spinal fusion???

[wilsonia@comcast.net]

I began having leg pain last May - thought I'd worked out too hard. I began to see a chiropractor, which was fruitless. I finally went to my regular G.P. and he immediately seemed to know what was wrong. He initially sent me for an xray, which was inconclusive. I then had an MRI, which revealed spinal stenosis at V 4&5 and no disc left at V3. I had a consultation with an orthopedic surgeon in my hometown, whom I found to be arrogant and flip. At that point, I was not in a lot of pain, so I didn't even wait around to here what "his" surgery would entail. He crossed his arms and said he'd wait to hear from me, as my problem would definitely get worse. I then had an out-of-town(Fresno, CA) consultation with a neurosurgeon that instilled a lot of confidence. Because I'm retiring soon, and hoped to wait until then, I had an epidural at Christmas to buy some time. It was miraculous. We had a family vacation to Hawaii in January, and we walked and hiked, and worked out in the resort gym. After about six weeks the pain returned with vengence. At that point, I determined that I was ready for surgery. The surgeon that I'd seen earlier, and liked, wanted to do TLIF surgery. My description of this probably isn't accurate, but he basically wanted to go in, remove bone at 3.4.&5, fuse the vertebrae and put small cages in with material that would allow the bone to regenerate. The pain dr. that did the injection and the physical therapist that I saw at a later date were surprised at this invasive procedure, as they said that my range of motion, symmetry, and flexibility were all good. As the pain increased in February, I decided to proceed with the surgery, and was scheduled for March 8th. The scheduling nurse called 5 days prior to say that my insurance (Anthem Blue Cross) would not approve the surgery saying that it was too invasive. The dr. and his staff appealed it, and it was denied again. They then took it to the "peer to peer" appeal, and it was still denied, saying it was unnecessary surgery. Because of the intense pain, I had another injection on March 17, which is still effective, thank goodness. I have another consultation on April 12th with a southern CA doctor, who gets good reviews from folks I've talked to. If anyone could chime in on this, I would appreciate it. Has anyone else experienced a similar situation? The doctor that I planned to have surgery with feels that my insurance is suggesting a minimal procedure, which will likely call for another surgery several years down the road. He feels that everyone is looking for a non-invasive or minimally invasive surgery, but that they are rarely effective. This TLIF surgery would require a 2-3 mo. recuperation. Reviews that I've read on "Healthgrades", and other websites that review doctors, gives him rave reviews and comments. What to do???

[dshobbies]

Hi Wilsonia.

First, if this is your email address, I'd suggest changing your screen name to simply wilsonia. Your choice.

Next, welcome to the forum. Hopefully, as others chime in, you've come to the right place.

A spinal fusion is removing the disc matter and in your case, enlarging the nerve passageways, replacing it with bone fragments, placing a cage around it so it will stay in place until it grows into solid bone, after which the cage is no longer needed but removing it is only done when if it causes problems down the line.

We all hate insurance companies but perhaps they feel this very invasive procedure is premature because you haven't tried a laminectomy or foraminotomy or perhaps even physical therapy (or something else I'm unfamiliar with). I also have to say that a 2 level fusion at L5/3 is drastic and can impact the quality of your life. Though some have only minimal limitations, your back moves the most from these discs and bending over may no longer be possible. Climbing stairs may be forever difficult. Also, the adjacent segments, S1/L5 and L2/3 will take on the additional burden and could herniate down the road, perhaps quite soon. Then too the healing process of 2/3 months may be very optimistic. 6 months or even more is not uncommon.

Though insurance companies are all looking out for themselves, I would have to say I agree with them on this one. A 2 level fusion is a drastic first step and though it may ultimately become necessary, you should familiarize yourself with both this surgery and alternatives. Once you understand the various procedures, I think you would also agree that this recommedation might be too drastic a first step, even if eventually needed.

Please seek other opinions. We all understand the arrogance of some spinal surgeons but if the doctor has an excellent reputation, that's something you might simply have to endure. Many of us saw multiple doctors before deciding on which surgery and which doctor.

Please ask as many questions as you can until you're satisfied with your own knowledge and then make your decision.

I wish you good luck,
Dale

[mmglobal]

Looking forward to hearing about 4/12 consult... who is the doc?

[wilsonia@comcast.net]

I'm actually seeing two drs. and postponed until April 19th so that I could see them both - LA is a 3 hour drive from my home. I have appointments with Dr. Dillin at the Kerlan Jobe Clinic, and Dr. John Regan with the Spine Center at Beverly Hills. Thanks for your good wishes - I will chime in after I have more information. I'm still receiving good benefit from the epidural injection from March 17th.

[grantwb1]

Welcome to ispine,

I can tell you from experience, I am two months post op from a TILF that spinal fusion is NO JOKE!!! From my experience it is the hardest thing in my life x100!!! Is it worth it don't know yet, I am still heavily medicated and hurting. Use other peoples experience and see more than three docs, this is not to scare you but read around a lot of doctors have the wrong interests and motives and you in pain for the rest of you life does not bother them or their pocketbook. In my opinion this is the place to get good answers. I could not live without Mark Mintzer. I hope you do not ever need surgery. If you have any questions about my exp you may pm me.

[Maria]

Dr.Dillan spoke to me over the phone for a half hour back in 2001 and I think may have saved me from one of the greatest mistakes I didn't make .. having a 3 level global fusion (L3-L5S1). He just talked to me generally about the success of 3 level global fusions and told me I could make an appt. to see him and have a discogram done (had already had my first one by my OSS). Anyway everytime someone mentions his name as a consultation I think it's a very good idea to see him.

