1. Community
  2. Brain and nerves
  3. Spinal Problems

L5 s1 spinal spondylosis and stenosis along with sciatica questions about surgery when to have it

Posted , 3 users are following.

lindsey85506
lindsey85506

I I am a 36 year-old mother of three I had my oldest that 18 middle at 21 third one at 23 I was an active child in dance and figure skating I have had this issue since my first pregnancyI have done physical physical therapy chiropractic different kind of massage therapies all through the years I have worked out cotton shape none of it seems to matter that always comes back I have done some research and it says that stenosis is non-progressive it's caused by degenerative changes and it gets worse over time my surgeon today told me that it could get better... it also says it becomes to the point where there's pain in the legs that it becomes unbearable to walk short distances and that is where I'm at they are suggesting a pain relieving device for my spine inserting small wires into my nerves to tell my brain it's not in pain I'm kind of wondering if anyone has used one of these if it works or if it will be a waste of my time and what are my downfalls of surgery in my years to come and the success rate that people have had

0 likes, 10 replies

10 Replies

  • Alayna
    Alayna lindsey85506

    Posted

    I have a spinal cord stimulator implant and love it. It has reduced my pain by 80% and I no longer have to rely on pain meds.

  • CHICO_MARX
    CHICO_MARX lindsey85506

    Posted

    "...pain in the legs that it becomes unbearable to walk short distances ..."

    Yup. Had this 8 months after a knee replacement. Chiropractic, PT and pain shots didn't work. My neurosurgeon did a CT/Myelogram with contrast to definitively diagnose bi-lateral foraminal stenosis at L1/L2. This is where the vertebrae get too close together, narrowing the foraminal canals that allow nerve roots to pass from the spinal column out to the rest of the body thereby pinching the nerves and causing the problem.

    He recommended a Lateral Lumbar Interbody Fusion (LLIF or XLIF or OLIF...basically the same with slight differences). Docs go in from your side, drill out the disk and insert a device that acts like a car jack. They insert an actual Allen wrench to expand the device to the desired spacing and then close. For mine, it was immediate and complete relief, one night in the hospital, no brace, no rehab. Again, for me, it was a miracle op...waaaaay better than my previous L3 through S1 TLIF (rails and screws) that had me in the hospital for 12 days plus 4 months of outpatient rehab 3X/week and 6 months in a brace. Don't want to do that again.

    To do this, you'll need a neurosurgeon experienced in the technique plus a general surgeon to do the open and close. The neuro will recommend one that he/she's teamed up with for a while and works well with together. If a neuro says they'll go in from your spine, question: "Why not an XLIF?" If there's no good medical reason, see another doc. A second opinion is very helpful. Make sure doc #2 does the XLIF.

    For a great animation of the procedure, search YouTube for "Globus LLIF Technique" and then "Globus ELSA" to see the device itself in action. This is a picture of mine...you can see the rails of the TLIF right below it. Good luck.

    Oh...for the sciatica, check another of my links...

    Sciatica

    You don't EVER have to live with the pain when there are solutions available...

    image

    • lindsey85506
      lindsey85506 CHICO_MARX

      Posted

      this this would be on my l5 s1 so it sounds like that one is pretty bad

  • Seafarer123
    Seafarer123 lindsey85506

    Posted

    Hi Lindsey,

    So sorry to hear you are having such pain, especially at such a young age. I've had experience in this area (as a patient not as a medical professional) so let me share some thoughts:

    First - the kind of surgery you are likely to have (I presume an L5/S1 decompression surgery, which I have had) can generally be done in a minimally invasive way. I was home in 24 hours and back at work in 3-4 days. It doesn't work right away (although due to the anesthetic, you will have a "glory week" right after the surgery in which you will think you are Superman), you will need to be disciplined about going to physical therapy after the surgery. The surgical site will hurt for a number of weeks (after the glory week wears off), as nerves, flesh and muscles re-attach. But typically the majority of people get relief from that kind of surgery. The bad news is that the majority of people, after about 5 years, have a repeat of the symptoms that drove them to the surgery in the first place - either a repeat of the previous condition or the onset of new spinal problems, such as continued degeneration and/or spinal arthritis. But for me, having about 4 years of relief was worth it, even though my condition eventually worsened again.

