Do I need back surgery?

[Paul K]

All:

I've had constant back pain for as long as I can remember. Tried just about everything- acupuncture, various types of massage, PT, chiropractic adjustments (partially successful), traction, spinal injections, all to no avail. Met with a surgeon last week who offered to fuse 3 of my vertebra together- I'm not sure what their names are, but you can see from the pic which ones have fuched discs;



I've heard bad things about surgery, but most seems to centre around the damage done by gaining access. This guy claims that is not an issue because he does it 'keyhole' (not his words). I'm only 43 and have constant back pain & frequently 'throw my back out' sometimes with disastrous results (couldn't walk once, massive pain, walking about shaped like a question mark, etc).

Proposal is to fuse the 3 discs with some hardware, add synthetic discs & cadaver bone so it all grows together.

Thoughts?

Thanks in advance.

Paul.

[yetibone]

I'm on the fence about back surgery as well. My case is a bulging, or possibly herniated disc between L5, and S1 that is putting pressure on the sciatic nerve to my left leg. The discomfort is almost always there as a feeling like I've been hit in the back of my leg with a hammer. When transitioning from standing to seated, or from seated or crouching to standing up, I get a 30 second hot, crampy, plasticy feeling all the way to the ball of my left foot that makes sitting still impossible, and walking difficult until the feeling passes.

Injections have made all but the hammer blow sensation go away temporarily. I usually enjoy about 10 days totally pain free afterwards, but the symptoms eventually creep back. I've had 4 so far, and the second one I had right before I took a vacation was a dud. I have a back brace for when I know I'm going to be lifting something heavy or awkward, and Norco for when the discomfort really starts pissing me off.

I currently can't see it fit to shut down work for recovery and rehab after surgery because I continually have too much to do, and no suitable understudy in the wings. I have a great fellow working with me now at the shop who's very well skilled, and full of common sense, but I wouldn't expect him to take my place in my absence. Also, it's not like the pain is unmanagable, but it did take me about 13 months to adjust my daily routines to include mitigating the chronic physical discomfort, and just learning to live with it.

I know that one day, I'll have to get it fixed.

[HardDrive]

I'm 45 and have 2 badly ruptured disks. Before I go further, I think its important to point out that everyone is different, and 2 people with exactly the same scans can have radically different symptoms.

In the past, I have had symptoms so bad that I could barely stand from a sitting position, and terrible pain. Today, its managed pretty well. I keep myself trim, keep my core strength up, do a few physical therapy exercises, and take 400mg of ibuprofen every day. Keeping hydrated also seems to help.

Have you tried yoga? Might seem hippy-dippy, but I would try that before surgery.

[Cajundaddy]

Originally Posted by HardDrive

I'm 45 and have 2 badly ruptured disks. Before I go further, I think its important to point out that everyone is different, and 2 people with exactly the same scans can have radically different symptoms.

In the past, I have had symptoms so bad that I could barely stand from a sitting position, and terrible pain. Today, its managed pretty well. I keep myself trim, keep my core strength up, do a few physical therapy exercises, and take 400mg of ibuprofen every day. Keeping hydrated also seems to help.

Have you tried yoga? Might seem hippy-dippy, but I would try that before surgery.

Everyone is indeed different. My back had pretty severe scoliosis and I did things in my youth that no one should ever do to their back. I allowed myself to get soft in my 30s and back pain became unbearable to where I could barely walk in the morning. PT and regular daily exercise to keep my core strong takes the pressure off my spine and was as close to a full cure as anything. Things are pretty good now. I still must be careful lifting though.

My wife is a Radiologic Technologist and sees a lot of spinal images before and after surgery. She said about 50% are better after surgery and 50% are worse. Lousy odds IMO. Her suggestion is until you have Jack Lalanne abs and all forms of PT have been exhausted, avoid the knife. Of the patients who were worse off after surgery, 90% were also overweight.

[M.D. Holloway]

Dont do it ! I have yet to know anyone that back surgery worked. I need it on 2 discs but with excersis and dieting it has help big time.

[Paul K]

Originally Posted by HardDrive

Have you tried yoga? Might seem hippy-dippy, but I would try that before surgery.

Yes, sorry- forgot to add that. Yoga was very painful.

[Chocaholic]

Originally Posted by M.D. Holloway

Dont do it ! I have yet to know anyone that back surgery worked. I need it on 2 discs but with excersis and dieting it has help big time.

This is wrong...or at least based on 20 year old information.

[pavulon]

There are no guarantees in life or back surgery. Avoid anyone offering one. Avoiding back surgery is always plan A but if plan A isn't working despite your best efforts, then it may be your best plan B.

Spine surgery can help or hurt but if you go down that path, find a skilled surgeon as best you are able (talk candidly to non-biased physical therapists about surgeons' results...) and know that each patient's result can be markedly different. Good luck!

[LWJ]

Here is what I know. Exhaust ALL options prior. Why? I know a fellow that runs a workers comp program. He has paid for thousands of back / neck surgeries. His summary? 30% work. 30% no change. 30% worse. The balance? Who knows. I too have had back / neck issues. It sucks. Back. I wish I had a solution.

Good luck. Report back. (no pun intended!)

Larry

[aigel]

Are you overweight?

[Paul K]

Originally Posted by aigel

Are you overweight?

