CalistaParticipantFebruary 25, 2020 at 6:28 pmPost count: 18
I had an L5/S1 360 fusion for isthmic spondylolisthesis, the outcome was good until the dreaded ASD.
5 yrs later painful adjacent segment pathology became incapacitating at L3-5. MRI revealed L4/5 herniated, L3/4 had bulge, both levels had spondolytic changes. I had 2 episodes requiring narcotics, muscle relaxers and bed rest. Then was able to manage, become somewhat active, and used NSAIDs/ice.
15 months later, L4/5 extruded, there are fragments under L4 nerve root (left side) L3/4 herniated to the right, have severe left, moderate right foraminal stenosis at both levels, central canal stenosis, facet joint hypertrophy, infolding of ligamentum flaven, a good amount of disc height loss and grade 1 retrolithesis.
My symptoms started up again with awful axial pain first radiating to left, then bilaterally. Then within a month of onset of the severe pain, I woke up with vice like left leg muscle spasms in gluteal and quadricep muscles, my knee is buckling, have left side groin pain and saddle numbness, and radicular pain radiating around left hip to lateral thigh and crossing over my shin. No narcotic or muscle relaxer is providing any relief. ESIs are contraindicated.
I need to make a decision quickly as to what surgical approach to consent to. I am 46yo, BMI ~21, have connective tissue/ automimmune disease, suspected collegen defect based upon hyperextensive joints, so know my genetics play into my condition. Not to be construed as “medical advice” but just looking for help since I have received conflicting opinions. I am leaning towards a posterior full decompression with lateral fusion, knowing the continued risks of further ASD. However one surgeon mentioned discectomy, vs extension fusion.
I fear that more surgery would be likely at the same levels and that statistically my chances of a good outcome decline with further surgeries at the same levels, and having postetior scar tissue if further surgery is needed. Is my thought process reasonable, or should I go with the “deal with disks hemi-laminectomiesonly approach in your opinion?Donald Corenman, MD, DCModeratorFebruary 29, 2020 at 2:03 pmPost count: 8468
Did you have another post that I had previously answered or is this a new subject?
Dr. CorenmanCalistaParticipantFebruary 29, 2020 at 4:27 pmPost count: 18
This is duplicative. I thought adding MRI report would help. I replied to your reply on the other post with information known to me regarding your questions that I could give answers to.
This situation is distressing because of conflicting opinions followed by vagueness. I feel like I am left in the dark, and given the pain is beyond anything I have experienced, and I cannot even think straight due to not being able to sleep – if I were a canine I would be euthanized humanely, not be dealing with conflicting opinions by one surgeon, which is quite confusing.
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