Spondylolisthesis and DDD
I am a 52 year old female with no prior surgeries. I have suffered lumbar pack pain for 30 years. It started out hurting from time to time. Now I have constant pain and have trouble getting out of bed in the morning and can barely get the dog walked. Doctors have told me I need spinal fusion of L5-S1 and possible L4. Also, disc replacement of L5. I have seen an Orthopedic surgeon and a Neurosurgeon for opinions. The neurosurgeon wants to do the surgery. The orthopedic surgeon said his goal is to keep me off the operating table because I am opening myself up to a whole host of problems if I have the surgery. I decided to see another spine doctor. They currently have me on Gabapentin, 2 capsules a night which has made zero difference in my pain. They want me to work up to 3 capsules a night but I'm not happy about taking it. It makes me dizzy and has other negative side effects. My question is: Should I have the surgery? Or do I need to accept my condition and learn to live with a decreased quality of life?
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@red3 I would encourage you to get some more surgical opinions as you may be offered different procedures. There are also some pelvis alignment disorders that are physical, and can mimic a lumbar spine problem and cause sciatic pain. If your imaging indicates a structural spine problem, physical therapy won't change that, but you could have a misalignment of your pelvis and muscles adding to symptoms and putting pressure on your spine. Research any surgeon you are considering because surgery can make you worse, and all spine surgeons are not equal. Some are excellent, and others are not. Make sure that this is the only type of surgery they do so they will be more experienced with spine issues. Read their research papers, and success rates for the procedure, as well as the success rate of the hospital of institution. I had cervical spine surgery at Mayo, and a great recovery and would highly recommend my neurosurgeon who is a spine deformity and cervical expert with spine orthopedic fellowship training too, and who does artificial discs and fusions. The lower end of the spine bears all the body weight, and any twisting or bending can put pressure on hardware like rods and screws that are used in spine surgeries. The screws can pull out if not placed correctly and held in place by good quality bone. There are also issues for smokers and healing from spine surgery, and many surgeons make a patient quit smoking before they operate. Smoking can cause a fusion to fail as a non-union. There are pros and cons to both fusion and disc replacement and some surgeons prefer one over the other. They are trained by the companies who make the hardware, so it's good to ask why a particular hardware or implant is recommended and if there are any other options to consider. You might want to get an opinion from a surgeon who does both. Here is a patient story about my Mayo surgeon and another patient with a lower spine issue that may be helpful. There is also a link about Lumbar Plexus Compression Syndrome written for physical therapists that explains the pelvis misaligmnent issues.
Lumbar plexus Compression https://trainingandrehabilitation.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
@jenniferhunter. So glad you are back. This is a perfectly outstanding reply. Hope your time away was joyful. Chris
@artscaping Thanks, Chris. We had a nice time enjoying the beauty of the Rockies and the foot of snow that fell while we were there. I kind of feel like the seasons are backwards because we left our home with the trees in glorious color, went to the mountains and it was winter, and now back at home it is still fall for a little while yet. Thank you. It's nice to be welcomed back.
Jennifer, I have been thinking about your post and appreciate it, as well the links that you included. I am glad that surgery was a good solution for you and your pain is alleviated. I have a very solid diagnosis of spondylolisthesis (Grade 3) from quite a few doctors. I am an ex athlete, so it stands to reason. Like you, I have kept off the operating table thus far because I exercise daily. It's just that it's getting harder and harder to cope. I am definitely not a smoker. The surgeon whom I am considering is Andrew Metzger M.D. He operates on spines and brains. His bio seems highly qualified and he is in private practice. I did appeal to his office to ask to be put in touch with patients he has done the procedure on but I did not receive a reply. I think I will try again. I was also considering a neurosurgeon at Baylor University. However, after talking to someone who had the surgery I thought it would be less complicated if I had the surgery in the city I live (Albuquerque). But yes, finding someone who is most qualified is of upmost importance. As far as getting ahold of research papers..that is a good idea. Not sure how to do it other then googling his name and hope some links pop up? Thank you again for your input.
Chris, funny thing. My name is Ruthann Trout. I go by "Red" because I have ginger colored hair. Lol.
