Back Surgery

[frayne]

Looks like after years of lower back and sciatic nerve pain, back surgery is in my future. Just finished with almost three years of epidurals and steroid shots that just aren't working any longer. Waiting for the insurance sign off and then getting scheduled, probably in three to four weeks. Looking at fusing L4/L5 and S1 vertebras. The Doc said I was in pretty good shape for a 68 year old male, height and weight proportionate and no other health issues. Looking at a three to four month recovery cycle. Anyone else on the board have this type of surgery done or want to comment on their experience, any and all replies appreciated in advance.

 

[JoeWras]

Best to you frayne.

My back surgery was exactly 3 years ago. I had an L4/L5 hemilaminotomy and discectomy. Today, I'm a new person and am so glad I did it. Like you, I suffered for a long time and did all the protocols asked of me. But when you looked at my MRI, any layperson could see the impact on my nerves. This was causing me severe pain, mostly in my legs. So for starters, I want to give you confidence in your decision for surgery. You will hear, perhaps even on this thread, to never have back surgery no matter what and that it is always solvable through some other means. I disagree.

When I woke up from my surgery, I immediately knew things were different. The throb in my calf was gone. And it wasn't just pain killers.

Now let's talk about your surgery. You are going up a level from me. I had a hemilaminotomy and discectomy (partial). As far as back surgeries go, this is as minor as they come. Remove some bone, yank out the disk bulge. All done with an incision less than 2". I was confident to try this since it was fairly minor.

You are looking at the next step, which is fusion, probably with instrumentation (metal). Have you gotten other opinions? Some doctors default to fusion. The literature says fusion has a better outcome than laminectomy/laminotomy, which is probably true, but it also has a longer recovery and more risk. It will also limit your movement a bit, and if you have instrumentation, it may challenge some of the testing you can do in the future.

So, I'm not against it, but I'm just asking if you've explored slightly less invasive surgeries, or at least had the discussion with your surgeon. You may very well need the extra support, especially with three vertebrae involved. But I gotta ask.

 

[frayne]

Thanks for your response and to answer a few of your questions. Yes, I have gotten other opinions, this surgery is pretty much my last and final option. The doctor said the metal they will be putting in me is MRI and metal detector friendly, medical grade titanium, I believe. I spent an hour with the doctor yesterday and going over all of the potential surgery options and although this is the most invasive it has the best chance of giving me quality of life back for the longer term and is better than what I considered are stop gap measures. He also went over when vertebrae are fused how it can put stresses on other sections of the back. Surgery isn't something that just came up as I have been cautioned over three years ago that with my deteriorating discs and vertebrae misalignment that surgery would more than likely an eventuality, and the time has come. In going over my personal history; jumping out of airplanes, working construction in my youth, riding motorcycles and playing a boat load of golf, and probably a lifetime of using poor back mechanics, I'm fortunate my back has held up as well as it has.

 

[aja8888]

Best if luck, Frayne.

I'm getting hip No.2 in November and have been lucky enough to avoid (somehow) the back and knee issues @ 75.

 

[MRG]

I've not had surgery but it's been discussed for over 20 years. Mine would be cervical spine so not the same place but the technique is similar. One thing I've learned is the technology is so much better than even a few years ago. Things the doctor told me he'd have to cut into me to understand what was really occurring in my cspine are now clearly shown on the MRI.

Make sure your doc is up to date on current treatments and get well soon.

 

[HadEnuff]

Best of luck to you Frayne. I have suffered as well, but somehow just before I'm ready to submit to surgery, the pain abates. I and my caregivers pretty much expect at some point I'll need some surgery. I'm just about to turn 66, and like you, my caregivers all congratulate me on being in such wonderful shape for an old guy, and staying so active etc etc...but the pain is, well, a pain.

 

[chris2008]

DH had the fusion with titanium in his lower back 12 years ago. It worked well and, with a smaller correction 6 years ago, still does.
He has tried all kinds of training to avoid surgery before, but there was a point when nothing else helped.

Yes, mobility like bending decreased a bit. But he could adapt well.

We learned that it is important to take enough time for healing. Do not try to do too much too early. And don't try to force it.

All the best and good luck to you!

