Sciatica Surgery success rates

Where did you have it done? Most surgeons try to put you off spinal surgery for stenosis.

Hit me last October/November...x-ray was unclear...MRI showed the problem.  To confirm, my neuro did a CT/Myelogram with contrast (the "gold standard" spine test) in January and his partner injected some pain meds directly into L2/L3 to make absolutely sure in February.  Those meds don't really work on me but I did get a few days of relief.  The options were: remove all my L3 through S1 TLIF hardware and re-fuse me L2 through S1 (10 days in the hospital, 6 months of rehab)...or...the LLIF (pictures...posterior and lateral) with an overnight stay and zero rehab.

This was a no-brainer choice...did the op in March.  My guy is from the Fort Worth Brain and Spine Institute (Texas, USA)...saved my wife's life from a brain aneurysm 7+ years ago.  Trust him completely.  Understand that I have a metal hip and a metal knee plus the TLIF and LLIF spine hardware...after 45+ years of playing hockey, the bill eventually comes due.  Now I'm the TSA's worst nightmare at the airport!!!

To make a claim like that, you need to give us some peer review references.  NIH, AMA, papers published by verified sources only.  Where do you get 89% and "damage to the Sciatic nerve is cured with ONLY persistence" when mine was caused by a bone spur and totally cured by surgery?  If you're going to make those claims, you need to tell us the source of your data...else your numbers and claims are meaningless.

PS: You're up against a statistician.  Quote your sources.

I'm in Brazil and as I've read you've had a number of surgeries and after one surgery another problem comes up. Much of what people suffer Orthopedically is caused by weak muscles, lack of exercise, sedentary way of life, or an accumulation of accidents , bad posture and ignoring the first signs. I'm in Brazil, Rio De Janeiro where we have excelent surgeons, Specialists. Unfortunately the Spine Surgeon doesn't deal with Hips. They are all highly specialised . I went to the States where there is a whole department dedicated to what they cal FSS. Failed spinal surgeries. All you have to do is Google Spinal Surgery and you'll see that the great majority of indications for surgery are misplaced. I'm currently doing a course in Feldenkrais Therapy which cured Ben Gurion of his Sciatica and there is a photo of him standing on his head at the age of 71 after he had cured his pain. Pope Franscis has Scaitica and also has NOT operated. He does exercises. There is a dispositive which wone the prize for best invention of 2015 called Quell, it's a band that you strap below the knee, it uses electrodes and is sold on Amazon, it interferes with the peripheral nerve system and thousands have found relief from chronic pain. I've got one , but I'm not doing very well with it so far. I believe you have to use it regularly for it to work 100%. I thought that it would get me moving more so I'd walk more and be able to do more exercise.The thought of haveing screws and bolts in my spine doesn't please me and I have a G.P who looks after my health and he's got me off all the chemical drugs that are prescibed by Orthopedists, although the best ones don't like them either.  I suppose I could go digging into Google to support my statment. But then so could you, but I believe you're not in such good shape after your operations either.....Anyway nice that you care!  

I have already asked for 2nd opinion..

in 2012 I had an cervical ACDF in 2012 for a compression of the spinal cord in my neck due to stenosis the neurosurgeon who did the operation was brilliant, he actually said my neck was he worst he had ever seen as well as the spur compressing the cord all the other vertebra in my neck was badly worn so I need internal fixtures [plates and screws to stabilise my neck] I was terrified before the surgery but it was a complete success I made a quick recovery & I have nearly full movement back in my neck & no pain,  I have not had any problems with my neck since . the surgeon I have been with recently is not the same one & as said previously he tried his best to talk me out of the surgery...so I have now asked the previous surgeon who did my neck op' if he will do the surgery, I do know from the their stats that the one who operated on my neck specialises in complex spinal surgery so this to him should be a breeze, the other surgeon is just general spine & has now given me no confidence at all in allowing him to do it.