Depends on who you ask.

I'm 5'9 & 178#.

I used to be 5'9 & 154#.

That was 15 years ago.

FWIW, I tried an exercise ball as a chair, but everything got worse. I now have a sit down/stand up work station, and I have it 'up' about 85% of the day.

I've heard the 'three thirds' thing, but I'm not sure if it applies this this specific type of surgery.

[aigel]

That's not really fat, but it is probably overweight, unless you are very athletic / weight lifter. I would definitely try to get to 160 and see if that helps. Yes, you'll be skinny then, but it beats elective surgery IMHO. I have a buddy with several bad disks and weight makes a big difference for him. He carries most of it in a beer gut, so that seems to take the spine out of balance really badly. As soon as he is down to fighting weight, he feels a lot better.

G

[tsutton948]

Have you had a EMG? If you don't have hard neurological findings there is no reason to have a fusion. Unless you have an unstable spondylolisthesis.

[Paul K]

Originally Posted by aigel

That's not really fat, but it is probably overweight, unless you are very athletic / weight lifter. I would definitely try to get to 160 and see if that helps. Yes, you'll be skinny then, but it beats elective surgery IMHO. I have a buddy with several bad disks and weight makes a big difference for him. He carries most of it in a beer gut, so that seems to take the spine out of balance really badly. As soon as he is down to fighting weight, he feels a lot better.

G

I'll try that.

Originally Posted by tsutton948

Have you had a EMG? If you don't have hard neurological findings there is no reason to have a fusion. Unless you have an unstable spondylolisthesis.

Yes, I also have a spondylolisthesis. Not sure if it's unstable or not. And part of one vertebra is broken.

[tsutton948]

A flexion extension xray should tell if the segment is unstable. Do you get pain below the knee?

[Vipergrün]

I've had surgery twice. First lasted 10 years, second still going (knock on wood). I would not hesitate another. I tried PT, injections, etc. Surgery was immediate relief both times.

I have been doing a lot of core stuff with bootcamp workouts. A strong core is the key to less back issues.

Have you tried inversion therapy? We bought an inversion table. Really like it.

[M.D. Holloway]

Originally Posted by Chocaholic

This is wrong...or at least based on 20 year old information.

nope, in the past year. My brother in-law, father in-law and neighbor. Maybe you have access to a better doc but these folks regret it. They were told there was no other choice. Not saying there is but I'm just going off people I know that have gone under the knife is all.

[Craig T]

LIke many have said, everybody is different. A 5mm herniation can cause severe pain in some where others have 10mm and don't even know it.

I had a similar issue with my neck without much problem. I'd lift wrong and have pain for a few days, then it would calm down, but a mountain bike fall caused one of the herniated disc to swell. That put me where it sounds like you are now….so I had the cadaver bone fixation fusion.

It took several months of post op physical therapy, but I had a 100% recovery. I have ZERO neck or back pain, I'm racing cars, paddle boards, hard mountain biking, all with no issues.

[MJHanna]

There will be a point that you cannot continue to live with the pain, your pain meds no longer work and you don't want to be a druggie cuz you have to work for a living. When I was told that they wanted to cut me in the front move everything over to get to the damaged area, then flip me over and cut my back I told them to go f themselves. I did all the things you have been doing until I did not care anymore about what they were going to do. When I could not function anymore doing what I wanted to be able to do I had the surgery. I had a fence post that needed to be replaced and I knew that to dig the old post out with the concrete would be so painful that I would not even “try” to attempt the repair. That was my turning point. When I had to pay someone to do tasks that would be on my “normal I can to this project “
Try Pilates it helps strengthen the core. After I had the surgery I ask my neurosurgeon what I could do help get my core back and he said “Pilates” I said ummm what else, he said “Pilates”. I have been doing it for over 4 + years and it helps me more than the Physical therapy. The surgery worked for me for about 3+ years, I knew (was told that the vertebra above it could also degenerate in 5 -10 years.) I did not get that may years… But after I had it done I took nothing no ibuprofen nothing … for 3 years. I’m having issues now with the vertebra above and below the fusion and will not undergo the surgery again until till I can’t stand it. I’ll know when and it’s not right now. Sorry if this is not a direct answer but it’s an individual problem that only you can answer.

[tadink]

I had surgery in 2001 for L5-S1 bulge - they did a partial discectomy (SP?) and i've been great ever since!

Get in shape FIRST - it will help everything, even if you don't elect to proceed with the surgery. Get to a PT that knows about backs and can run you thru the exercises that won't do MORE damage, DO NOT JUST ASSUME THAT CRUNCHES ARE THE WAY TO GO!!

There are specific AB exercises that will strengthen and tone, and then if you do the surgery you will be stable POST-knife, and not re-injure yourself....or do more damage.

FIND THE BEST DOC YOU CAN - they are not all created equal. My guy works at the SF Spine Center, where botched surgeries go to get fixed. I can give you a referral if you need one -

And, while you are shopping around, remember that the neuro guys like to do neuro surgery, and the ortho-guys like to do ortho-surgery.....you are looking for the one that thinks surgery is the LAST result, not some cut-happy gungho surgeon!!!

I know your pain, and it is not fun.....hang in there and keep looking for the right option for your situation!

best wishes

td