 

[JoeWras]

I have been cautioned over three years ago that with my deteriorating discs and vertebrae misalignment that surgery would more than likely an eventuality, and the time has come. In going over my personal history; jumping out of airplanes, working construction in my youth, riding motorcycles and playing a boat load of golf, and probably a lifetime of using poor back mechanics, I'm fortunate my back has held up as well as it has.

Yeah, I get it. Sounds like you have done your diligence. I totally understand about deterioration. A lot of people who only have had severe muscle strain issues cannot fathom what it is like to have stenosis due to bone spurs and injury, disc deterioration (causing compression), etc. Back pain due to muscle strain is a totally different animal. It is one reason they put us through this protocol, to weed those cases out.

Sounds like you are ready. If you are like me, you get to a point where you don't care what people say about all the things that could go wrong. I wasn't living anymore. I was barely existing. If it went bad, it would have just been a different kind of bad.

I'll probably be up for fusion in about 10 years too. I have changed my behavior somewhat to avoid some of the things you mention. I really limit the shock to my spine.

We learned that it is important to take enough time for healing. Do not try to do too much too early. And don't try to force it.

This is very important. +1

In my case, Doc said "Resume normal activity at 6 weeks." Well, I was very, very careful. I eased into it at that point (bike riding, swimming, home improvement). I didn't lift anything heavier than 15lbs for 6 months. I didn't do anything really heavy for 1 year. And to this day, there are many things I won't do, period. Example: lift a new 5 gallon pail of paint.

During those first 6 weeks, I didn't lift anything heavier than 1/2 gal of milk, and only at chest level. I used my grabber for everything these 6 weeks with almost no bending.

I believe this helped me a lot. I got plenty of exercise mostly in the form of walking. I literally walked 1 house more per day up and down the block. My first day after surgery was only 2 houses.

Be careful. Don't "Tiger Wood's It". Tiger was my inspiration to what not to do. He came back from laminectomy/discectomy way, way too fast. After that fiasco, he went a different route and had an ALIF. After the ALIF, he finally took the proper time, nearly a year.

BTW, ALIF is the ultimate surgery for us. Not sure if you discussed it with the surgeon. It is worth a discussion at least. It kind of scares the crap out of me because they operate from your front/side, and have to potentially move your descending aorta or vena cava (don't criticize, I'm not a doctor) and that just scares the crap out of me.

 

[Alan]

Best of luck Frayne.

I had an L4/L5 discectomy 29 years ago at age 35. Best advice I can give is to take the advice of the docs and physios after the surgery. After my recovery period I gave up soccer and tennis, became a soccer referee. Vigorous exercise was okay but I needed to give up those activities with violent twists and bumps.

 

[SteveNU]

I'm a little over three years out from an L3-L4 fusion to correct severe nerve pain due to spondylolisthesis. After months of PT and epidural injections I ended up in the ER bedridden and in intractable pain.

I can only say that it's better now but I still get leg pain if I overdo it. It wasn't until this past spring that I really started to feel normal. Lifting anything over about 30 pounds is where I try to limit myself.

The best thing you can do is take it easy and let things heal. It's a long process and I was thankful that we were both retired so I didn't have to rush back to work and my wife could take care of everything.

Here's a link to an old thread about my surgery and others experiences.

http://www.early-retirement.org/forums/showthread.php?t=82625

 

[bolt]

Looks like after years of lower back and sciatic nerve pain, back surgery is in my future. Just finished with almost three years of epidurals and steroid shots that just aren't working any longer. Waiting for the insurance sign off and then getting scheduled, probably in three to four weeks. Looking at fusing L4/L5 and S1 vertebras. The Doc said I was in pretty good shape for a 68 year old male, height and weight proportionate and no other health issues. Looking at a three to four month recovery cycle. Anyone else on the board have this type of surgery done or want to comment on their experience, any and all replies appreciated in advance.

Research Dr John Bergman, Huntington Beach, Ca. USA & Tj, Mexico.

Neveragain,multi-fused@MGH.

 

[Ian S]

Best of luck Frayne.

I had an L4/L5 discectomy 29 years ago at age 35. Best advice I can give is to take the advice of the docs and physios after the surgery. After my recovery period I gave up soccer and tennis, became a soccer referee. Vigorous exercise was okay but I needed to give up those activities with violent twists and bumps.

