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To Fuse or Not To Fuse

AnonymousUserAAnonymousUser Posts: 49,002
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
Recently, my dad had back surgery to eliminate the pain down his leg with a scrape of the vertebra and partial removal of the disc. He was walking 2 hours after surgery and came home that same evening. He had the same symptoms I'm experiencing. So, when I had my appointment with the spinal surgeon yesterday, I was expecting to make a surgical appointment for the same procedure.

To give you a little history, I had an MRI done in 2000 for back pain shooting down my right leg. It showed a herniation to the disc and so I went through about 3-5 months of physical therapy and shock treatments which seemed to work. Through the years, however, I would continue to experience pain now and then off and on and gradually it would get worse and the time span on the pain longer. It lasted up until this past July or so when it was becoming nearly every day with pain, only it's in the left leg now. After the 2nd MRI, there seems to be deterioration between the L5 and S1 vertebra and the space between them has become smaller, not by much, but enough where it's noticeable.

The first doctor I went to was a retired surgeon which my primary failed to mention. His recommendation was a complete removal of the herniated disc and leaving something behind for a cushion so the bones would not collapse.

So, when I went to the second doctor he highly recommended me to, I was expecting the same results.

No to be.

This doctor said that because there is degeneration of the disc that is obviously present, removal of the disc would only temporarily fix the situation. Eventually, due to more degeneration (may be months, may be years), my vertebra would indeed collapse and I would be looking at permanent nerve damage. So, his recommendation is for the removal of the disc followed by fusing the two vertebrae together leaving a space in between or for a Transforminal Lumbar Interbody Fusion (commonly known as TLIF).

80% of patients have had a successful fusion while there is 15% that have failed (estimate). I don't want to be part of that 15%.

Honestly, I'm terrified of this procedure, but I also know I want my life back. But, there's a chance this might not work and that's what is scaring me the most. What if I get worse? But, in the mean time, I'd be able to walk again with having to rest after like 20 minutes. I can sleep in my own bed (which cause tremendous pain currently - and it's a new softer mattress). And the pain shooting down my leg is most likely to stop happening.

I am a 40 year old mother of 2 beautiful and willing to nurse me back to health girls, ages 12 and 10. My husband is being very supportive. I work at home on my computer almost 46-50 hours a week. I know I can still work but need time for getting up every hour to walk around for a few minutes at a time. Can't go outside for a walk in Michigan in the middle of January unless I wanna freeze everything.

The negatives that are possible? The domino effect could happen over time where the next two vertebrae become herniated and so on and so forth. The fusion might not work or growth doesn't happen within the bones and I'm back to square one only worse cause now I have now disc left. A rare instance but still possible: the doctor makes an error and I'm paralyzed for life.

I honestly don't know what to do. The last two weeks I've been nearly pain free. It's like my back decided to get better or else like a child. I know the pain will be back, it always does, but do I fix it now when I'm fine? Or do I wait and run the risk of possible nerve damage that could be permanent the next time around?

I would really like more opinions on this and if it helped them or not.

I'm begging for help or advice. I haven't been myself since yesterday cause I have a date already scheduled and it's in a little over two weeks (the 28th). I'm scared, yet a part of me knows this is a good solution of preventative maintenance for later in life. But there's that part of me that says NO WAY.

Sorry for venting all this out, but I've always been told no question is a stupid question and you won't find anything out unless you ask.

Thank you in advance for your words of encouragement or discouragement. :)


  • SpineAZSpineAZ WiscPosts: 1,082
    Since you are younger the doctor may partly be looking for what works best and lasts longest in an active 40 year old person.

    Perhaps another opinion would be good. If you've seen a Neurosurgeon then get an appointment with an Orthopedic Spine Surgeon. I would totally discount the opinion of the retired surgeon...he can make all the suggestions he wants but if he's no longer an active surgeon he may not be up to date on the research, outcome studies, etc.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Thank you.

    The first surgeon is part-time and minor surgery now until he fully retires from the practice. He did the reconstructive knee surgery on my husband in 2004 so I hold him in the highest regards for his opinion. I can't help it, he made my husband walk again.

    I do believe the surgeon has the best interest in mind for preventative surgery. And yes, I'm still at a young age (even with the grey hair and all) where the fusion might take better than if I waited til I was 50. You know?

    Thank you though, I do appreciate such a quick reply.

    I wanted to add some information. God knows if it help or just be more jibberish coming out of my mouth. I'm known for that. LOL But, this is a spinal injury from a incident in school back in 1986. I was trying out for the high jump but when I landed, I landed on the bar and it went up my back twisted a couple vertebrae the wrong way. I went through about 6 months of chiropractic therapy, but the pain never went away and I had no choice but to do as my mother told me at the time. That's another long story.