    Second, let me discuss the electrical device you mentioned - it is called a "spinal cord stimulator (SCS)." I've had one inside me for about a year and a half. It's not a panacea and it doesn't always work for everyone but like Alayna below, I have used mine to great advantage. It has allowed me to cut my pain meds down to about 1/3 of what I was taking before, and I am in less pain. But I am not pain-free, nor am I completely off my pain meds - so don't think of it as a cure-all, it generally is not. Also, for about 30% of people who get an SCS (and I am one of them), they suffer from what the SCS maker calls "over-stimulation." Us folks who have that issue just tend to be a little over-sensitive to the electrical stimulation that pulses through our bodies night and day and eventually it can cause your nerves and muscles to react negatively - you have the sensation of new pain (or sometimes it amplifies your existing pain). This can be very frustrating and often very difficult to figure out whether it is due to the SCS device or from other sources (like straining yourself, or illness). The good news, though, is that the over-stimulation can be eliminated simply by turning the device off (or at least turning the power down) and leaving it off/down for a few hours or days, at which point you can power it back up again. Also, the SCS companies have literally thousands of programs they can try on you and hopefully one of them will work but not cause over-stimulation (or hopefully you are one of the 70% of patients who don't suffer over-stimulation at all). The other benefit of the SCS that few other treatments offer is a "trial version." They can "partially implant" the SCS in you for a week (the wires go in your spine but the battery/computer remains outside your body for a week or ten days). It gives you an opportunity to see whether the SCS will work for you and also to see whether you are vulnerable to over-stimulation. If it fails they remove the wires (very easy, no anesthetic needed), or if it seems to work, they leave the wires in and then implant the battery/computer in you (usually in your butt cheek) and then you have it permanently. Few other procedures offer you this kind of "trial run" which can be really helpful.

    The last thing I would say is this - a decompression surgery can help, and so to can an SCS implantation. But they both involve surgery and, in the case of decompression surgery, a moderately long period of healing. And as my general doctor said to me many years ago - be careful of back surgery: in my experience with my patients, back surgery just leads, eventually, to more back surgery and worse. This has been very true in my experience. So my advice about these two surgical procedures is: they can be beneficial, and maybe you should do them, but try EVERYTHING ELSE first, and leave them as a last resort. Try pain meds (don't be all judgmental about pain meds - take them if they work); try epidural injections and/or nerve blocks; ask your doctor about something called a "radio-frequency ablation," which is not a permanent procedure but can give you sustained relief for 6 to 12 months. Also try ultrasound, TENS therapy, traction, etc. And of course the simpler solutions - lose weight and do lots of physical therapy - should never be forgotten. And if eventually they all still fail and life is just not pleasant despite trying ALL of these more conservative treatments, only THEN consider surgery or an SCS...

    Good luck and let us know what happens...

    • lindsey85506
      lindsey85506 Seafarer123

      Posted

      so so the spinal unit that you have installed that was after the surgery? I have an MRI from 10 years ago that shows more degenerative spinal stenosis and I've been dealing with this issue for 14 years do you think the spinal implant is a good first option I was worried about it may be damaging the nerves more because I've also been told once a nerve is damaged it will always be damaged

    • Seafarer123
      Seafarer123 lindsey85506

      Posted

      Hi Lindsey,

      All good questions, let me give you my thoughts...

      First, my lumbar decompression surgery was in May 2010, and my permanent implantation of the stimulator (SCS) was in June 2018 (my trial with the SCS was in March 2018 and then I chose to have it permanently implanted in June 2018).

      So I went a number of years between having the decompression surgery and then later getting the SCS. For the first 4-5 years after my decompression surgery it was actually very successful - I was virtually pain-free, and I was able to stop taking any and all pain meds. But at about year six, pain started to return. My doctors said that it wasn't the same problem that drove me to the first surgery (i.e. nerve compression), it was a new problem (called "facet joint arthritis"), which was very likely due to a combination of my degenerating discs and the fact that I had had surgery previously (something you can look up called "fail back surgery syndrome"). That new pain got worse and worse and, recently, has started to include a return of the nerve compression issue that drove me to my get my surgery in 2010.