I had an l4/l5 discectomy way back in 1981. My neurosurgeon was a pioneer in using a surgical microscope for the procedure with less tissue trauma and supposedly faster recovery. There was no fusion but then I was only 29 at the time. I have had flare-ups over the years but have generally been sciatica-free since the surgery.

In those days there was no MRI: instead surgeons used a myelogram to image the problematic area. I ended up suffering more from the myelogram than from the surgery itself: about a week of intense headache within 20 minutes or so of rising from a prone position.

 

[Alan]

I had an l4/l5 discectomy way back in 1981. My neurosurgeon was a pioneer in using a surgical microscope for the procedure with less tissue trauma and supposedly faster recovery. There was no fusion but then I was only 29 at the time. I have had flare-ups over the years but have generally been sciatica-free since the surgery.

In those days there was no MRI: instead surgeons used a myelogram to image the problematic area. I ended up suffering more from the myelogram than from the surgery itself: about a week of intense headache within 20 minutes or so of rising from a prone position.

When my neurosurgeon examined me he told me that he believed I had a fragmented disc between L4/L5 but that the insurance would insist on an MRI before he could proceed so I had an extra 5 or 6 day wait before he could operate as I also had a nerve conductivity test as well as an MRI. He was right, fragmented disc with one of the fragments trapped between a ligament and a nerve root. When he did the surgery he told me next morning that the root was compressed flat which is why I still had pain down my leg. The leg pain lasted about a year and a week after being discharged from that facility I was back again, this time with spinal meningitis. I joked with the staff that I expected an invite to the Christmas party due to the amount of business I had brought them.

 

[JoeWras]

I'm a little over three years out from an L3-L4 fusion to correct severe nerve pain due to spondylolisthesis. ...

The best thing you can do is take it easy and let things heal. It's a long process and I was thankful that we were both retired so I didn't have to rush back to work and my wife could take care of everything.

Here's a link to an old thread about my surgery and others experiences.

Back surgery L3-L4 fusion. Now in recovery and looking for tips. - Early Retirement & Financial Independence Community

Right on, SteveNU. Be careful on that recovery.

I remember your thread well. I didn't participate in that thread because of a kind of jinx worry. I was going through my MRI at that time and for the first time ever, considering surgery.

I heeded the calls on that thread to take it easy with recovery. I re-read it just now and saw a post about walking too much, too fast. Very good post for me, because my instinct would have been to walk 5 miles as soon as I could. Instead, I used the "add a house or two in length" every day method and it was the way to go.

Grateful for the discussion.

I had an l4/l5 discectomy way back in 1981. My neurosurgeon was a pioneer in using a surgical microscope for the procedure with less tissue trauma and supposedly faster recovery.

That was pioneering! This is basically how they do it all now. Some surgeons have upped the ante and gone to extreme small cuts and tiny tubular retractors. I've actually read mixed results on those "only need a band-aid" surgeries. But anyway, yes, you were at the forefront. My dad had l4/l5 surgery the same year at the VA. The cut on his back was about 6" long. Many mylegrams, which he also cursed. I'm glad mylegrams are not routine anymore.

 

[Bamaman]

My family has access to one of the premier neurosurgeons anywhere. He is a professor at a medical school and designs surgical tools, implants and "hardware" with one of the famous device manufacturers. And he travels the world teaching minimal evasive surgical techniques to other neurosurgeons.

He looked at my sister's MRI and in a split second told her "you need a fusion." It was that quick. No if's or and's--surgery was required.

My sister was a professional dancer and very active. In her 30's to 60's, she had a house in Colorado and her best friend was a ski instructor. And one's back has just so many moguls in it. She continued skiing when her back pain was telling her it was time to take up another hobby. And then she was a "he man" and ignored the pain until it was too late for regular back surgeries. After the fusion, she's still in misery at age 72. But she's allergic to pain medications and opioids and has few options.

 

[JoeWras]

And one's back has just so many moguls in it.

I cringe when I watch a young person ski moguls. For fun a few times? Sure. As a pro, constantly? There will be a price to pay.

 

[pacergal]

Best wishes for a speedy and successful surgery/recovery. Do take the time to rest and heal, rushing things almost never works well.
Keep us posted.

