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  • TToney
    Member
    Post count: 3

    Dr. Corenman,
    I have a question/dilemma that I was wondering you if you could possible help me with. I’ve been an athlete my whole life and currently own a CrossFit affiliate. Weightlifting, running, jumping, climbing is a big part of what I do on a daily basis. Unfortunately this is accompanied with chronic pain. I’ve been suffering from back pain for the past 6 years. I attribute this to years of wear and tear accompanied with lifting weights incorrectly (squatting/deadlifting). In the last few of years I’ve learned to lift the correct way, improve my posture and strengthen my core. Overall, the pain has kind of come and gone, but for the last year it has been pretty constant. I had a significant flare-up last year around this time. I’ve tried chiropractic, decompression, message therapy, injections, etc. I am a big proponent of proper lifting technique and active mobilization. Unfortunately, I am beginning to think that my injury is beyond recovery through mobilization.
    My last MRI in Jan of 2013 showed a herniated disc at L5-S1 with a stable grade 1 retrolisthesis. There is evidence of moderate to advanced DDD at this joint level as well. I’ve been to numerous consultations with surgeons and they all recommend a TILIF fusion. I am at a loss as to what to do. I deal with pain/ numbness at different thresholds almost daily. For the most part it is tolerable but is getting to the point of frustration. I attribute CrossFit training for keeping me in the game this long. I have a really strong low back/core but the constant nagging pain is wearing on me. Part of me believes that surgery is inevitable at some point. Am I correct in thinking this?Based on your experience, do athletes recover from this type of surgery? If I were to have it performed, what are my limitations once I have fully recovered? Are my days of squatting, deadlifting, running, jumping, pressing over with? We have a few members at our gym who have had lumbar and cervical fusions and they are performing great with minimal limitations. Is this the norm? To me, it is strange to think that I am a spinal fusion candidate with all of the things I can still do in the gym. With that being said, I am tired of the pain. My thinking is to fix the damaged joint and start completely over with the knowledge that I have gained of proper body positioning and mechanics. I am hoping that you may be able to shed some light on my situation. I thank you for your time Dr. Corenman

    Sincerely,
    T. Toney

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    You are asking whether you need a fusion for lower back pain. The answer is that it depends upon the cause of your lower back pain. Degenerative disc disease can be quite painful and possibly you could need a fusion to relieve your pain.

    Have you had a conservative treatment? This includes medications and injections (epidurals)? I assume that you have a strong core so PT might not be necessary.

    Have you had a workup? This means possible facet blocks and/or a discogram? Depending upon your examination findings, it might be that the facets are causing your pain and you do not need a fusion but need rhizotomies (see website). If there is more than one disc that is degenerative, you might need a discogram to make sure this lower disc is the painful disc.

    A lumber fusion are generally very good for pain relief in the right patient. I am a bit worried that you plan to go back to squats and dead lifts as these actions place tremendous sheer forces on the discs. In my opinion, these actions should be avoided in your case.

    Dr. Corenman

    TToney
    Member
    Post count: 3

    Thank you for the reply Dr. Corenman. I truly appreciate your time. The last MRI revealed that all other discs above L5 were in normal shape and good condition. I have had numerous epidural injections to attempt to calm the area down at L5 S1. Other conservative treatments have included, spinal decompression, message/physical therapy. In my experience, these only provided temporary relief. I am scheduled to have a RFA performed on the nerves. Is this the same as rhizotomies that you mentioned? I’ve read on forums that many people are worse off after having this done. Any truth to this? I’m just wondering if all of this is just a temporary solution to the problem. With the DDD and retrolisthesis at L5-S1 is it not correct to think that fusion surgery is inevitable at some point?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The RFA is radio frequency ablation which is the long way of saying rhizotomies. I would recommend this treatment next as long as you had an adequate trial (facet blocks or medial branch blocks that gave you great temporary relief).

    Finally, if nothing else is effective, a fusion could be in your future. There are certain appearances on the X-ray and MRI that can indicate a better success rate but your history does indicate you could be a candidate for fusion surgery.

    Dr. Corenman

    TToney
    Member
    Post count: 3

    Dr. Corenman,
    I’ve decided that L5-S1 fusion is on my horizon. With the DDD and retrolisthesis at L5S1, conservative treatment has not worked. A recent RFA provided no relief in symptoms. Some days, I feel great other days it’s aggravating pain. I’m tired of the cycle. I’ve had numerous consultations with neurosurgeons within the last year and some have recommended a TLIF fusion. The most recent surgeon that I have consulted with believes a PLIF is the best approach considering my spine condition at that level along with my lifestyle expectations post surgery. Are there advantages or disadvantages of either. Why the differences in approaches by the surgeons? Any help in clarification would be greatly appreciated. I appreciate this forum and the time you devote to answering questions.
    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The difference between PLIF and TLIF is not a big one. The fusion rate should be the same. TLIF however only requires the retraction of one nerve root for the surgery and PLIF requires the retraction of both sides. It is rare to have a nerve root “complain” from retraction but if you want to split hairs, there is slightly more chance of an irritable nerve root from a PLIF than a TLIF.

    There always is a difference in “style” between surgeons. Find the one that you think is the most competent and educates you the most completely regarding his or her type of approach. Don’t be afraid to ask questions.

    Dr. Corenman

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