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  • Abbeygirl
    Member
    Post count: 40

    Hi Doctor
    Thanks again for the great service just was wondering what are your thoughts on fusion L5/S1 I had a decompression surgery at that level just over 12 months ago but still am in a lot of pain so i have been back to pain management doctor who gave me facet joint injection with no relief so went to a nerosurgion and she found that I have spinal stenious and a prolapse disc at the L5/S1 Level and has said that I need a spinal fusion at that level I have had a second opion he said I might need other levels done but get this leval done first and see how I recover my question is are spinal fusion very successful because at the moment I am in a lot of pain been on oxycontin and endemp for a long time now and I am Scared to have a this operation just in case I came out worse than what I am now even though I am Going Crazy I still get around a little bit just need some advice I hope that makes sense these pain meds make me bit hazy sick of taking them just so I can function Thanks again Doctor for trhis great service

    Donald Corenman, MD, DC
    Moderator
    Post count: 8376

    You have to ask yourself what the fusion is going to do for you. First- where is the pain coming from? This requires you to describe your pain. Is it pure lower back pain or is there a component of leg pain? If so, what is the percentage of leg pain vs. lower back pain? Do you have more of one vs. the other?

    The reason for these questions is you have to define what you are treating. If you had mainly leg pain and had a new disc herniation causing nerve compression and previously had only one surgery at this level, you would probably be a candidate for another simple decompression.

    If you had mainly back pain and a fusion is recommended- what was the work-up that led to the decision for fusion? What do the surrounding discs look like? Is there instability based upon X-rays (flexion/ extension)? Was a discogram performed to determine the pain generator (see website for details)?

    There are many unanswered questions.

    Let us accept that you need a fusion of L5-S1 and this is the only pain generator. The success rate for a one level fusion performed correctly is about 90% for 2/3 relief of pain.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Abbeygirl
    Member
    Post count: 40

    Thanks Doctor for your response I have had two previous surgeries the first one was 14 years ago a laminotoy which was very succseful on the L5/S1 level then 12 months ago I had decompression surgery on the S1 and have been a mess ever since I have had two steriod injections in my back Then went to see pain managment doctor who sent me for two facet joint injections and felt the same no relief but did not feel worse after those injections just had the same pain then went to a nerosurgion that check me for reflexes and bending forward and backwards and ask where pain was which is in my lower back al the time also numbness front right thigh both legs ache as well but not all the time and at different timesmy big toes go numb as well also my pinky finger and half of my ring finger goes numb on both hands but the numbness in my fingers and my right front thigh have started after tyhe last surgery I had one year ago I am in more pain now then iwas before my last operation the surgion said that it was a quick surgery and I would be right after six weeks so now I am scared to have fusion surgery but then i do not want to live the way i live now but i have been told that fusion surgery is pretty successful the thing that worries me is with the mri i have had post surgery they all come back with that i have a lot of infamation so if i have another surgery will the inflamation bbe worse again because that will be the third surgery on that area

    Abbeygirl
    Member
    Post count: 40

    Thanks Doctor for your response I have had two previous surgeries the first one was 14 years ago a laminotoy which was very succseful on the L5/S1 level then 12 months ago I had decompression surgery on the S1 and have been a mess ever since I have had two steriod injections in my back Then went to see pain managment doctor who sent me for two facet joint injections and felt the same no relief but did not feel worse after those injections just had the same pain then went to a nerosurgion that check me for reflexes and bending forward and backwards and ask where pain was which is in my lower back al the time also numbness front right thigh both legs ache as well but not all the time and at different timesmy big toes go numb as well also my pinky finger and half of my ring finger goes numb on both hands but the numbness in my fingers and my right front thigh have started after tyhe last surgery I had one year ago I am in more pain now then iwas before my last operation the surgion said that it was a quick surgery and I would be right after six weeks so now I am scared to have fusion surgery but then i do not want to live the way i live now but i have been told that fusion surgery is pretty successful the thing that worries me is with the mri i have had post surgery they all come back with that i have a lot of infamation so if i have another surgery will the inflamation bbe worse again because that will be the third surgery on that area

    Donald Corenman, MD, DC
    Moderator
    Post count: 8376

    Your symptoms are varied and not all related to your lower back. The arm and hand symptoms are generated by your neck, shoulders or arms. The lower back pain is most likely from your L5-S1 disc but that is also predicated upon how the other discs and facets look above the L5-S1 level.

    You have had two prior surgeries at the L5-S1 level so a simple decompression is probably unlikely to be indicated. Also, decompression does not typically help lower back pain symptoms.

    Fusion might be helpful as long as the L5-S1 disc is significantly degenerative (most likely) and the other levels on MRI and X-ray are normal in appearance. A test called a discogram can indicate if this disc is the pain generator (see website). If you are a good candidate for fusion (see section on when to have lower back surgery), then you should be satisfied with this surgery.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Abbeygirl
    Member
    Post count: 40

    Hi Doctor I have not replied for a while waitng to go to nerosurgion to inform her that I will go ahead with surgery fusion L5/S1 but I have now got another problem and was wondering if you could give me your professional opion if this syptom could be coming from my back in the past couple of weeks I get pins and needles in my right foot on the side of the foot when i put pressure example when I take a step not always there but becoming more frequent i hope that is enough information one other thing the two surgions i have seen said that i will still have back pain after the surgery i hope not i am very nervious about this operation thanks again doctor for this great service

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