    EDIT: And OOOPS, the doctor who recommended the fusion is an orthopedic spine surgeon. Maybe I didn't say that. I sincerely apologize.
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  • I had a two level fusion a year ago tommorow. I had torn diecs so I dont know that my problem is the same. The fusion worked, but I still have alot of pain. I also have to add that I have had 9 surgerys in 2 years, so I am sure healing for me will be longer than the average person.
    I dont know if anyone can tell you what to do. If you dont feel comfortable with your opinions, get another and another until you do. I went for 2 years before they could tell me what was causing my pain. I had every test and scan, until I had one that did a discogram and it showed the torn discs. So I guess, my reasoning is, you are going to have a long relationship with your Dr. If you have a fusion, over a year. Make sure you are confident in what you are doing, or find someone who makes you confident. I did, and although my results havnt been what I want yet, I still have faith that I made the right choice and that my Dr will be with me until I feel much better. That is what my goal is. Hope this makes sense. Good Luck. Love Robin
    PS Check with an orthopedic surgeon and see what they say.
  • Okay - here's my 2 cents:

    Have you had a discogram?? You really should. It can verify that the disc the dr. is planning on working on is really the one causing your pain. It sure set my mind at ease when I had to make the decision.

    I had a 2 level fusion about 18 months ago. I had left leg sciatica and CES (very embarrasing and yucky). I did have complications after my surgery (see my signature) and ended up with a numb leg. But - I would do it over.

    I've not had one instance of CES since surgery. The left leg pain is gone. I get little shooters sometimes, but it's not a daily occurance and it doesn't take me to my knees.

    I worked really hard to get back in shape post-op. I've lost 40 lbs and I am incredibly mindful of proper back mechanics. My L4-L3 is close to going out - I want to make it last as long as possible!

    Other than that, I was 42 when I had my surgery - so not much older than you. My NS also recommended fusion because of my age - fusion is the industry standard for younger backs if I remember right.

    I know it's a scary decision. It's so good that you have a wonderful support system. No matter what you decide - you WILL get cases of nerves where you doubt your decision. My philosophy is to always make sure I'm making the best decision I can based on all the information I can gather. After that I don't allow myself any 'what ifs' - after all, what else could I have done after weighing the pros and cons??

    p.s. I was ready to spend life in a wheelchair if I had to to get a chance at a new life. CES is a bugger.(sorry for the language)
  • Everyone on this forum who has had a fusion faced these same questions, concerns, fears. It is completely normal; and most people who do have a fusion comes to a point of clarity; where it all makes sense to them. Honestly, that point is such a relief. That is when you can move forward and prepare for your future.

    I am only 17 days postop PLIF, so I certainly have no point of reference about a successful fusion. What I can say is to do your research, find a surgeon who performs the procedure frequently, get another opinion if you still have doubts. Make sure that you and your surgeon have mutual goals for you and regimens for postop pain management; and stay on this forum...take your time if you can, so that you make the right decision.

    This is a big surgery, and you are the only one who can make the decision about surgery. For me, I was working in pain daily, it was consuming my life; effecting my work, my family and social life. I had to take a chance; I felt it was worth the risks. I did physical therapy and epidural steroid injections, and felt I exhausted all of the less invasive measures. Time will tell....

    Good luck,

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  • Hi there,
    I'm facing the same decision but slightly different.
    I had a microdiscectomy (they remove the portion of the disc that is herniated and pressing on nerve). I am not a doctor but the national statistics indicate that this will be a 90% success rate. Personally, I wanted to try the epidural but my situation was pretty bad (ended up in ER) and this was a good alternative. I still took several days and 3 doctor opinions before I agreed just to this surgery.

    Unfortunately, I re-herniated the disc.
    Interestingly, I am faced still with a decision to fuse or not fuse. My problem is at L5-S1 (common) and I am 40 as well. I have finally admitted to myself that 'normal' will likely be different from now on regardless of the decision. I lost feeling in my left buttocks, back of upper thigh, and left heel to outer toe . . .just to explain the symptoms and compression on the sciatic nerve.

    I was told try the revision b/c a fusion is permanent. But I was told by others (dr) that the revision is not likely to work for long and I should consider a fusion. Well, if the revision will work for 5 years, who knows where technology will be and maybe I'll have more options.

    Some things to think about
    - consider getting another opinion and see if you can find a doctor that encourages minimally invasive procedures (i.e. conservative approach to surgery)
    - consider the fact that a fusion IS permanent and that there is a good chance that you may need another one above/below the point in 10-15 years.
    - consider how large the herniation is and compare disc height to other discs.
    - ask your doctor about hemi-laminectomy. I'm trying to learn about this but from what I understand they remove some of the bone so if in fact my vertabrae collapse, the nerve won't be choked. And, they would do this anyhow if they did the fusion (I think).
    - ask your doctor how they will track progress if you opt for the microdiscectomy (non-fusion)? Typically they see you 2 weeks post op and 6 weeks post op. Ask him how he measures success? If you opt for this surgery, be honest and make sure you are honest about progress speed/or lack of. I was not thrilled at 2 weeks but was off pain meds so thought I was progressing. At week 5, I wanted to go in but waited for my 6 week appt and was very clear things were not going according to my expectation. Doctor even agreed and put me on prednison and saw me in 4 weeks. I should have gone in after I knew the prednisone didn't work. I was very clear and he sent me for MRI which confirmed I re-herniated the disc.
    - if you are considering a fusion, ask him about his technique - does he do TLIF and if yes, have him explain it, have him explain the recovery, the pain management, the realistic expectation about short and long term recovery. Have him explain what he uses when he removes the disc . .. does he use a synthetic spacer or bone from hip or cadaever