The sciatica I have is caused by stenosis of the lumber spine. I have to wait now for a yes or a no from the other guy  , if I get a no I don't what I will do, this leg & buttock pain is driving me nuts & it is at its worst when I first get up in the morning or if I have been sat for a long while the pain kicks in as soon as I stand up, bending also gives me nasty shock. in short No Quality of Life

You may want to look into the LLIF for L5/S1 as I described above.

Hi I am not as familiar as you with all this terminology . I am in the UK so have to rely on the NHS & I know from other experiences that cost of surgery is a huge factor especially if the condition is not life threatening...from the MRI scans I have had they say my problem is with the facet joint areas at L5/S1 & L4/5.

The consultant I have been seeing has done facet joint injections & then 8 weeks a nerve block which only lasted 24 hours.. as said previously this consultant has tried talking me out of having surgery, but my condition has deteriorated over many years to the point where I cant cope with it any longer.

I have both hips replaced the 1st 15 years ago & that is now ready for doing again so I need to get back sorted out first, the 2nd hip op' last year 

OK...English...

From what I understand, you have a definitive diagnosis (facet joints) and have tried all the therapies available without success...or have you?  I have done both chiropractic and acupuncture from time to time and have had success when the problem does not require a surgical fix.  I've had spinal injections plus cortisone in various locations...neither worked for me either.  PT, posture correction (brace), heat, lifestyle changes and anti-inflammatories are ALL non-surgical treatments for facet joint problems and may very well work for many people.  These are options you may have already tried but they also never worked for me when the problem required a true surgical fix (ex: my L4 bone spur).  Your untreated pain can ruin your life, so if these haven't worked for you, then you need to look further.

If the doc is sure of the diagnosis and the only real fix is surgical then that's your path.  I would talk to the consultant and ask what he/she recommends when all other therapies have failed.  What would they do if this was THEIR spine?  They are obligated to treat your pain...not just let you suffer for years.  Long-term pain meds are not the real answer either.  If your quality of life has deteriorated to the point where you cannot live or work without pain then it would seem that they have to address this.  (I'm in the US so I don't know about UK healthcare rules.)

The next step is some kind of surgery and should only be used when all other treatments have failed.

If you need surgery, one possible fix is a Laminectomy.. This surgery creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.  Your question to the consultant is whether or not this procedure can be used to correct your facet joint problem.  I don't know that answer.  If it will work, then it's a simple same-day procedure with no real lasting adverse effects.  Had one...worked great. 

If a laminectomy is NOT the correct solution for facet joints, then the fix could very well be a fusion.  There are two types:

- TLIF (Transforaminal Lumbar Interbody Fusion):  This is the "traditional" fusion where the docs go in from your back and use spacers, rails and screws to fuse the vertebrae. (See the first "blue-ish" picture...that's my L3-S1 fusion).  Hospital stay, brace, rehab.  This is a BIG surgery not to be taken lightly.

- LLIF (Lateral Lumbar Interbody Fusion):  This is the one where the docs go in from your SIDE and insert a device between your vertebrae replacing the disc.  This can be done for one or two discs in the same operation.  Fast, overnight stay, no brace, no rehab.  Magic. (Second picture is my LLIF at L2/L3.)

So those are your surgical options...although there may be other procedures I'm unaware of.  I've had all three so that's from my experience.

Recommendations:

1. Do the research...educate yourself...take full control of your situation.  Once you have the knowledge, you are in a better situation to make good choices instead of being at the mercy of "the system".

2. You have to use your "quality of life" card to get the help you need.  Very powerful tool.  Put the consultant in your situation.  Turn the tables and get what you need.

3. Make sure you have exhausted ALL other therapies before discussing surgery.  That will leave the consultant with no other choices.

4. Anyone who claims that ALL spine problems can be fixed with just exercise when some cases absolutely require a surgical fix (ex: my bone spur) is completely, unequivocally delusional.  I will bet that if they were in your shoes and exercise alone didn't solve their problem leaving them in constant pain and destroying their life, they'd be at a neurosurgeon's door in a heartbeat.

