatment and then some. In 6/02 I had discogram done, and had positive results on L3-4, L4-5 &L5-S1. Tears in all three levels, , L4-5 is complete tear and virtually flat and unstability, L5-S1 is about 3/4 flat and almost complete tear.
DDD throught all 3 levels. L3-4 although pos, was the leaset painful( if you can call it that :eek :)

In 12/01 I had a 3 level IDET. I had complications, and my nerve got tweeked on the way out, and my good leg(rt one) went completely paralized, so I was in a walker for 5 weeks, as my left leg was already week and painful from prior and then even more so from IDET, and my good leg was useless from nerve tweek during IDET. I felt it as it zapped me.

We did the IDET in hope of a better outcome for a later fusion, as studies(my dr is very invoved in everything new) are showing ppl that have had IDET prior to lurabar fusion are getting so much better results with helping both back and leg pain. I would not have been a candidate for IDET soley based on too much damage and too many levels, so this was done for a 2 part hope in better recovery.

Well, of course I haven't had success with the IDET, but we hadn't planned on a miracle( thou would've welcomed it if it had happened) and my Ortho just had new MRI taken and wanted to see my discogram results from 6/01 to determine if we could get by with a 2 level fusion, sine L3-4 wasn't as bad as the others, and with the IDET, if the tear was sealed, and no further DDD in it, could it sustain the pressure of fusion below.

My back/leg pain has increased since the IDET, and weakness and nerve pain has greatly increased since. I told my Dr that after my last disco, I would NEVER have another, ( I have a extremely high pain tolerence, but I screamed, and almost passed out from pain), but I was a bit concerned at going ahead with fusion based on a disco report from 6/01, especially since my IDETY was done after that, and there have been changes, too.

Would you undergo another disco before surgery, just to make sure the L3-4 was in the same shape? I just feel unsure about having surgery without making sure of the most updated results. I don't want to end up back in having L3-4 fused, just because 2 yrs ago it showed it wasn't as bad as it could be now.

I am on 300mcg Duragesic/48*, Topamax and MSIR 60 mg /bt, and have no life from the back pain and leg weakness/pain, even at these med levels. L4-5 is very unstable and I trip so much from the leg weakness, I can't just "hang in there" any longer. It has been 4 yrs since initial back injury, and if I have any hopes of having a life, I need something done now. :( I see my dr on the 10th, and I am going to suggest a new disgogram and another ortho opinion as to the fusion, and what they think of the levels.

I can't believe that the ortho would evaluate surgery based on a 6/01 disco especially after I had an 3 level IDET after it. I don't trust that kind of doctoring.
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Any suggestions?

Thanks to all, and hope everyone is having a wonderful evening!

Lori

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Hi Lori, :wave:

I'm so sorry that you have to be going through this process :(

In my honest opinion, and if I was in the same exact situation, I would be 100% sure to have a repeat discogram.
I think that is the way to go.

My discogram was so painful that I also said I would never repeat one, but now after getting over it, I would have another one in a heartbeat to make sure all of my bases were covered.

I wish you well
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Please leep us posted :)
Be Well,
Baxter
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Two level laminectomy fusion L5-S1 & L2-3 done on 12/6/02.
Fifteen inch scar from the very top of butt crack (sorry), to the bra line.
BAK cages, roRAB & screws.(Titanium)
My pelvic bone was used for grafting.
Praying that the other two discs in between, won't have to be fused later, as I was told it was a possibility, due to the other two discs in between, not being in that great of shape.
Doc didn't want to fuse four levels, unless it is really necessary.
I would hate to repeat the surgery, as the recovery period, is so very painful.
I also have a free fragment in my T11-12 area, that I'm still refusing surgery for, at this point in time.
That surgery is way too dangerous for me to consider, until if affects my being able to walk.
 
Hi Lori,

I'm with you...do NOT go with a surgery based on an old discogram! ooooooo....too scary to contemplate. What about the nucleoplasty? Is it too late to do that after the IDET? I had both done at once...talk to your doctor about that first before discussing the fusion. You may still need fusion, but always good to have options.....eh?

