Back surgery?

[pomtzu]

Hi Ellie, I am reading your message again, more carefully now that it is getting closer to my second visit with the surgeon and my consult with the second surgeon.

Dr. Brodkey, the neurosurgeon I saw, wrote in his letter about his consultation with me:

--------------->
Impression:
Lumbar spinal stenosis L4-5, L5-S1.
Spondylolisthesis L4-5,L5-S1.
Degenerative disc change L3-4.

.. In her case I would recommend a decompression and a fusion, and the difficulty is to decide what levels to include. In her case, based on her curve and the disc degeneration and facet arthropathy, my feeling is a decompression from L3 to the sacrum would be best for her.
This is certainly a huge undertaking and does carry risk... [and he goes on to detail these..]
-------

Is this like what was going on with you and the kind of surgery you had?

My brother and sister both advise strongly against having surgery, before exploring and trying every possible non-surgical alternative.

Thanks!

Yes Pat - this is/was precisely my issue too. The surgery in 2010 fused the vertebrae of L4, L5 and S1 - just as you describe your issue. Normally this would have been the end of it, but my bone density is so ultra crappy that the hardware failed on one side when I took that very hard fall in November. Now that has to be repaired, and L3 will be fused also - some kind of crap going on at that level too.

I'm wondering why you elected to see a neurosurgeon rather than an orthopedic surgeon. I had a neurosurgeon do a number on me (almost paralyzed and could have killed me) when I had the cervical fusion in 2006, and it took my current spine surgeon (the orthopedic surgeon) to repair all of that damage to get me back functioning again. Even with that, I still had to retire early on disability since it left me with limitations, but at least I was alive - no thanks to the neuro doc. My entire cervical spine had to be fused from C2 to T2 - he actually saved my life. So when I had the lumbar issues, of course I went back to him. Unless you have some other issues, I don't know why your doctor says it's such a big risk. And I don't understand the 3 or 4 weeks in rehab that you mentioned earlier also - that's over the top. But of course, every doctor is different in how they do things. I had no rehab and didn't even do physical therapy. Heck - when I broke my hip I was in rehab for just under 2 weeks and the same with the cervical spine fusion.

I don't know what other options you would have other than physical therapy and epidural steroid injections. Doc said I could try the injections, but no guarantee I would get any relief if they worked at all, and it would be a temporary fix at best - he compared it to putting a bandaid on a gaping wound. I've had steroid injections in my knee and elbow, but with no relief - just a waste of time and $$$. And not to scare you, but just last week I read where the FDA issued new warnings on the epidural steroid injections - "rare but serious neurological effects, including loss of vision, paralysis, stroke and death". Nope - no way I'm going that route, no matter how rare these complications are.

I personally wouldn't let family influence any decision either, but that's up to you. You and your doctors know what's best. This condition isn't just going to go away by itself.........don't we wish, tho??? !!

My surgery has been rescheduled for May 28th. I could have had it on May 14, but then I wouldn't have been able to attend my granddaughter's graduation from college on May 21. No way I'm missing that.

So this is my side of the story - hope I shed a little more light on it for you. I just wish you lived closer - I'd take you to Baltimore to meet with my doc. He's tops in his field (specializes in all spine issues), and is very well known and respected in the area. He's a relatively young guy - in his late 40's but looks like a college kid, but he's head of the spine surgery department at the Univ of MD Med Cntr - definitely knows his stuff ! I trust him 1000%.

Keep me posted on your progress. Here's hoping and praying that you can get this taken care of soon, and successfully, and with as little inconvenience as possible.

[krazyaboutkatz]

Pat, I'm just now seeing this. I'm so sorry to hear that you're in so much pain. I sure hope that if you end up having surgery that it'll go smoothly and you'll finally be pain free. My mom, my aunt, and my cousin all have spinal stenosis. My mom has tried almost everything without any luck. I've also been having some lower back pain recently but I'm trying physical therapy and so far the exercises that I've been doing have really helped. The PT said that my
L4 and L5 were very stiff and my lower left side is worse than my right side. I also asked him what kind of lumbar seat cushion he'd recommend. He showed me an inflatable kind that you only blow up a little bit. It can then be strapped to your chair and will conform to your lower back. I bought one for home and one for work. So far it's also helped a lot. I go back to work on May 7th whether I'm better or not because I just can't afford to take any more time off. Good luck with everything.

[phesina]

Thank you so much, Carole and Ellie and Tracey. I will write more when I have a little more time (especially about surgery and surgeons, etc., Ellie!). Meanwhile, I really appreciate all your good thoughts and wishes and advice!

from Pat (and cats)

[phesina]

Pat, I'm just now seeing this. I'm so sorry to hear that you're in so much pain. I sure hope that if you end up having surgery that it'll go smoothly and you'll finally be pain free. My mom, my aunt, and my cousin all have spinal stenosis. My mom has tried almost everything without any luck. I've also been having some lower back pain recently but I'm trying physical therapy and so far the exercises that I've been doing have really helped. The PT said that my
L4 and L5 were very stiff and my lower left side is worse than my right side. I also asked him what kind of lumbar seat cushion he'd recommend. He showed me an inflatable kind that you only blow up a little bit. It can then be strapped to your chair and will conform to your lower back. I bought one for home and one for work. So far it's also helped a lot. I go back to work on May 7th whether I'm better or not because I just can't afford to take any more time off. Good luck with everything.