Surgery is NOT to be taken lightly, so make sure you have not only tried all the other treatments but have given them a chance...the time...to make a difference.  I've had lots of sciatica episodes over the years.  Depending on the trigger, some were fixed in minutes, others over the course of 4-6 weeks.  If you have truly given these other treatments a good chance to work and they have not, then that's more ammunition on your side.

Good luck with this.  Remember that you have to put your pain aside and take control of your own health.  No one else will do it for you.

I fully agree with you I am attempting to make someone see that my quality of life is poor and chronic pain my permanent partner!

i am driving my wife crazy as I'm always search online for suitable solutions, firstly non surgical of which I've exhausted all non-surgical options. So my answer to Greebo64 and anyone in our position is to fight for the treatment you need if possible solution is available and I wish you all the best in your personal pain journey's.

Hi again Chico

The consultant I have been seeing has expertise In general spine only, he advised me "if he was me" he would go for other alternatives, chiro', acupuncture, etc before surgery, he also went onto to say if I pushed for the surgery there would be no further negotiations after the surgery [I don't know what he meant by this]

he also did not explain what kind of surgery he proposed. the consultant I am going to ask for 2nd opinion is the one who did the ACDF in 2012 & as mentioned previously he specialises in complex spinal surgery, I have no problems since.. however I have not mentioned previously that in 2012 I saw 3 different consultants, the 1st & 2nd offered surgery that was wrong for my condition, from doing my own research I had the feeling that they were not right & so asked for a 3rd opinion the 3rd consultant told me that I had done absolutely right & that if I had had the surgery proposed by the 2 previous consultants I would have finished up worse off than if I had no surgery & my neck would be unstable, he went onto to say that the surgery they were offering was a quick fix surgery that would take around 1 hour basically to remove the spur & a coupe of vertebra but no internal strengthening , he then told me then what I needed was far more complexed  surgery including internal fixings [see images] & the surgery would take nearer 4 hours, he then arranged an MDT before the actual surgery to confirm with other colleagues what needed to be done. the images below show the end result.

The difference between the neck condition & the condition I have now in my lower back  is that if I had not had the ACDF op' I would have finished up in a wheel chair.

You fought for your first surgery and stayed out of that wheelchair...time to put on the gloves again and jump back into the ring.  I'm not a doc so I don't know for sure what the right fix is for you...but someone over there does.  Your job now is to find him/her.  And find out what that "negotiations" crap is all about...

Hi

I had surgery this year august on L4/5

After having no life for a year

It was a success to be able to sit and stand no pain ,drive my car after not being able to for a year ..

Then 5 week into it I woke up omg noooo it was back again agony nno sleep can't sit Wen I try to get up it's like someone has locked my hips my feet and ankles have began to swell again ,I have scan Friday I can't believe this has happened to me again I have been house bound for a year then to have 5 weeks of bliss to go out and drive and see people back to a recluse I feel rock bottom I'm like you driving everyone nuts trying to find answers I'm also on the UK ..but like I tell people if I could do this and that I would I'm not wanting to be this way ,I think you have to suffer to understand x

Hi Sorry to hear your surgery has not fixed the problem... I think this is why the consultant I am with now [not the one who fixed my neck] does not recommend surgery & is basically also saying if you go ahead & it does not work to come back for further negotiations 

BUT I think like Chico says it is getting the "right neurosurgeon" to do the "right kind of surgery"...up to now I don't know what kind of surgery he is proposing, the one thing I do know is I wont be having this current consultant to be doing anything, I am waiting for a email from the secretary to see what he has wrote up, but I will be requesting a 2nd opinion from the consultant who fixed my neck...

Right now 7 weeks on after suffering terrible pain it as now eased off a lot however I am still getting some sharp sciatic pain in my buttocks and top/rear thigh region especially when standing after being sat down for a long while also when I get out of bed in the morning, bending down & then straightening up can give me a kick in the back of my legs.. if I keep on my feet & walking around I get very little pain [only certain movements give me a kick], also no pain when I am sat down or laid in bed...but all in all it has improved a lot...I will keep you posted when I eventually get the 2nd opinion.