 

[Chuckanut]

Best wishes for a good recovery.

 

[Chuckanut]

My sister was a professional dancer and very active. In her 30's to 60's, she had a house in Colorado and her best friend was a ski instructor. And one's back has just so many moguls in it. She continued skiing when her back pain was telling her it was time to take up another hobby. And then she was a "he man" and ignored the pain until it was too late for regular back surgeries. After the fusion, she's still in misery at age 72. But she's allergic to pain medications and opioids and has few options.

I had a similar story with a former neighbor. He had a knee replacement in his mid 50’s. He was told, no running, no twisty sports like basketball and tennis, and no very heavy lifting. Well he insisted on using knee machines with heavy weights to strengthen your his knee, playing tennis, playing soccer, jogging, and marathons.

In his early 70’s he wore the joint out prematurely. The second replacement is not nearly as good as the first, plus he has additional arthritis in his ankles and back. Now he is lucky to walk two miles and not be in pain.

 

[Ian S]

That was pioneering! This is basically how they do it all now. Some surgeons have upped the ante and gone to extreme small cuts and tiny tubular retractors. I've actually read mixed results on those "only need a band-aid" surgeries. But anyway, yes, you were at the forefront. My dad had l4/l5 surgery the same year at the VA. The cut on his back was about 6" long. Many mylegrams, which he also cursed. I'm glad mylegrams are not routine anymore.

My surgeon published a paper just 8 months before my surgery (abstract here: https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.1920020204 ) about his technique and you are right about the small incision (1" that I have) versus the 6" cut that was the standard then. At the time, I recall some advice that was given to me: have a neurosurgeon do it rather than an orthopedic. I doubt that advice holds today if it ever really did but my neurosurgeon was at the forefront and he did nothing but back surgery in a small hospital in the Virigina DC suburbs. Being in my 20's at the time I thought back problems were an old folks' problem but the majority of patients I saw in Dr. Goald's office appeared to be in their thirties which surprised me. Googling his name suggests he's still alive and in his 90's.

I was living outside Baltimore at the time and drove myself down to the hospital for the myelogram. They kept me overnight to make sure there were no complications then discharged me the next day. I was feeling great and began the drive from Alexandria back to my apartment. The headache started about 15 minutes into the drive and it was all I could to get home and collapse into bed! Then within 10 to 15 minutes, the headache was gone but would recur if I spent any time not flat on my back. So weird!

 

[Fireup2020]

L4/L5 Fusion two years ago (Aug 23, 2017) Laminectomy/decompression same level Jan 2017 - I had recurring two synovial cysts come back after a few months post-decompression - so in for the fusion to remove the cysts and degenerative facet joints causing problems. I'm so grateful I did this - recovery absolutely SUCKS!!!! - and as others have said, take it slow, follow doctor's orders, and walk, walk, walk...I'm finally getting to a point where I'm feeling closer to my old self - hoping to golf again soon, but volleyball and softball are no-no's for me these days. But your X-rays will look cool!
LOL Wishing you the best!!

 

[Teacher Terry]

My husband had a ruptured disc in 1977 despite being young. On the advice of a nurse we went to one of the best neurosurgeons and it turned out great. When I worked in Vocational rehabilitation the clients that had a neurosurgeon versus a orthopedic surgeon had much better results. Good luck!

 

[Conundrum]

I had a procedure done by a neurosurgeon about 2 years ago L3-4 discectomy: L4-5 laminectomy. I’ve had numerous broken bones and knee surgeries but the pain from those were child’s play compared to the back pain. I would guess about 80% improvement in back symptoms which I call a complete success.

Get a couple of good grabber sticks and use them a lot. Get the temporary bars for the toilet so you can use your arms to raise / lower yourself. Takes a ton of pressure off your spine. Don’t push your recovery and try to get back to “normal” life too fast.

Most importantly. Pay close attention to your physical therapists instructions. Diligently do your PT exercises every day for the rest of your life. Best 30-45 minutes you will spend on yourself

 

[JoeWras]

Get a couple of good grabber sticks and use them a lot.

Good advise. I still use them all the time.

They'll also probably get you one. I bought 2 of slightly different type, and got one from OT meeting that was cheaply made, but still helpful. Use all three to this day.