Severe spinal stenosis: Would you do surgery?

I had Vertiflex L3&4, L4&5 on Nov 22. Still lots of pain walking, pain in rear and upper thighs. Cannot stand for more than 5 mins w/o pain. Will be 3 weeks tomorrow. I had a lot of bruising at incision site. Hoping time will resolve this but I’m losing hope. Anyone else have this? I really want to know!

I'm wondering if surgery is really warranted in my case.

The findings below are from an MRI done 1 year ago. Five years ago, I had similar findings. I declined surgery last year which was contrary to medical advice. The surgeon was somewhat exasperated.

I'm scheduled for a follow-up visit soon as I said I would consider surgery in 2023. The plan is to repeat the MRI in order to see if things have deteriorated. I don't think anything is worse than last year. I somewhat committed myself to doing surgery during Feb 2023. My follow-up is a pre-op visit for a "limited" L4-5 lumbar fusion as compared to an "extensive" multilevel lumbar fusion.

Any suggestions??? I don't want surgery at all. I only said I would consider the limited lumbar fusion. I have been diagnosed with inflammatory arthritis but things seem quiet at the moment as far as pain goes. I do have significant leg numbness and weakness with right foot drop. I don't want to rock the boat too much.

Feb 2022 Findings:
Pronounced lumbar lordosis.
Grade 1 anterolisthesis of L4 on L5. Degenerative disc disease at multiple levels most pronounced-L1-L2 and L4-L5

L5-S1: Broad-based disc bulging effacing the right exiting nerve root with bilateral facet degenerative changes bilateral foraminal narrowing without overt central spinal canal stenosis

L4-L5: Broad-based disc herniation with pronounced bilateral facet degenerative changes and severe right greater than left foraminal narrowing with effacement possible degree of compression of the right exiting nerve root. Small 3.7 cm synovial cyst arising off the medial aspect -left facet joint. Combination findings with severe central spinal canal stenosis at this level

L3-L4: Broad-based disc bulging with moderate bilateral foraminal narrowing without overt central spinal canal stenosis

L2-L3: No compressive central disc herniation and no overt central spinal canal stenosis

L1-L2: Broad-based disc herniation with inferior migration disc material in the central/right paracentral distribution with moderate right greater than left foraminal narrowing and mild central spinal canal stenosis

Conus medullaris terminates-L1-L2
Thickening-caudal nerve roots: cannot exclude history of arachnoiditis
Bilateral lumbar paraspinal muscular atrophy

Impression:
Disc herniation with severe, right greater than left, foraminal narrowing and severe central spinal canal stenosis-L4-L5
Additional lumbar spine degenerative changes from prior MRI's

@dadcue Hello, Dadcue, let me introduce myself. I am the patient who couldn't get a spine surgeon to help for a few years, and kept looking for a specialist to help me. Five of them turned me down who could have helped. My case had some confusing symptoms, so surgeons passed on me, and I feared that I would become disabled because of cervical spinal cord compression. As I see, you have a list of structural spinal problems and are exhibiting a degree of disability with drop foot and leg symptoms, and you have a surgeon willing to help who is frustrated because you deny the help they offer.

Could you explain what you mean by not wanting to "rock the boat" too much? I also see from other posts that you have been using prednisone long term for another health problem. This is something that needs to be fully disclosed to a spine surgeon because healing a fusion depends on the inflammation process to begin laying the framework to grow bone to join bones together that previously were separate.

From my perspective as a patient who was loosing the coordination of my arms, and with foot drop and walking with a limp, I knew that my future would be of advancing disability when I was older, and likely a wheelchair. I have been a caregiver to my aging parents in wheelchairs and their life was so difficult. I just can't imagine having a choice to prevent a disability, and the possibility of paralysis if a future injury should occur and not taking it.

Was I afraid? You bet. I knew I needed surgery and every morning for 4 months when I thought about it, my blood pressure shot up and my heart raced. Being caught in that trap was awful. Every time I was waiting for a new surgeon to walk into the exam room, I was really nervous, and when they were not interested in my case, I wondered what next, and I asked myself why I was doing this to myself, and being so afraid of surgeons? Fear can be overcome if that is what is holding you back. I started working on that, and I found answers that freed me from those chains, and about that time, I found a truly wonderful and gifted surgeon who changed my life and gave me back my ability to work as an artist.

I comes down to a choice between being afraid of surgery, or being afraid of the disability that will come from the advancing progression of a spine condition left untreated. I didn't want to loose what I had worked so hard for in art school and the ability to do what I loved to do. You have to ask yourself what is important in your life.

I have seen the posts of a young woman on facebook who neglected to have spine surgery. She is wheelchair bound and cannot take care of her child. She is in constant pain and has become a burden to her family who has to care for her and give up other things that they could be enjoying. Beyond that, they are broke because of her care and trying to sell possessions for money. If you cannot take care of yourself, that burden falls to someone else, a family member or a hired worker. Health insurance wouldn't cover that. If that hasn't happened to you, you may not fully understand how difficult life will be if you got to that degree of disability. I can also compare my injury of a severely broken ankle which was very disabling because of not being able to bear weight for months, and then rehab. I still have pain and weakness even 2 years later, and I think it takes a very long time to regain strength in walking. That was worse, and more painful than my spine surgery and for a much longer period of time. Of course every patient is different in how they experience spine issues and recovery.