Thanks to all who have replied 

Hi Chico

just thought I would let you the neurosurgeon who I recently seen [the one I am not keen on] has proposed a " BILATERAL / LATERAL RECESS DECOMPRESSION & BILATERAL INTERLAMINAR DECOMPRESSION "..,.BUT in his letter to my GP [a copy to myself] he goes on about not guaranteeing a good outcome, he says the operation will do nothing for my lower back pain & it could make my leg pain worse...How can anyone go ahead with surgery when this is the surgeon has no confidence of any success.. ....however he seems keen to get on with it as I have already got the papers for the operation next month...but not a chance....yet

in the letter to my GP he again recommends pain management which I have been through before [3 months of it several years ago] a waist of time & no improvement, also to lose weight & exercise [ I am 6ft / 16 stone ] not fat at all just a little bit of a belly, but I am 66 years old, 

I am not excepting anything or any operation until I have had the 2nd opinion which is also set for next month.

I would like to know is your opinion on the proposed detailed procedure mentioned above ?

Perfect.  You need to see someone else.  Also, do the research into those conditions and see what procedures get the best results.  I know of laminectomies plus TLIF and LLIF fusions.  Each do different things for different problems.  You need to educate yourself on what the correct procedure is for your situation.  You cannot accept a doctor telling you that you have to live in pain the rest of your life.  NOT acceptable.  Let us know what happens.

Hi again.

I am really not sure how I can educate myself anymore than I already have, if I cant rely on a Neurosurgeon to offer the best surgery for my condition then who can I rely on ? When I had the ACDF in 2012 there were no negativity at all the surgeon who did the operation did not mention anything going wrong other than  the usual surgery risks, I was lucky in that I asked for 3 different opinions & its a good job I did as I mentioned before if I had had the 2 previous consultants to do the op' I would have been much worse off.... the consultant who I am now having a 2nd opinion from next month is the one who eventually did the successful cervical surgery, but I am not sure what he will make of this now.

Quote: TLIF and LLIF fusions.  Each do different things for different problems ...are these what the consultant proposed & I would I know which was the best for me .

BILATERAL / LATERAL RECESS DECOMPRESSION & BILATERAL INTERLAMINAR DECOMPRESSION "

I don't know which is best for your condition.  I do know that the LLIF can be used for one or two-level issues...If you need three or more fused at one time, then it's the TLIF.  I just don't know if a laminectomy or a fusion or something else is indicated for your situation.

Also, a surgeon might recommend a certain procedure simply because he's not trained in or has little experience in or is uncomfortable doing a different procedure that might be a better solution for you.  All docs have their biases...don't get caught in that trap.

Example:  The doc says you need a 2-level fusion.  You educate yourself in both the TLIF and LLIF methods.  He recommends the TLIF...you say: "Why not an LLIF?  Same fusion, faster op, less hospital stay, no brace or rehab.  Why not that procedure?"  What does he say next?

If he says: "What's an LLIF?", you get up and leave.  The doc MUST give you a reason for why he's choosing a certain procedure instead of another.  That's why you have to know your options.  It all starts with: "What is the recommended procedure for my diagnosis?" and "What, if any, other options exist?" and "What are the success rates for the different options?"  You have to know this stuff to get to the right doctor.

When  I Google your diagnosis, I keep seeing "decompressive lumbar laminectomy" and nothing about a fusion.  I had one of these at L4-S1; same day...walked out...pain gone.  Also see some references to "microdiscectomy"...don't know what that is.  If a simple laminectomy is the solution, this is a same-day, no-brainer op.  If there's stenosis involved and the laminectomy will not to the whole job, then a 1 or 2-level LLIF is possible.  My L2/L3 LLIF cured my stenosis in one day.

Hi Chico

The injections I had a few weeks ago was for L5/S1 L4/5, but regarding the surgery he did not mention anything about fusion.

I have googled.. Bilateral  Lateral Recess  Decompression & Bilateral Interlaminal Decompression " & it does not mention fusion. on the internet & youtube the info is about all this is mind blowing. I think I will now have to wait to see what comes out of the 2nd opinion, the appointment is for the 14th November.