    I have been using this board, lots of other reading, speaking to my primary care physician, and am lucky to have a work doctor too to consult with. Use your resources and do not rush into it. This way, regardless, you can make an informed decision.

    A fusion is a big decision.
    I had the less invasive surgery (sounds similar to your dad's) and am considering a retry of it knowing full well if it doesn't work the 2nd time, I will have to do the fusion.
  • Oh thank you so far.

    All I do is sit at my computer and cry in fear.

    My problem with waiting is this:

    Insurance - We have a $500 deductible then 20% of bills up to $1250 then it's 100% paid for each person in our family. This is up the end of the year and I'm over the 500 ded easily.

    We are broke, literally broke and although I surely want to do more research, my husband is sick of seeing me in pain. He wants me to have this done too because of the insurance. He is afraid that our deductible will go up and if it did, we definitely could not afford the bill and I would suffer greatly.

    I do not know why, but I feel perfectly fine right now. I did a test last night and slept in my bed which I haven't been able to in the past 6 months. We bought a brand new mattress to try and help my back, but it didn't. I'd wake up and couldn't move without struggling to get out of bed. My legs felt like they were going to fall off. However, I woke up this morning just fine. I've been walking around just fine. Why in world would I be in pain for 6 friggin (excuse my frustration) months and now it decides to stop? When I have to make a life changing decision?

    The orthopedic spine surgeon told me that there is a change in height between L5-S1 from my last MRI which was in Nov from the first one which was in 2000. It isn't a significant amount but enough to determine that it's probably degenerative and it will only get worse as time goes on. How fast will it progess is my MAJOR concern. The first surgeon (who is retired from major surgeries and has 35 more years exp) told me that I could probably go another 2 years or so, IF I can endure the pain.

    I was able to endure the pain for about 2 months, then it became every day with every movement. It especially hurt right after a hot shower or bending down to get the lunch packs out of my kids back packs or to grab my shoes and go to the store. I could not sleep in bed and I couldn't walk for more than about 15 min before the pain was right back again.

    But like I said before, no pain, just soreness in the buttocks and small throbbing down my leg every now and then for the past almost 2 weeks now.

    Back to the orthopedic surgeon and his procedure to answer DNice. The procedure is the TLIF and he uses part of the bone removed to get to the disc along with synthetics. The nurse I spoke with on the phone yesterday with my questions told me he does at least 1 or 2 of these same procedures a week? In her words "a kazillion of them" and I that shouldn't worry, he knows what he's doing.

    The orthopedic spine surgeon also said, they could do the microdisectomy but because of the decrease in height from the MRIs, it is most likely I will end up with a collapsed vertebrae eventually. He said it could be a couple of months or it could take a couple of years. That's a big difference. He said then you're looking at possible permanent nerve damage. Basically he told me that this is more of a preventative measure so that I won't have to face this later in life with the possibility of a longer healing process (you heal slower as you age). He told me I had good bone structure and this is what he recommends.

    I'm calling my primary doctor today and asking for another spine surgeon's number for a second opinion. When I went and saw this doctor, he seemed very arrogant which right away had me sitting very uncomfortably. He had two students with him and never once did he ask if it was ok for them to be there in the room with me. I kind of thought that was a bit rude. And, the fact he made a decision so quickly kinda had me wondering. But then I talked to the nurse and she said he certainly knows what he's doing and has done so many of these that if he recommends that type of surgery then he's probably right.

    I guess this is just happening so quickly because of this STUPID insurance thing that I can't allow my mind to comprehend what I need to do. I feel like I'm in a fast moving movie and can't stop and think. I'm sorry if I'm babbling, but I'm so scared of making myself worse by having the surgery and then I can't walk with my kids to the Wizarding World of Harry Potter or the store or the park or anywhere or not being to "be" with my husband or sleep right ever again. And then if I don't have the surgery and the doctor's right about waiting and nerve damage, what then? I face having to have permanent damage?

    I'm shaking now writing this and still my heart beats so darn fast. I wish I had a magic answering device that could tell me what I need to do, you know?
  • Just a quick short note, that I have an appt. on Monday with another Neurosurgeon for a second opinion. My heart has stopped beating so fast and the shakes have actually subsided.

    This will help me (hopefully) make a good decision.
  • Yes, good for you - the second opinion.

    Let us know....
  • Way to go, Renee!!

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