spinal fusion

[Fred Perreault]

I know that this is not webmd.com, and I am not looking for medical advice. But I have had serious back problems as a result of my occupation and life style that required surgery more than a decade ago. Now, at 66 years old I am having even much more serious issues with debilitating pain and the doctors I have consulted indicate that fusion would be necessary because of the messy condition of my lower back. It is structurally weak and they are talking about the need to fuse several vertebrae to get to solid footing. In any event, is there anybody here who has had some form of fusion, and if so, would they share here or by PM their experiences? How might it affect posture, rotation, bending, standing at the lathe, sitting for periods of time, operating heavy equipment, etc.?

Thank you for your time, Fred

[James Conrad]

Hi Fred,

Looks like we are just about neighbors! This hits close to home, so to speak, as I spent the past 3 weeks in bed due to a recent back injury. I have a friend and family member that has gone through fusion. Both had a long road to hoe after surgery, but they lead pretty active lives now however, anything involving impact or a great deal of twisting is out for them.

If you have not done so, a second opinion is a good idea, I can recommend docs and surgeon at the Baptist Hostial spine center in Boston. PM if you want the info.

Good luck!
James

[Val Kosmider]

I have suffered spinal 'problems' resulting from a fracture of the lower spine way back in the ....ahem....70's. I have not had a fusion, and off and on, have simply used medications to control the pain, which NEVER goes away. I have had two surgeries, once to repair the fracture, remove some discs, and relieve pressure on the nerves; and once to remove more discs, remove bone fragments, remove scar tissue, and relieve pressure on the nerves. I would characterize both surgeries as 'successful', but not without their complications.

BY observation, fusion is a hit and miss process. Is it all done with metal rods/screws/fixtures these days? If they revert to the 'old' practice of using bone from your hip i would seriously reconsider whether i wished to do that because the bone may, or may not, graft to your spine. If it is all metal fusion materials, i would be a lot more comfortable about undergoing the procedure. Once they operate on you, scar tissue develops, as well as the likelihood for a host of problems, and so it is not to be undertaken casually.

From observation and conversation, the people with the 'bone graft' type of fusion are generally unhappy. Those with metal fusion have certain limited mobility, but generally resume a full and normal life, with simply some mobility limitations. It doesn't move that much, but the lower portion of your spine (S1, S2 and L1-L5) does move some and having the bones fused is limiting.

If you get through the surgery with no complications (infection) i believe you will recover fine and be a much happier camper. Presumably you are in pain, and simply getting rid of some of that pain is like being granted a wish from heaven. The pain never fully goes away, but some relief is wonderful!

BTW, i have had numerous 'spinal injections' and none of them has been particular helpful ( i recently had my knee injected for a torn Meniscus and the procedure was extremely helpful), so if that comes up in conversation, i would listen but not get too excited.

Good luck in whatever you decide. It is hell having back pain, and there is no 100% solution, but rather a series of events and lifestyle choices that help you to cope and live with it.

[Scott Shepherd]

My father had it done. He lives a perfectly normal life. There is some limit to how far he can bend his back, but for the most part, the only time I see that issue is when he's trying to get into certain cars. Some cars with smaller openings, where you have to bend a little to get in and have your head clear the roofline, is the only time I see it. He's pain free and does whatever he wants. Had it done probably 4-5 years ago now. Never heard him complain once since he had it done.

[Fred Perreault]

Thank you all for the responses. I had surgery at 3-4-5 in 2002, and now I have a displaced vertabra, total absence of disk cushioning, and constant major pain from mid section to toes. It has also affected my bladder and groin as well as my sleep. I have been operating bulldozers and such for 50 years and have abused myself a lot. The neurosurgeon indicated mechanical fusion and Kyphoplasty ?? (opening up the spine and installing a cement between vertebrae) at several points. A life changing event, for sure.... Thanks again, Fred

[Larry Frank]

Good Luck..I had spinal fusion 10 years ago. I had no other options and it helped a lot.

I still have pain but much better.

We will think about you and hope all goes well..let us know how you are doing

[Andrew Joiner]

My wife had fusion 18 years ago. They took bone from her hip to do it. She was pain free after a few months of recovery. Of course get opinions from more than one doctor. In my wife's case she's extremely happy with spinal fusion to this day.

[Lori Kleinberg]

Hi Fred, I know alot about what you are going thru. I've had a total of 3 back surgeries, the last a fusion of L4-5, S1 done in 1996. I've met people that have had success with this surgery and those that have experienced failure as I did. I have to rotate positions (sitting, standing, walking) frequently. I have held off as long as I could and will be under going my 4th back surgery (2nd fusion) at the end of the month. I do have mixed feelings about it but don't feel as though I have a choice.
I wish you luck with whatever you decide and if you need more info just pm me.