My pain at the moment is brought on more when I first get out of bed in the morning or when I have been sat down for an couple of hours [when watching TV etc] when I get up the pain is in both buttocks & goes into the top of my thighs but once I get moving around & walking the pain eases off...it is at its worse at the end of the day & in the evening...but when I am sat down or laid down I don't get any pain at all, i only get it when I get back up on my feet.

I will keep you posted

Thanks !

 

It sounds like a laminectomy is the recommended procedure.  Google that and read all about it so you know what's going on.  Ask the doc if the laminectomy is what will fix you up.  Worked for me in the exact same location about 5 years ago.  Give the irritated nerves a week to calm down after surgery.  After that, for me, it was like it never happened.  100% success.

I have googled the procedure that was proposed for me "BILATERAL / LATERAL RECESS DECOMPRESSION & BILATERAL INTERLAMINAR DECOMPRESSION " there is a lot iof info about theses different methods, it also says that this procedure is more effective if it is also stabilised [fused] , I had already asked the consultant that question at my last meeting & he said no it would not be fused or screwed, but from what I have read if its not stabilised then it can slip again....any thoughts on this ?

I had my decompressive laminectomy at L4/L5 and L5/S1 three years before my fusion.  Never felt anything wrong.

Chico

Regarding your last post above, why did you need a Fusion if the surgery went well ?

The Laminectomy was necessary for a bone spur crushing my sciatic nerve root at L4.  Completely different problem than the disk degeneration and other issues necessitating the L3-S1 fusion years later.

You have really  gone through the mill my friend...are you all fixed & pain free now....I would hope so..

At almost 70, it's not like being half that age.  Recovery is slower and the fusions carry restrictions.  At least all that previous pain is gone.

Nice to know the pain has gone.

I am 67 years old in December, I just hope that I can get rid of my pain, I don't expect to be able to do all that I could do when I was in my 30's I just have to get rid of this debilitating pain.

I am Not having much luck with consultants as mentioned previously I asked for a 2nd opinion but only got the feeling of being fobbed off, after doing loads of my own research I believe the surgery i need that gives the best success for the long term is a decompression / laminectomy but with stabilisation using bone graft to fuse also screws & rods to keep the position of the spine stable, this is the only way to stop future slippage. this is not only the most effective but also expensive, hence my problem with the NHS. if you pay private or you are in the USA with medical insurance cover then its not a problem ,but anyone in the UK would have to be on their death bed to get any expensive treatment. in the UK They would rather do a much less expensive procedure even though they know that there is a good chance it could make the pain worse, they have offered me a "bilateral decompression / laminectomy" but not fusion to stabilise my spine...the consultant actually said to me this could make the pain worse & its success rate is not good, & if he was me he would not have the surgery, he went onto to say that If I went for this procedure & it did not work out that there would be no further discussions after, in other words if the pain returned & was worse than before there would be no further treatment  ...I found his comments unbelievable & I have told him and his colleagues what I think, I have also complained to my GP...but I am not holding my breath

Quote from !Mayfield "Spine & Brain" 

spinal fusion may be done at the same time to help stabilize sections of the spine treated with laminectomy. Fusion uses a combination of bone graft, screws, and rods to connect two separate vertebrae together into one new piece of bone. Fusing the joint prevents the spinal stenosis from recurring and can help eliminate pain from an unstable spine.

https://patient.info/forums/discuss/sciatica-surgery-success-rates-617211

I have two fusions but the op to fix my sciatic problem (before any fusions) was a simple laminectomy/decompression.  Then again, your spine is seemingly different if the doc is looking at stabilization.  I will tell you that I had a TLIF of L3 through S1 and an LLIF at L2/L3.  Both were very successful although my restrictions on bending are tough.