Dear Tracey, thanks for your message and good wishes. I'm going to be trying some physical therapy soon too, and I'll see if that helps too. A friend recently gave me what I think is one of those cushions; it has an inflation opening that blows it up a bit. She didn't give me any instructions on just what to do with it, so I've been sitting against it with it both crosswise and upright. It helps some. It doesn't have straps to attach it to a chair.

Thanks again, and best wishes going back to work pain-free!

[phesina]

Yes Pat - this is/was precisely my issue too. The surgery in 2010 fused the vertebrae of L4, L5 and S1 - just as you describe your issue. Normally this would have been the end of it, but my bone density is so ultra crappy that the hardware failed on one side when I took that very hard fall in November. Now that has to be repaired, and L3 will be fused also - some kind of crap going on at that level too.

I'm wondering why you elected to see a neurosurgeon rather than an orthopedic surgeon. I had a neurosurgeon do a number on me (almost paralyzed and could have killed me) when I had the cervical fusion in 2006, and it took my current spine surgeon (the orthopedic surgeon) to repair all of that damage to get me back functioning again. Even with that, I still had to retire early on disability since it left me with limitations, but at least I was alive - no thanks to the neuro doc. My entire cervical spine had to be fused from C2 to T2 - he actually saved my life. So when I had the lumbar issues, of course I went back to him. Unless you have some other issues, I don't know why your doctor says it's such a big risk. And I don't understand the 3 or 4 weeks in rehab that you mentioned earlier also - that's over the top. But of course, every doctor is different in how they do things. I had no rehab and didn't even do physical therapy. Heck - when I broke my hip I was in rehab for just under 2 weeks and the same with the cervical spine fusion.

I don't know what other options you would have other than physical therapy and epidural steroid injections. Doc said I could try the injections, but no guarantee I would get any relief if they worked at all, and it would be a temporary fix at best - he compared it to putting a bandaid on a gaping wound. I've had steroid injections in my knee and elbow, but with no relief - just a waste of time and $$$. And not to scare you, but just last week I read where the FDA issued new warnings on the epidural steroid injections - "rare but serious neurological effects, including loss of vision, paralysis, stroke and death". Nope - no way I'm going that route, no matter how rare these complications are.

I personally wouldn't let family influence any decision either, but that's up to you. You and your doctors know what's best. This condition isn't just going to go away by itself.........don't we wish, tho??? !!

My surgery has been rescheduled for May 28th. I could have had it on May 14, but then I wouldn't have been able to attend my granddaughter's graduation from college on May 21. No way I'm missing that.

So this is my side of the story - hope I shed a little more light on it for you. I just wish you lived closer - I'd take you to Baltimore to meet with my doc. He's tops in his field (specializes in all spine issues), and is very well known and respected in the area. He's a relatively young guy - in his late 40's but looks like a college kid, but he's head of the spine surgery department at the Univ of MD Med Cntr - definitely knows his stuff ! I trust him 1000%.

Keep me posted on your progress. Here's hoping and praying that you can get this taken care of soon, and successfully, and with as little inconvenience as possible.

Hi Ellie, wow, isn't that a difference, all right, for treatment for the same problem!

Thank you so much for your detailed and thoughtful response. I was referred to the neurosurgeon by the non-surgical (Physical Medicine and Rehab) specialist I saw, after I'd been referred to him by my primary care physician. I didn't know there were different surgical possibilities at this point and assumed I had been referred on to the best type of surgical consult.

The one I am seeing next week is an orthopedic surgeon, an "Orthopedic Spine Surgeon" according to the paperwork that clinic sent to me. And I just now noticed that he is not an MD but a DO. He was highly recommended to me by a fellow volunteer at the local Humane Society.. she said he operated on her husband in time to save him from paralysis.

Maybe I should come to Maryland to see your doctor! I'd like to see someone at U-Michigan, but I was told, when I asked the PMR guy for a referral there, that it take two to three months just to get into their system. Maybe it would be worth the wait. Dr. Brodkey did say I have plenty of time to check out all the options I wish.

When I see Dr. Brodkey on Friday, I will ask him why the long rehab time. And then there's the question, how do I manage after i get home from that long time there? There's no one who can stay with me or with whom I can go live as I recover enough to function on my own.

I also plan to ask, since I'm about to turn 70, what does age have to do with all this?

My brother Dan, who is 10 years younger than me, has extensive spinal deterioration and damage. For a long time he was involved in intense martial arts, and as my sister said, he's broken just about every bone in his body. He has been researching this quite thoroughly. He saw a surgeon at one point, said the guy told him "We can get you in in three weeks!" (At least my guy told me, take your time deciding, this is a major undertaking..) Dan said, wait a minute.. He has been doing chiropractic and getting the shots and walking and everything else he can come up with. He says he actually has been improving. He's talked with some people who've had the surgery done.. one who was happy with it but one who is much worse off. And he said he knows a guy who was a football player at one time but now after having this kind of surgery, and then other surgery to deal with complications, he's like a shriveled-up old man now. So Dan is deeply opposed to surgery as long as there is anything else you can do to deal with the pain.

I'd wondered that about the epidural shots.. seems to me I'd heard somewhere along the line that steroids are not something you want to be taking permanently (same warning re: pets) even if not very often.

I've also thought, this deterioration doesn't stop happening or get better on its own. So it's just going to keep going on.

Thanks again, Ellie!