A tri-level IDET...wow (and ow!)...from my understanding there have been NO successful tri-level IDETs, ever. They (doctors) don't even want to do a bi-level (which is what I had done) IDET. They WON'T do a quadra-level....out of the question. So.... in answer to your question, get the discogram. My only suggestion regarding the pain is if you can prep yourself the week before stating (to yourself) that you will be aware and alert for the disco, but that you will NOT remeraber anything about it after it is completed. I did this and it worked! But then I meditate and stuff too..... I catch myself now and again thinking "hmmm, I wonder if I tried to remeraber, and then go....ding-dong! forget it!" hehe But I truly cannot remeraber the pain nor the procedures (of both the discogram nor the IDET/Nucleoplasty procedures). I remeraber entering the operating room, getting poked with a needle to administer the meRAB... and that was it! Of course, all the nurses and doctors verified "WITHOUT A DOUBT" that I was responsive and awake during the entire procedure(s). hehe Must have SCREAMED pretty loud...teehee. Who me? ;)

I hope this helps.



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successtory
Oct 2000: Repetitive Stress Injury-Inverted Hernia
Feb 2001: MRI. Shows only slight bulge at L4-L5
Dec 2001: Discogram/CT scan shows Inverted Hernia at L5-S1. L4-L5 & L5-S1 ruptured in all 4 quadrants. Unable to walk.
Feb 2002: IDET, Nucleoplasty, Intra-Discal Injections
Sept 2002: Rated in the top 10% for successful patients. Retraining for new career.
 
Successtory,

I wish I didn't remeraber my discogram, but I remeraber every mind nurabing second of the tourcher! The only time I don't remeraber, is after the needles came out, and my Dr shot me up with a huge does of Fentynal (I am aleady on 300mcg so she had to make it a doosy), I passed out, and don't remeraber going to the CT scan at all, didn't wake up until recovery. I was fully awake for the needle placement and vert tourcherous thing inbetween. We did levels L2-3 thru L5-S1. 2-3 was the good disks.

Right before my dr knocked me out with the meRAB, I told her it was her turn next, and to clirab up on the table. She knows me very well, and she said if I was in that much pain, she could not even imagine how much it hurt. I'd have liked to show her, at that moment.
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You all are right, thou, my instincts said no way to a 2 yr old disco, especially since the IDET was done to alter the disks.

We did the 3 level IDET to aid in the fusion, not in hopes are a cure, like I said, I wouldn't have been a candidate for an IDET in normal settings. But, ppl with both back and leg pain have been having much better success w/ IDET done prior to fusing. My dr and her colleages have been studying this, and she has had many ppl get great results doing it this way. When you think about it, it does make sense, doing the two procedures to take care of their specific pain areas.


Well, I guess it is back to the torchure table for me! :eek:She'll be surprised when I say I want a new disco(but will completely agree)as she knows how adamant I was to "Never AGAIN!"
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I'll ask about the nuecloplasty(sp), but I have so much unstability , especially at L4-5, and worsening weakness, that they have said fusion is going to be a must. I wish I could hold out for ADR, but even if they could do 3 levels, I couldn't wait that long, pain/weakness wise.

I have also had 13 major pelvic surgeries for endo, cervical cancer, and severe adhesion disease, so I have to have my pelvic rebuilt after this fusion cuz the car accident that caused the back stuff , messed up my last pelvic surgery where I had tissue expanders placed in there, so it will be difficult to go thru the ab on a 360* like they recommend.

They want to do it all at one time, 360 fusion and rebuild the pelivc area/floor, release adhesion, colon, bladder,intestines, and replace the expanders.
SounRAB like fun, huh? At least I get an epidural again for use for several months while recouping. It is a hassle, but wonderful pain control.

Thanks for the support and suggestions,
Hope everyone is doing better, and recouping from their surgeries!

Hugs to all,
Lori
 
Caliecat,
I just read your story - my goodness you've been through a lot. I hope everything works out well with the fusion.
Good luck to you and I wish you pain-free days ahead.


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Had right pain down butt/leg/toes for over 2 years.
Tried chiro, PT, epi steriod injections, more PT... to no avail
Had L5-S1 hemilaminectomy with microdiscectomy on 2/18/03 - now pain free!!!
 
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