Hi Chico

An update on my position with the consultants, I saw the surgeon 2 weeks the one who did my ACDF in 2012 for the 2nd opinion, I had the feeling he he did not want to see me I felt really uncomfortable during the appointment, but he did say that if I was to have surgery it would NOT be what the previous Doc' wanted to do which was bilateral decom' / laminectomy with no fusion. he said I would need bone graft & fusion with pedicle rods a screws etc, but he then said he wanted to x-rays of me stood up bending backwards & then forwards to see if there was any instability, I had the x-rays & went home after, a week later a letter was sent to my GP with NO results of the x-rays, but he said in the letter because my leg pain had settled [ I don't know where he got that from] so he then suggested that I carry on with the lumber spine injections & referred me back to the previous Doc'. I wrote a letter to this consultant & a copy to the first Doc' with my concerns about the appointment & the letter to my GP, I did not get a reply, but I had a appointment with the first Doc' on Monday & I was simply being fobbed off yet again, he even suggested that the consultant who did my ACDF did not want to see me again, he even wanted to discharge me or re-refer me to another hospital in the area, but this hospital does not have any neurosurgeons it only has orthopaedic spinal surgeons "unbelievable", I refused this & i also refused to be discharged....I told him I would be willing to try physiotherapy & if that did no good I would try a chiropractor. I don't hold up much hope at all.

just a reminder of my condition, I have bilateral stenosis & sciatic pain in both legs...my left leg is the more pain full buttock & thigh area, my right its the leg buttock area also but its mainly & more consistently in my right calf.

I would love to hear your thoughts.

PS.. I also offered to pay for any surgery myself providing it was the correct procedure done by the right, but that made no difference

Consultant

 

The test you need is a CT/Myelogram with contrast.  This is the "gold standard" test for the spine.  It will lead to the correct diagnosis.  And yes...you need a neurosurgeon for this...period.

Chico,

the guy who did my ACDF in 2012 is the one who gave me the 2nd opinion this time he did talk about fusion & stabilising the spine , he is the one who does the hardware surgery he sent me for the x-rays & said he would organise an MDT, but I new when he did not want to see after for the follow up & referred me back to the Doc' who cant do the hardware that I was not getting anywhere, he suggested in the letter to my GP that I carry on with the injections...so I wrote to this consultant myself expressing my opinion, but no reply.. when I saw this doc' for the follow up he actually suggested that the other consultant did not want to see me anymore, this is obviously because I challenge his opinion he obviously did not like the letter I sent him...how arrogant is that.. but then for them to try to transfer me to a clinic that only has orthopaedic spinal surgeons is unbelievable... I obviously refused & I refused to be discharged, they have taken a dislike to me because I have my own opinions.....but going back to 2012 when I eventually had the ACDF, if I had not challenged the 2 previous consultants who both proposed inadequate surgery that would have left my neck unstable & asked for a 3rd opinion, then I would not be in a wheel chair now... so I am getting absolutely nowhere.

The other thing that shocked me in my last appointment was that the doc' said to me "this condition is not life threatening" so it has to be life threatening to get the surgery if its not then they expect me to continue to suffer the pain....UNBELIEVABLE !!!!!!!!!!

CORRECTION TO THE PREVIOUS POST TO Chico

 Wrong...> Then I would not be in a wheel chair now

 this is what it should say "Then I would Be "in a wheel chair" now" 

You seem to be trapped by a system that will not allow you the care you need. Not a great place to be.  I understand your frustration but cannot feel the physical pain and emotional agony this is putting you through.  I don't know how your system works so I have no idea if outside, positive consultations or legal maneuvering will break the cycle and get you what you need.  "Life threatening" is not a requirement for back surgery here in the US.  Are there any advocacy groups over there whose members have run into similar situations?  What did they do?  Maybe a chorus is better than a single voice in this situation.

Again, I have no idea what the "rules" are over there and how to break through the red tape.  Your attempts at direct confrontation have hit a bureaucratic stone wall regardless of the intellectual justifications of your argument.  I would try and find people who have been in your situation and got around it.  May a new post with a UK-specific title will get you the responses you need.  I'd give that a try.  Wish I could help but the inner workings of your healthcare system and your path to relief are beyond my knowledge.

One thing I wish for you is a very Merry Christmas.  For one day, put this aside and feel the love of the people closest to you.