[Jim Matthews]

I had a brief stint selling many of the positioning products used in surgeries, as in the previously mentioned Kyphoplasty.

I'm not a doctor.

From what I can glean of the lay literature, anecdotes from pain sufferers and limited contact with interventional radiologists (the speciality that injects pain meds at the spine under Xray exam)
there are serious surgical complications that can be overlooked by people in constant pain.

It appears that taking things away in spinal pain cases is preferable to adding things...
the less weight you carry in your abdomen, the better.

A large belly is a canitilever pulling a deeper curve into the lumbar spine.
Excavation of the pedicle surrounding the nerve root adjacent to a bulging disc may also provide some relief.

I purchased a classic LazyBoy recliner in 2003 when I had my last episode, and it was a Godsend.
I could find the position that allowed me to nod off.

I wish those suffering back pain at least one decent night of sleep during a flare, I found that was the worst torment.
(I had a miniscule T5 fracture from a knee in the back, playing hockey which has resolved.)

It's when you're completely exhausted that you most want sleep and back pain prevents rest for many of us.

If your weight is up before surgery, recovery may be slow.
If you can manage walking while you're in pain - it may help ease the symptoms and cut some weight, too.

I don't mean to dissuade anyone from surgical interventions, which can be effective -
I would caution anyone that's in rough shape now from anticipating a return to the days before your back was wrecked.

If you do follow through to a procedure like this, take your pre-opertative skin prep (http://www.medscape.com/viewarticle/763958) seriously.

[Phil Thien]

What Jim posted above sounds pretty much identical to what I was told by my physician about 15 years ago, after I had been injured falling off (of all things) a chair (broken, unbeknownst to me).

The pain in my leg was epic, and caused nerve damage (numbness and loss of power) in my left leg. A neurologist told me I needed back surgery, my regular physician and an orthopedic surgeon (that did everything save for backs) that was in the same office suite strongly discouraged it.

I was told to walk and exercise, which I did, and the improvement came slowly. They told me I didn't have to rush into back surgery, and that I should do a ton of research before proceeding.

The books I read, and the people I found that had undergone surgery, scared the crap out of me. I don't think I ever really found someone that had a successful back surgery. They all told me about their first, second, then the soon to be third.

I was lucky in one regard, though: I was able to sleep pretty comfortably. My pain came when standing up or sitting down. Laying down and sleeping was okay. I think if I had been unable to find a comfortable position ever, I would have been more likely to seek surgery.

Also, if the nerve damage was continuing to worsen, I'd have gone under the knife. That was one aspect that my doctor continued to monitor, he always wanted to know if the numbness or strength was worsening. As long as they weren't, he wanted me walking and exercising.

Having gone through this I have the deepest sympathy for those going through it now. The path I chose worked great for me, but I did live a bit in fear that symptoms will return/worsen as I age.

Sitting at one point in a back surgeon's office waiting room, I spied people coming/going that were in far worse shape. Their injuries had amounted to partial paralysis. So I count myself pretty lucky.

[Scott Shepherd]

I might add one thing that you'd think is obvious, but the choice of your doctor is paramount, in my opinion. In my opinion, not all doctors are created equal. Ask nurses, or other doctors their opinions of who the best back surgeon in the area is. Ask your current doctor if he had to have his back operated on, who he'd get to do it. Do not just go to whoever is recommended from a primary care doctor and live with it. Spent more time picking your back surgeon than you would picking a car or piece of equipment. I would want the best of the best doing it. The person with the highest success rate. You don't know those answers until you start researching.

I consider my Dad's surgeon to be on the best, if not the best, in this area. However, I hear stories all the time (heard one yesterday) of people who's surgery didn't go well. I always ask who did it and it never seems to be the surgeon my Dad used.

I can't stress it enough- do your homework. There are good and not so good surgeons out there. Just because they have the certificate doesn't make them qualified.

[Jacob Muldowney]

I can share my experience with you. I have what is called isthmic spondylolisthesis. Long story short for those reading this. My L5 or last vertebrae above the sacrum is fractured in a way that the part that holds my spinal cord stays in place but the vertebrae shifts forward pinching nerves. This made my life very rough. It felt like I was attacked with a bat from the waist down everyday. I lived an active life full of contact sports etc. Which most likely was the culprit. In some cases this can be managed with physical therapy. Andre Agassi actually has this. Some people are what they refer to as stable and get by with modifying their actives. I was not one of these people. I went to several doctors and chiropractors. All but one missed this diagnosis. I had given up on chiropractors but a good friend recommended I go see his buddy. I talked with him and he was very knowledgeable compared to the others I had seen. Withing 2 minutes of my xrays he said I know what is wrong and helped me manage the pain.