I saw Dr.Regan in 2003 for a consultation re 2 level ADR surgery or ADR and fusion and I was very glad I had a consultation w/him and felt it was well worth my time. I was impressed with the time he spent w/me and what he had to say and how he said it. If WC hadn't authorized someone else to do my surgery I think I would have prefered Dr.R based on this visit.

Overall to date I've not moved forward with any further surgeries since my last discectomy in '92.

Good luck.. I think these 2 surgeons are excellent choices for consultations.

[Katie]

I've heard very good things about Dr. Regan.

Personally, I've recently had two level fusion at L4/5 and L5/S1. Both were done using the Nuvasive PEEK cage, and the L4/5 was done via XLIF, a minimally invasive method that went in through my side. It is a very small incision and barely hurts at all. The L5/S1 had to go in through the right front/side of my abdomen, because he had to go up over my hip bone. Even that was not majorly painful. I am three weeks out from this surgery (including a disc replacement at C5/6) and am almost completely pain free. (There were three separate incisions and an eight hour surgery because of 'surprises' part way through.)

I am only continuing on with my pre-op pain medications to avoid withdrawal right now while healing, plus a small amount of back pain from normal healing.

I had to travel out of country to get this surgery as I needed non-metal devices, having discovered that I am severely allergic to all of the metals used in spine surgery. I was able to find Dr. Luiz Pimenta in Sao Paulo, Brazil and traveled there for my procedure. He does, however, travel to the US regularly.

After reading the reports from some others who have had regular fusions, I am so relieved to have gone this route. My S1 had slipped forward ahead of my L5 vertebrae, causing a great deal of pain and putting my spinal cord out of alignment. It was not that obvious from my several MRIs or x-rays and he had to change his plans after starting surgery. If I hadn't had to do the L5/S1, the surgery would have been a breeze...no exaggeration.

My recovery now is mainly through sleep...my body is insisting on about 15-18 hrs of sleep a day, and I am listening to it

This is just to say that there are good surgeons out there and to keep the faith. Dr. Regan has a great reputation as I said above. I had to go through about eight different consults to find someone who felt right and I had confidence in.

Good luck with everything. You certainly deserve it.

[dshobbies]

Katie,

Wow, only 3 weeks out and almost pain free. 2 thumbs up- and listening to your body is a hard lesson to learn- 3 thumbs up on that one.

Dale

[Katie]

Not to say that I'm not spending a great deal of time healing. I'm sleeping at least sixteen to eighteen hours a day since I came home almost two weeks ago. Wow, the time is flying by...my surgery date was March 17.

I don't want to hijack this thread, as Wilsonia has a huge amount to talk about and needs help here. I just wanted to say that when things look darkest, help can be just around the corner.

[wilsonia@comcast.net]

I had my 2 Southern Ca. consultations yesterday, and am pleased to report that there appears to be a consensus that my original surgery recommendation was "was over the top". The first doctor, Dr. Regan, suggested a microdecompression surgery. Dr. Dillin, from Kerlan Jobe, suggested a possible laminectomy, but felt that films needed to be updated. Both felt that surgery would be a possibility for the future, but not nearly as aggressive as what was originally recommended. Since my last injection on March 17th, I'm still feeling quite fine, and along with physical therapy, these doctors felt that I might be able to go awhile without surgery. We walked a total of 3 miles to and from Dr. Regan's office, and I had no pain. Both doctors mentioned that sometimes additional injections have a cumulative or collective effect, and that, based on my current symptomology, neither would suggest surgery in the near future. We'll see. I'm also looking into some imagery, relaxation, and meditation, as we've had some tragic experiences with one of our sons, and there is a theory out there that the stress of this emotional pain might be a contributing factor - an interesting theory.

[Maria]

Wilsonia,
Glad you felt good about the consultations and that they were similar in recommendations..

I started w/episodic low back pain in '82, had first discectomy in '89/good results then more spine probs in '91 and second discectomy in '92 w/very bad failed results and start of chronic low back and lower extremity pain bilat.

Getting surgical opinions from 2001-2006 all recommending further surgery however meanwhile I had started low dose pain meds in 2001 and getting ESIs with excellent results every year w/exception of one year until now.

Since 2005 even tho my clinical picture has degenerated my actual pain levels are much less hence I have thus avoided further surgery.

Because of my very bad failed surgery and the residual increased pain it caused for 5 years post op I am not one to advocate surgery if something else works and it can be avoided however then again I did stop working in 2000 and I'm still on low dose pain medication every day and gabapentin for neuropathies.

The dramatic reduction of pain for me may have also come about because of natural autofusion of the L5S1 level after so many years. Personally I think this is it tho I have to say the ESIs still do wonders for my L4 level which still is problematic.

Good luck with your journey and I hope you continue to do so well! Be careful not to work yourself up into a flare up however as the steroid relief is coating the problem that still exists (this is from personal experience too many times!).

[dshobbies]

Wilsonia,

This is good news. And indeed, stress can kill you. With stress comes tension and holding your body rigidly doesn't give your muscles any time to relax. This is why meditation and other relaxation techniques are valuable medical tools.

Also, with the news that your back isn't as bad as previously thought, that stress has been lifted.

Please continue to listen to what your body tells you and keep us posted.

Dale