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  • Crogers01
    Member
    Post count: 6

    Brief History:
    Started having “dull” back pain in 2003 at the age of 24. In 2006 it stated getting worse and I was treated very unprofessional by doctors that I visited. Fast forward to 2010, an MRI in Feburary showed a broad-based herniation that have the S1 nerve roots on both side pinched. Underwent a Discetomy in March 2010. Before having surgery I had done multiple injections, PT, Medication, etc. Anything ever offered to me, I did.

    After the surgery I was as close to pain as I had ever been in 7 years but after 4 months my pain came back and increasing got worse over the past 2 years. Since my surgery I have had 15 transformainal bilateral injections( 5 series of 3 injections) so actually 30 injections, PT again and exercise over the past 2.5 yrs. I’m currently taking Oxycontin 20mg every 12hrs and Percocet 10/325 4 times per day PRN.

    X-Ray Report:
    L5-S1 degenerative space narrowing
    Grade 1 retrolisthesis of L5-S1 in the supine position.

    MRI Report
    1.) Mild epidural fibrosis, mild remaining disc bulge without recurrent herniation. 70% disc dessication at L5-S1
    2.) Note is made however of increasing type 1 Modic change at the disc level which has been reported in the setting of instability and flexion/extension views may be useful.

    NOTE: The report does report the previous surgery changes to the Lamina and Disc due to the surgery in 2010.

    My surgery is well-known in this region for neurosurgery and he told me before I had the first surgery that there would be good chance I would need further surgery in the future and that “I would probably become disabled from this and that’s when we would talk about other surgery options.” On Oct 15th I seen his nurse pract and she ordered the X-rays and MRI.

    Question is- Am I gonna need a fusion at L5-S1 sometime in the future? Symptoms are extreme back pain, left leg “Shock” with certain movements, and a stabbing pain just to the left of my scare when I bend left laterally.

    Thanks for any help.

    Chris
    Knoxville, TN 33yo

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    You have classic findings for isolated disc resorption of L5-S1. The retrolisthesis of L5 on S1 is typical for severe degenerative disc disease and you have no reported recurrent herniation. You have type one Modec changes of the endplate. These are small fractures of the endplate and trabecular bone from impact and lack of shock absorption.

    You do not note detailed current symptoms but I assume you have back pain with activity significantly increased by impact activity (jumping, tennis, vibration as in riding in a car). You also probably have delayed onset pain with activity. That is, pain that occurs 4-8 hours after the inciting activity.

    This condition can also be associated with foraminal stenosis. This would manifest as pain the buttocks and legs with prolonged standing or walking. This might explain your left leg “shock” with certain movements.

    You could be a candidate for fusion surgery with a TLIF to reconstruct the height of the eroded disc. You should be satisfied with surgery. I am just finishing a paper with patients just like you and a 90% satisfaction rate.

    Dr. Corenman

    Crogers01
    Member
    Post count: 6

    Dr. Corenman,

    Thanks for your response, I really appreciate it. A lot of what you said is what I am currently experiencing in regards to my pain. I can feel pretty good some days and then I will play disc golf or play with my daughter and then a few hours later I am almost bed-ridden with sharp pain in my low back and hip area with some leg pain as well. It’s very frustrating and then I have to “chase” the pain with medication for the next 12-24hrs and this is the most frustrating part of this. After my MRI & XRAY results were read by my neurosurgeon, his office called me and scheduled a follow-up visit in 2 weeks to “discuss my surgical options” which I am 99.9% sure this means I am a candidate for a single level fusion.

    The fusion surgery doesn’t scare me, it’s the affect is has on my family during the recovery process. I have a 3 yr old daughter and my wife works full-time at the hospital I will be having the surgery at. The post-op pain doesn’t scare me either, I am use to chronic pain, I have been experiencing it for the past 7 years with a 4 month period of pain free after my disckectomy in 2010.

    In your experience, what type of post-op pain will someone that has a single level fusion experience? Will I be able to walk around the same day I have the surgery? Do you recommend your patients do physical therapy in a clinical setting or just “at home” walking and other exercises? My job is not physically demanding, I sit for 6-8 hrs a day, how long before I could work again?

    I have a great team of doctors that include my Primary Care Dr(which I have her personal phone #), my pain management doctors 24/7 access, a therapist that I went to after I started getting depressed about my chronic pain and then my surgeon’s help. All of these docs have been great and I’m thankful that I have access to so many caring docs that are always willing to help me. I believe they have helped me prolong this pending fusion as long as possible with alternative treatments such as yoga, acupuncture, PT and exercise.

    Final question, my pain management docs have tried to get me to get the implanted spinal cord stimulator in the past and just recently at one of my appointments. Is the spinal cord stimulator the last line of defense in someone with clinical findings that possibly warrants a Fusion? I appreciate your answers and your interactiveness on this website is great.

    Chris
    Knoxville, TN 33 yo

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Your symptoms are classic for isolated disc resorption of the L5-S1 disc. A TLIF fusion has about a 90% success rate for your satisfaction after surgery (would you do the surgery again under the same circumstances?). See the section under “Pre & Post Op”, “Recovery information by surgery”; “Lumbar Fusion” to understand my protocol regarding the time frame for recovery.

    All individuals can walk around the day after surgery and many walk the very same day. Return to work part time under light duty can take from one week to four weeks. I still cannot predict how quickly one individual can return vs. another. It varies person to person.

    An implanted spinal cord stimulator is not indicated in a repairable surgical pathology. The disorder is fixed first surgically. If for some reason, there is no reduction of symptoms, a stimulator can then be implanted but these stimulators are notorious for not being too effective for spine pain. Stimulators are more effective for leg or arm pain, but those are not your symptoms.

    Dr. Corenman

    Crogers01
    Member
    Post count: 6

    Thank you so much for your responses. My appoint is November 21st and I’m sure fusion is going to be the option. As for the spinal cord stimulator, I keep telling the pain docs that I am going to fully explore all surgical options since the stimulator is not going to do anything to “fix” my problem.

    I appreciate the links you referenced and I will look over those in great detail. A spine fusion is something I have been preparing for and I have researched everything I can find and read. I’m so sick of pain meds and pain management gimmicks that I’m 99% sure I will go through with a fusion. Those people that get pleasure out of pain meds have not experienced “real” pain and they would be so sick of them if they had to take them for a real reason or a medical condition that doesn’t respond well to any treatment, even pain meds. Even with meds, I’m usually at a 4 or 5 on the pain scale and if I play disc golf(which I started playing for the exercise) I jump to 6-7.

    Thanks again and I will post again once I know exactly what the doc plans on offering me.. (Which approach) Thanks for a great service.

    Chris

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Please keep the forum apprised of your progress. I think it is great education to allow others to see how the surgical process progresses. Thanks for your participation.

    Dr. Corenman

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