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No matter what I did I still had pain and living on Oxycontin was not a long term solution for me. I researched a local spine clinic at the UW Madison. They tried a nerve block which had no effect whatsoever.

They advised fusion. I was against the classic fusion of fusing several vertebrae to stabilize the area. I had read up on the subject for hundreds of hours. Many had stated it was helpful for a period of years but then led to other issues like degenerative disc disease etc. Which makes sense when you think about it. Eventually the disc right about the fusion starts to break down to limited range of motion etc. I talked with my Dr as he was pretty involved with new methods and treatments, since he works for hospital tied to the UW and is a teacher too. He suggested a new treatment of repairng the pars defect itself. They used 4 titanium pedicular screws. One above and below the fracture on each side and then connected those with a titanium bars. They then harvested bone from my hip and used that in the fracture to help repair it. In February it will be 3 years since surgery. I am glad I did it, that said it was at least a year till I was back to any form of normal. I retain my full range of motion. I do have issues with the muscles back there from time to time as they cut through 3 places. When it acts up I do a bit of PT and I am back on track. The other downside is I know when the weather is changing with the seasons before everyone else, or if it is going to rain or snow.

Have they discussed artificial discs or any other forms of treatment with you? I am not saying fusion is a bad idea, I just am a big fan of knowing all of your options. Also a second or third opinion never hurts. I hope this helps you and perhaps gives you a bit of hope yourself that there is life after back problems and surgery. I know our issues are not identical but share some similarities. Best of luck and if you have any questions feel free to pm me.

[Ruperto Mendiones]

Choice of doctor is paramount x 10^26. Check on how frequently the surgeon does the particular procedure you are having [after all your first 5 dovetails weren't perfect--were they?] See if you can get a handle on frequency of complications--particularly infections. Base your choice on experience and complication rates.

[george wilson]

I have a titanium implant in my bottom 3 vertebrae. I had spinal stenosis and had to have it done as I got too painful to walk. No pain from the surgery,but it is hard for me to put my socks on,and nearly impossible to clip my toe nails. My pain is in my sacrum. My pain doctor just yesterday told me to NEVER let a surgeon fuse my sacrum. It HAS to move,and I'd end up in big trouble if I had it fused. I went to a surgeon last week,and was told to just keep doing what I was doing: Getting injections in the sacrum. I'm getting spinal stenosis just ABOVE the titanium implant,but so far it is not bothering me,so I';m not doing anything about it. If I get more vertebra fused,I will be even more unable to get my socks and shoes on.

My first sensation of spinal stenosis was that I was being pushed up into the air. Then,I had a strong spring between my legs so that I had to concentrate on walking normally. Finally,I had too much pain to walk much. Then I had the surgery. All this happened while we were MOVING!! Not the best time for this to happen.

The farther DOWN they operate on your back,the less chance there is of complications. About half way down your back,the nerves branch out and go their way.

I had a pair of bones in my neck fused,too. I have constant pain there,but don't know if it was from the surgery or not,as I hurt there anyway. Had to wear a brace on my neck,and not bend it for 6 weeks or so. They went in from the front,drilled hole between 2 bones,and inserted a bone plug of sterile cow bone(I think). I have lost 2" of height over the years due to my back wearing out.

[Fred Perreault]

Thanks all..... what a great source of information. I am taking up PT for the Fall, and hope that PT, exercise and weight reduction will aid immensely in reducing my issues. It is definitely the lack of sleep, or at this time the near lack of same, that is the most troublesome. Welding my spine into a rigid form at any level is not on my list of favorite things to do. I have too many things to do before I retire to a rocking chair :) :)

[Phil Thien]

I'm going to add one more thing, and I know I'm sounding like a broken record, but make absolute certain you're getting enough vitamin D.

Don't trust me, do your own research. Google "vitamin D back pain" and you will find articles like this:

http://www.webmd.com/pain-management/features/vitamin-d-deficiency-and-chronic-pain-link

I learned the significance from a customer that is an ER doctor. He saw me struggling (awkward posture, sort of limp) when my back was acting up one day. He sat me down at the computer and started showing me the research.

I now take some daily joint supplements that have about 2000 units of vitamin D in them. Some people argue for more.

But the greatest improvement in my condition started AFTER I began taking vitamin D. My wife noticed that I'll stop and pickup things off the ground now, which I never would have done just a few years ago. I used to live in fear of flushing the toilet because just bending over to do so could trigger an attack that would last for days/weeks. I'd never stop taking the stuff now.