Two Stage Fusion/Laminectomy - Anyone Have Perspective?

Posted by Phil, Volunteer Mentor @upstatephil, May 13, 2023

I had a successful C4-7 ACDF in Feb. Now, 12 weeks post cervical, I return to Mayo for a two-step lower back procedure. I was wondering if anyone has experienced this process and can assist with their perspective???...Day One is a "typical" L 2-5 Fusion. Day Two I will walk the halls of the hospital (Mayo) and "feel" how much improvement Day One surgery produced. Two ways forward...If I feel significant improvement, Day Three will be a "typical" L 2-5 Laminectomy and done. If I don't feel much/any improvement...Day Three will be a monster T10-S fusion and laminectomy. I can safely say I don't want that!!! But I have no idea how to evaluate what level of immediate "improvement" I will feel on Day Two. Will I easily be able to feel if the L 2-5 work was enough? Anyone have this experience that can share?

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@upstatephil I am a Mayo spine patient, and I know you're in good hands there. As a comparison, did you feel immediate improvement from the ACDF procedure? I know I did. I had central canal spinal stenosis at C5/C6 because of a ruptured disc with bone spurs. It was generating pain all over my body, and when I woke up from surgery, all that pain was gone! The pain I had at that point was from the incision and surgical path. Did you have an experience similar to that from your first procedure?

A laminectomy adds space similar to raising the roof on a house to build another floor. They remove some bone during a laminectomy and that can be effective. My older cousin had just a laminectomy and it helped him quite a bit. He did not have any other spine procedures.

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I am having laminectomy/fusion work in the T 10/12 area June 12, all in one surgical procedure. I lost most use of my legs about a year ago. I will work at strengthening my legs, a continuation, after surgery. I was told that with the surgery I may be able to strengthen my leg muscles, no chance without surgery. This was the hook to my agreeing to surgery. I am 85, in a wheelchair but well otherwise. Don

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I am having similar surgeries but all at one blow, see detail description attached. Don

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@jenniferhunter

@upstatephil I am a Mayo spine patient, and I know you're in good hands there. As a comparison, did you feel immediate improvement from the ACDF procedure? I know I did. I had central canal spinal stenosis at C5/C6 because of a ruptured disc with bone spurs. It was generating pain all over my body, and when I woke up from surgery, all that pain was gone! The pain I had at that point was from the incision and surgical path. Did you have an experience similar to that from your first procedure?

A laminectomy adds space similar to raising the roof on a house to build another floor. They remove some bone during a laminectomy and that can be effective. My older cousin had just a laminectomy and it helped him quite a bit. He did not have any other spine procedures.

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Thanks for that. I am leaning towards "just" doing the L2-5 work and passing (at least for now) on the BIG T10-S option. I suspect I will see some improvement from the L2-5 and will learn to live with whatever isn't "fixed". I just cannot see myself going through the post-surgery drudgery of the BIG surgery...

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@gemini1505

I am having laminectomy/fusion work in the T 10/12 area June 12, all in one surgical procedure. I lost most use of my legs about a year ago. I will work at strengthening my legs, a continuation, after surgery. I was told that with the surgery I may be able to strengthen my leg muscles, no chance without surgery. This was the hook to my agreeing to surgery. I am 85, in a wheelchair but well otherwise. Don

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Best of luck to you Don!!!

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@upstatephil

Thanks for that. I am leaning towards "just" doing the L2-5 work and passing (at least for now) on the BIG T10-S option. I suspect I will see some improvement from the L2-5 and will learn to live with whatever isn't "fixed". I just cannot see myself going through the post-surgery drudgery of the BIG surgery...

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@upstatephil The bigger the surgery, the more hardware that gets installed and possibly rods or longer rods than a surgery of fewer levels. The big surgery may be a future option if you get to where you do really need it as long as you are healthy enough to be able to go through the trauma of surgery at a future age and with good enough bone quality, etc. I know that is a tough decision, and you'll have to feel your way through it, but I do agree with your assessment. I think I would do the same. Certainly do discuss this when you follow up with your surgeon and ask any and all questions you have at that time, and about what future decision could be made and the window of opportunity to do that if you go with a smaller surgery now. Ask what could happen and if the spine condition will progress after a lesser surgery. Also ask the risks of the different choices. They may have told you this already, but would the bigger surgery carry more risks?

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Thanks Jennifer. That is helpful and reasonably in-line with my current thinking. It's nearly impossible assess risks in these surgeries as there are too many variables plus success data is clouded considering individual health is a major factor as is quality of surgeon. But I will certainly be having these conversations with my surgeon!!! Thanks again.

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Am 67 and had a Laminectomy and Spinal Fusion surgery from T-10 to S-1 one year ago. Still having mobility issues (am on a cane) and dealing with discomfort and pain. Being upright and walking even short distances leaves me gassed and extremely fatigued. Spend a good portion of my day laying in bed.

Would tell you to get several different opinions and prayerfully seek guidance about whether or not to proceed. In my case I have questioned many times whether or not I should have even had the surgery, but these decisions are up to the individual and their surgeon.

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Wow. Thanks for your directness. From everything I've read I want to avoid the T10-S1 surgery at literally all costs! That recovery is rough and the probability of surgical success declines as complexity of surgery increases. I'm strongly leaning towards "just" the L2-5 fusion/laminectomy then taking my chances that is enough to get me through the balance of my active life (I'm 71). I hope you find your way through to a better outcome!

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Hello,
I had L 2-5 and was ambulatory, taking showers and going to bathroom on my own by the end of the first day after surgery. I was walking the hallways and with the proper meds had minimal pain. Sadly after one week I had a fall the first day in the nursing home and pulled out two screws from the cage so it has been hall since then but right before the nursing home incident I was up and Tatum, walking with my walker and doing everything without assistance even getting dressed. Just use the Log Roll to get up and down and DO NOT BEND FORWARD, TWIST of EXTEND. Good luck avoiding the more complex surgery. PJ in San Jose

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