Posted , 5 users are following.
Hey I'm a 28 yo VERY active person and have just been told I neee a L5 laminectomy and L5-S1 tlif. I've gone through 4 rounds of injections with no relie. Looking to see if anyone on here near my age that has had the surgery. Wondering about recovery etc.
0 likes, 12 replies
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allaroundanne Guest
Posted
Hey, I am a retired MD, I did anesthesia and pain management. You seem very young to me to be sent for surgery unless you are having significant symptoms beyond pain, ie some kind of muscle weakness, loss of bowel or bladder control, loss of sensation, those sorts of things do make doctors opt for surgery earlier in the process. You also don't mention if you have other problems with your back, like scoliosis that might be making the problem more than just a simple L5 disc. As an anesthesiologist I didn't get to see the recovery, but I understand it is a long one, as in 6-8 months. Cutting bone causes a lot of pain. You also need to understand that it's almost like virginity, once you lose it, it's gone. Failed back syndrome, ie a patient who comes to you with pain after back surgery didn't help them are a lot harder to treat than patients who have never had back surgery. I, myself, am a chronic pain patient, my spine is a mess but I protect my back from surgeons. There is a space outside of your spinal cord called the epidural space that pain management docs can use to help you by placing pain meds, steroids, anti-spasmodics and other medications into it. Once you have surgery this space gets scarred over and pain docs can no longer use it. They can't thread catherters in it and any medications they manage to get into it won't freely flow through it. I know you have tried 4 "rounds of injections". What kind of injections? Were these trigger points? Lumbar epidural steroids? Facet joint blocks? SI joint blocks? A combination of these? Who did the injections? Was it an anesthestiologist who did pain management? If not, I'd suggest you see one before you do the surgery for a consult. Perhaps your only choice is surgery, I can't tell from what you've said. But that's a big surgery and if I were only 28 I'd get a second opinion anyway.
Guest allaroundanne
Posted
Thankyou for replying. Sorry I wasn't very descriptive. First time joining one of these! I'll elaborate a little more...
I was told I have isthmic spondylolisthesisand a fracture of the pars interarticularis. This all came about after aggravating it on a rowing machine almost 2 years ago now.
I have been through PT, chiropractor, and I have had a combination of the injections, with no relief from any of them. The last one being the worst, causing throbbing pain down my leg. I do have some nerve issues, and have had a couple bouts of numbness lasting for a couple of minutes. NSAIDS and muscle relaxers do not help.
There are days where I feel ok, but the days I am in pain: I can't do anything to help eliminate it. I was told that I would need surgery eventually due to the condition. With my activity level and how healthy I am thinking it is wise to do it sooner rather than later?
allaroundanne Guest
Posted
Actually, since you are having those nerve issues, it's wise to do it now before your temporary nerve issues become permanent. You have pretty much failed conservative therapy and are at risk for some pretty serious complications should that slipped vertebrate slip even further. You really do need the fusion to stablize the whole situation. From what I read, you have a rough go of it for a good 6 months, but if you work hard with the rehab you will get back to your active self and no one will even know you had the surgery. It just takes awhile to get back to your old self. The approach they are taking from the side that is the "t" in the tlif is a less invasive approach than the older anterior approach which was more painful and had a longer recovery. All in all, you are healthy and young, you have that to your advantage, and this is something you need to do to stay that way. I wish you luck and will be thinking about you. Please write back and let me know how you did.
Lynn
CHICO_MARX Guest
Posted
Consider an LLIF. They go in from your side LATERALLY (LLIF instead of TLIF) instead of from your back. Overnight stay and zero rehab vs. a lot more. Just had mine done at L2/L3 almost four weeks ago for stenosis. Yes, there is post-op nerve pain because they have to retract all the nerve roots to insert the device. First two weeks suck but then it gets better fast. If you can't, or won't, take nerve meds (Gabapentin, Neurontin, Lyrica, etc.) because of the horrid side effects, heating pads and Aspercreme with 4% Lidocaine help. Muscle rubs have no effect; neither do opioids...it's NERVE pain!!! Should have asked for Lidocaine patches...
Need a General Surgeon to create the 12" long "tunnel" from side to spine and then the neurosurgeon does his work. Insert, expand, backfill with bone graft from your hip, close. Picture of mine is attached (it's above my L3-S1 fusion).
Search YouTube for "Globus RISE-L" for a cute animation of the procedure. Because they have to use an Allen wrench to crank it open, I have now given my neuro the honorary Brooklyn Sicilian Wiseguy nickname of "Tommy The Wrench".