      I was told by my doctors that, unlike with nerve compression, there was no easy surgical solution for the spinal arthritis. Potentially a more complex spinal fusion might have helped, but that to me is a big deal and I was trying to avoid it. So I tried spinal injections and pain meds for a while (which I had also used to forestall the 2010 surgery as long as I could), but they stopped working against the arthritis pain eventually. So I was down to two choices at that point: a radio frequency ablation or a spinal cord stimulator. I chose the SCS because I was told that the SCS could help BOTH the pain from the arthritis and the sciatic pain from the re-emergence of nerve compression.

      *

      So hopefully that explains my chronology and my thinking along the way, which you asked about. Now as to your next issue - should you get the SCS prior to any back surgery or perhaps in place of a back surgery. Based on all the doctors I talked to about the SCS, they were pretty insistent that the choice of an SCS should be after all other treatments (including decompression surgery) had been tried and had eventually failed. It should be a treatment of last resort. It's particularly important to have the back surgery first because all the SCS does is mask the pain and mask the ongoing (and perhaps worsening) nerve damage caused by the compression of either stenosis or disc bulging/herniation. If you mask it (with the SCS) the damage could get worse.

      *

      As for your comment about nerve damage being permanent (and also whether the SCS causes nerve damage), let me say two things - first, I don't believe the SCS causes ANY nerve damage in and of itself. It is simply CONFUSING the signals that your nerves are trying to send to your brain (messages of pain), but it is not harming the nerve, certainly not in the way that stenosis or disc herniation damages your nerves. The SCS gives off very minor levels of electrical stimulation, nothing that would destroy any nerve. Again, that's why you want the surgery first before the SCS - if the surgery can be corrective then you want the correction first. Only afterwards, if something arises that CAN'T be corrected do you want the SCS, because then the SCS can itself try to mask the pain that is irreversible and can't be corrected.

      As for the issue of whether nerve damage can be corrected. I encourage you to talk to a neurosurgeon about this and not to take my advice as a certainty, because I'm not a medical professional. But from what I understand, peripheral nerves (the nerves down your legs and arms) can actually be repaired or regrown. Only your spinal nerve, if damaged, can't repair itself. So what the corrective surgeries do is they relieve what is causing the nerve damage (the compression) and either allow the nerve to heal or allow new nerve pathways to form (new peripheral nerves grow at the rate of about an inch per month, so it can take a couple of years for new nerve pathways to reach far down your leg).

      But it's also the case that some peripheral nerves can be damaged beyond repair, and even though new pathways can form, the permanently damaged nerves can continue to cause pain. Several doctors have told me that you have a window of about 1-3 months to get the nerve compression repaired, otherwise the numbness and/or pain can be permanent. That's why eventually, if you don't get things looked at fast enough, surgery can no longer do any good and you might want to consider the SCS. Doctors call this nerve "renervation vs. denervation," meaning new nerves growing vs. other nerves dying. There is actually a test for this they can give you, called a "Nerve Conduction Study," which you should ask to have done - it can help tell you how urgent surgery might be, vs. whether it is time for the SCS.

      Hope that all helped. Be sure you have the right specialist for all this. Pain management doctors can be helpful, but for issues regarding surgery to correct nerve impingement and damage, you really want to go see a neurosurgeon.

    • lindsey85506
      lindsey85506 Seafarer123

      Posted

      that that is a very good point that I didn't think about as of now my significant other had had a similar issue and his nerves were unable to be fixed because he waited too long

    • lindsey85506
      lindsey85506

      Posted

      and and also they're wanting to do a lumbar fusion at my l5 s1 if I was to get surgery

    • lindsey85506
      lindsey85506 Seafarer123

      Posted

      yes yes I'm currently waiting for a second opinion from from another neurosurgeon my appointment isn't till the February 2nd so I'm trying to inform myself and get others opinions as much as I can before I go in there

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.