update - any advice?

[customsoda]

I had a discogram, new mri, and a follow-up visit with an orthopaedic surgeon in London Ontario to discuss the discogram results. L4/5 was tested and is a pain generator. Due to the MRI results of L4/5 and L5/S1, he cannot do ADR (OHIP only allows Ontario surgeons to do 1 level), and stated fusion is not recommended as he feels the risk of making my pain worse is high and making the pain less is low. I have a pain clinic appointment in January.
It is clear to me that I still have major pain from L5/S1, although he seems to feel my foot pain is not from the discs. Dr. Zeegers has not contacted me by phone or e-mail. I have contacted Stenum and Bertagnoli and will be sending my MRIs and x-rays for opinion.

Who has had success with 2 level surgery in Germany and who is disappointed with the results?

[Justin]

customsoda,

I had wonderful results after my 2-level ADR (lumbar) in 11/2003. I was pain-free for 4.5 years. Recently, I have hit a bump in the road and I am not pain free. I'm still trying to find my new pain generator at this time (scar tissue, L6/S1 disc, etc.).

I was bed ridden before my ADR surgery at 23 years old, and the instant I woke up after surgery I knew that my pre-op leg pain was completely gone. It was an incredible feeling. I felt like I was a new man.

Good luck in your decision -- I know it's tough. You only get 1 spine, so do what's best for you. Keep us posted on your progress.

[soljagirl]

Facet joints have a rich nerve supply and do cause pains into feet when they become inflamed (due to loss of disc height, etc.). I believe that lumbar ADR has the potential to improve lumbar/axial (discogenic) pain, but not guaranteed to improve leg pain (facet joint, instability).

I am a little surprised that you were told that you were not a candidate for fusion after having already had a laminectomy. One ortho told me (and others) that fusion was very likely 5-10 years post laminectomy. A different ortho told me that I would not be a candidate for fusion due to the three levels and my age, but that I would be a candidate for additional laminectomies. Dr. B has met someone who has had 9 laminectomies, making him no longer a candidate for ADR.

You might consider X Stop or some other form of stabilization to hold off fusion.

I would really like someone to explain why "fusion would make pain worse". Other than the potential increase in adjacent segment disease or risk of non-fusion, fusion removes the offending disc as well as excess movement from facets. So, at least in the short term, fusion should make pain better. Also, I thought doctors were beginning to use spacers adjunct to fusion to give the nerve room.

I wish you well in your decision. I know it is a difficult one.

[annapurna]

One potential explanation is that fusion trashes the facet joints faster than anything else. If you lock a joint in place and prevent it from moving, joint nutrition is lost and the joint quickly becomes arthritic and self fuses. Fusion can avoid this by removing the facets during the fusion surgery but it might be one reason that the surgeon felt that fusion could lead to prolonged facet pain.

The other reality is that fusion is "salvage surgery" according to many surgeons. It's often done when the pains associated with fusion are so outweighed by the pains of not operating that the patient is almost guaranteed to improve. The logical extension of that approach is that most surgeons expect patients to be in a fair amount of pain even following a good fusion.

[Terry]

Originally Posted by annapurna

One potential explanation is that fusion trashes the facet joints faster than anything else. If you lock a joint in place and prevent it from moving, joint nutrition is lost and the joint quickly becomes arthritic and self fuses. Fusion can avoid this by removing the facets during the fusion surgery but it might be one reason that the surgeon felt that fusion could lead to prolonged facet pain.

The other reality is that fusion is "salvage surgery" according to many surgeons. It's often done when the pains associated with fusion are so outweighed by the pains of not operating that the patient is almost guaranteed to improve. The logical extension of that approach is that most surgeons expect patients to be in a fair amount of pain even following a good fusion.

Which is a perfect reason to not get a fusion at all costs. To settle for a good amount of pain versus a monstrous amount of pain is ridiculous.

I do have some facet and Sacroiliac Joint issues after my ADR surgery but I can walk upright where I walked with a cane and hunched over prior to my ADR surgery.

I had Sacroiliac Joint injections today so I am hopeful that this will settle down for me.

I wish you all the luck and hope that you are learning what you need to learn to go forward in your treatment.

Hang in there.

Terry Newton