Put the whole story plus updates here...
https://patient.info/forums/discuss/the-expandable-spacer-570509
Comes in parallel (the whole thing expands uniformly) and lordotic (they can control the posterior and anterior expansions separately...like my 15 mm rear / 5 mm front expansion to maintain good curvature). Give it some thought as an option to slicing open your spine. I was walking swiftly and climbing stairs within a few hours of waking up. All stenosis gone; but then the anesthesia wears off and you get the nerve pain.
I've had 3 back surgeries, a new hip and a metal knee...plus four kidney stones. For me, this was FANTASTIC. Yeah, there's post op pain but after a knee replacement, this is a cakewalk. After 45 years of hockey, ya gotta pay the price sometime. This one had its moments but, for me, very doable.
Just sayin'...
jessica_78456 Guest
Posted
I had it when I was 35 it does help but now iam needing it again and spinal fusion. Depending on the individual and there help implications once s there's a weakness always a weakness especially in my case
CHICO_MARX jessica_78456
Posted
I was fused L3 to S1 two years ago and then got stenosis in L2/L3 this past October. Solved by the LLIF. Neuro was going to fuse L4 to S1 but saw that L3 would fail within a few years so he went one higher.
A CT/Myelogram with contrast test is the "Gold Standard" for spine work. Docs can map out everything they need to do. You need that test and then a great neurosurgeon to give you a customized treatment plan. There are soooo many new technologies out there. Search for "Globus Medical" on YouTube, go to their channel and look at all the insane new devices they've invented to solve these problems. Great animations describing each one. Your doc has lots of choices to fix your exact set of problems.
This is not easy...I know...three spine ops plus metal hip and knee. Recovery is tough but worth it. Start with the CT/M and a good neuro. Make a plan...follow it. Start living a better life.
jessica_78456 CHICO_MARX
Posted
I've already got stenosis had it for yrs ,had a ct recently to do doc Got a pretty good idea . Did u benefit from fusion. Am scared I might get worse
CHICO_MARX jessica_78456
Posted
The fusion was GREAT. Solved all my problems at the time. Kicked rehab's a$$ in six weeks (doing 230-pound leg presses...and I'm only 5'9", 190 pounds). The stenosis came almost two years later...totally separate. The LLIF fixed that in one day. Just getting past the typical post-op nerve pain.
Get worse... Untreated, yes it will. Treated, there's still a chance of developing weakness above or below the fusion over time. Re-fusion, TLIF, LLIF solve that problem with the LLIF being the least problematic. One day in the hospital, zero rehab. Just the 4-6 week post op decreasing nerve pain.
Scared is not an option. You go to sleep...you wake up...you heal. Finally get your life back.
allaroundanne CHICO_MARX
Posted
That nerve pain you are feeling postoperatively is the nerve regenerating itself after it has been, shall we put it mildly, "molested" during surgery. Regeneration is a fickle thing and it doesn't always occur. You can take Vit B-6 every day for the 18 months post op that it takes for a nerve to fully regenerate but sometimes those fickle nerves just don't have what it takes to do it. And, no matter how hard you work in rehab, no matter how positive a person you are, if your nerves just don't want to regenerate, there is not a thing you can really do, other than swallow a B-6 a day to help them along. That's why even in your link it says in one part 80% of patients are helped. The other 20%, I am betting a bunch of them are those with fickle nerves. I also wonder if this fancy gizmo you've become the spokesmodel of can even be used in our original poster's case, she has her L5 vertebrae slipping off her sacrum, not like your case where one vertebrae was slipping off another. I would worry also in her case if your gizmo involves so much nerve pain and hopefully only temporary damage would that mean she'd be experiencing loss of bowel and bladder control as those are the nerves involved in that area. If it were me, I'd rather go old school surgery and not have those nerves have to undergo regeneration/nerve pain and risk permanent problems with my bowel and bladder. Yes it is more down time but it's less risky neurologically. Those particular nerves are also notoriously fickle, just ask any woman who has had more than a couple of kids! LOL You learn quickly as a young doctor not to be so hasty to recommend things as you are doing that leave 20% of patients with no pain relief and the remaining patients with a whole lot of nerve pain to deal with for a long time. No one is very happy with you for quite a long time LOL. A very inauspicious start to a career indeed.
Limelady Guest
Posted
Guest Limelady
Posted
CHICO_MARX Guest
Posted
If talk is TLIF, see what your options are for an LLIF. They go in from your side, not back. One day in the hospital, no rehab. Had mine done a month ago for L2/L3 stenosis. Once you get past the resulting decreasing nerve pain (they have to retract the nerve roots) over 4-6 weeks, you're done. Way better than my L3-S1 fusion which was 10 hospital days and a 6-month rehab. Search YouTube for "Globus RISE-L"...cute animation.