What is different about Feb 2023? Is it a better financial or insurance situation making surgery a better option or do you feel like you are just ready to do it? Why are you limiting how many levels can be treated surgically when clearly there are other significant issues with recommendations from your surgeon?

There are many things to consider in the decision. What you need to know is what is the predicted advancement of spinal disease without intervention of everything on your MRI report. Multiple surgeries to address this later can add a lot extra cost and more scar tissue which can add to pain. What are the things that you are weighing in this decision? Have you sought a second opinion? Other surgeons may have different approaches to solving the problems. Please tell me how I can help you think about this spine condition.

Your surgeon may have an idea about when the window of opportunity is right for intervention with decompression surgery, but they don't know for sure exactly when the disability becomes permanent. There is a point of no return when nerves that are compressed simply die and dissolve. That could be damage that may happen anywhere along the pathway in the spinal cord and into nerves that service body parts.

Surgery at the lower end of the spine has a longer recovery time than my cervical fusion surgery because of bearing most of the body weight at that end, but I can tell you that the surgery with a good surgeon was worth it, and my life is better because of it.

I truly appreciate your response and feedback. I'm not afraid of doing surgery. I have had other surgeries in the past which were easy to face.

The decision to do bilateral knee replacements was easy. I was told that I would need a knee replacement at the age of 30 but I needed to wait until I was 60. I had plenty of time to prepare myself for knee replacements.

About 6 months after knee replacements, I had a microvascular decompression (MVD) surgery for trigeminal neuralgia. That was an easy decision because I had nothing to lose. The pain from trigeminal neuralgia could not possibly have been any worse than it was before the MVD surgery.

The above surgeries were all done about a year before sudden onset lumbar radiculopathy or sciatica. Surgery was called “urgent” at the time because of symptoms of leg weakness and foot drop along with the severe radiating leg pain.

The MRI that was done 5 years ago revealed the problems with my lumbar spine for the first time. I actually told the surgeon that I didn't know that I had a "bad back." I took a large dose of prednisone and the pain improved. The surgeon said surgery was risky because of prednisone. The agreement was that pain would determine whether or not to proceed with the extensive lumbar fusion. A second opinion also agreed that pain should be the deciding factor.

I have been off prednisone for several years thanks to a biologic medication that seems to control inflammation without prednisone. The neurosurgeon wants me off the biologic for the same reasons that prednisone made surgery risky. I don’t want to “rock the boat” by stopping the biologic for fear the autoimmune pain will return. The surgeon says I will be given pain medications for surgical pain but I worry about the autoimmune inflammatory pain just as much.

A bad surgical outcome is also a concern of mine. My knee replacements were complicated by extensive heterotopic ossification. An orthopedic surgeon actually advised me not to have any surgeries in the future. It isn’t clear that he meant a lumbar fusion would cause heterotopic ossification.
https://my.clevelandclinic.org/health/diseases/22596-heterotopic-ossification#:~:text=What%20is%20heterotopic%20ossification%3F,occur%20for%20no%20known%20reason.
My MVD surgery for trigeminal neuralgia also had an unexpected outcome. I think the neurosurgeon did the best he could under the circumstances. That neurosurgeon said I should ask God when I asked him what caused the problem that resulted in trigeminal neuralgia.

I realize that a lumbar fusion could be a good thing if everything went according to plan. I hope for a good outcome. However, surgery can make things worse too. I guess that is what scares me.

The "limited" lumbar fusion is the neurosurgeon's recommendation and not necessarily mine. I think the neurosurgeon was doing some negotiations to convince me to do surgery. However, it was mostly the surgeon's idea because L4-5 is the worst area.

I doubt I would ever do the alternative "extensive" lumbar surgery and I think the surgeon would refuse to do that.

I just need to hear about the positives because things can certainly be worse and I would rather not think about that.

Thanks again for your response. This surgery has been weighing on me for five years. I think it might be time to do it just to see what will happen.

No surgery unless absolutely necessary, especially if you have no pain or even a little pain. There are exercises that help if you wish to see a physiotherapist.
I am a RN and have seen many people go through needless surgeries and are worse than before the surgery. If surgery is necessary find the very best Ortho doctor possible. This is just my opinion. I wish you well!

My opinion only. Absolutely no surgery unless absolutely necessary. Physiotherapy can help if you wish to try it. I am an RN and have seen many surgeries with worse outcome than before the surgery. It is a difficult decision. If you can find the best possible Ortho doctor possible. I wish you well!

Where do you find a physiotherapist?

Hi
Your family doctor should be able to make a referral for you.
They have physio therapists at the hospital.
They may also have clinics of their own.
I am not sure where you live. I am in Eastern Canada.
I would look up PT's for your city on google!
Let me know if this helps. I just do not want you to go under the knife unless absolutely necessary.

Cheers, happy new year,
Debby

Just a little info but I am sure you already know this.

Well I have my first fusion in my twenties, my third and fourth in my thirties, fifth and sixth in my fifties, and my seventh and eighth (hip pinned) in my sixties. So be careful with starting the first surgery as in my case even few years the disc above the last fusion fails and you cannot stop Scarring which cause all kinds of neurological problems and damage. Just get the right surgeon and a second opinion!