@red3, Hey there Ruthann. Are there a lot of Trouts in your extended family? Any from Delaware? How about Robert Weldon Trout? ……..have a peaceful evening. Chris
@red3 I searched in Google Scholar and came up with this about using an MRI in the operating room. https://www.ajronline.org/doi/full/10.2214/AJR.06.1247 Perhaps that is the surgeon you mentioned? Google Scholar keys in on research studies. https://scholar.google.com/
The institutions sometimes have links to their research papers from the bio of the surgeon. Mayo does that. You can look at Becker's Spine Review for information and search doctor's names and institutions. They have a list of 100 surgeons to know, and career updates. It might be a starting point for further searches. https://www.beckersspine.com/ You can also look at the manufacturers of spine hardware and sometimes find literature about procedures with the hardware or a list of doctors who use it, and you could search for research on particular implants to learn about any issues. Once you find one study, there are often related links to studies on the screen in sites like Pub Med. I even looked at the government trials website for spine implants. You can learn a lot by reading what excludes a patient from a government trial study and that can hint at what some of the drawbacks could be. Also ask the surgeon you see specifically what hardware they use, and look up any studies about that implant or adverse reactions. There is also US News rankings of doctors and institutions at https://health.usnews.com/doctors Also for your state, search on the medical review board to make sure there is no disciplinary action listed. There is information at https://www.spineuniverse.com/ with case studies by some surgeons on there if you look up a doctor.
The most important thing is to find the doctor you think has the best skills and area of interest match for your condition. If you can find that close to home and you know you can trust that surgeon, that would be great and you need to be comfortable with your decision. There are also hospitals around the country that are affiliated with Mayo and have remote access to Mayo specialists. Mayo Clinic has a Care network where they work with other hospitals and doctors have access to consult with Mayo Physicians. https://www.mayoclinic.org/about-mayo-clinic/care-network/members
I have watched a lot of online spine surgery conference video presentations, and sometimes you can find a surgeon you'd be interested in teaching there. Be prepared to see actual surgery photos/video, otherwise, just look at the names of the presenters and their information and title of their topic. The Seattle Science Foundation has videos from spine conferences on You Tube at https://www.youtube.com/channel/UChIIig54yF9aQYvpWGe1DPg/featured
If you scroll down that screen, there is a Spine Conference section, Neurosurgery Grand Rounds section, and Cranial Conference section with videos. I learned a lot by watching surgeons teach other surgeons.
You really have to do your homework to pick the best surgeon for you, and believe in a great outcome. Ask what you can do that could help make the surgeon's job easier. I was told to stretch my neck with my hand to keep it loose. I also had done a lot of myofascial release with my physical therapist before surgery, and that made my muscles looser and easier to retract during surgery, and after, it helped break the tightness of the surgical scar tissue when I was recovered enough to begin. Here is our Connect MFR discussion https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
I couldn't find any surgeons who would help me close to home, and I went to Mayo after 5 spine surgeons turned me down over a 2 year period. It was a 5 hour drive for me to Rochester and it was worth it. I knew a lot by that time, and it helped me ask good questions when I met the surgeon who did help me, and I had seen enough of my imaging to know that he was giving good answers and a good explanation of the problem at my evaluation. If you want to consider Arizona, there is a Mayo campus there, and also the Barrow Neurological Institute that I have seen in my online wanderings of looking at leaders in spine surgery. You should seek the very best, and I wish I had come to Mayo first instead of wasting 2 years chasing doctors. Initially I tried to find help in a major city near me, and every surgeon could read the MRI, but they didn't understand how to connect my unusual symptoms to the imaging, so I was the patient that these surgeons didn't want to take a risk on. They have success ratings by insurance companies and patients, and a possible poor outcome would lower their ratings. I had unexpected pain all over my body from spinal cord compression in my neck. I found a medical case study similar to mine, and sent that with a letter to the surgeon at Mayo, and that is how I became his patient. I have a biology degree and used to work in university research for a neuroanatomist, so looking for medical literature was somewhat familiar. My tissue preparations from the lab and my technical drawings were published years ago in the Journal of Neuroscience.
It sounds like you are doing all the right things. It's an important decision, and get enough opinions so you can make an educated choice and have the absolute best surgeon. It will be a long recovery and you'll need patience and a good support from your family. Hopefully something in my long list can help you on your journey. I had a lot to do to work through my anxiety over major surgery, and if you have that, seeing a counselor sure helped me along with all the creative things I did on my own to overcome my fears.
Jennifer, I too always love reading your replies. We just got back from the Rockies 2 weeks ago. I have never been and I got so sick. It was the altitude and I could not catch a breath. It was awful. I thought I might be having a heart attack.
I need the same surgery as red. Except I have spinal stenosis also. The neurosurgeon I have seen is Alexander Ropper at Baylor in Houston. I don’t hurt all of the time, but I have neuropathy and my leg and foot is bad. He said he thinks he can help me and I do want a better quality of life plus I don’t want to get worse. It’s a decision I need to make. Red what dr. Did you see at Baylor?.
@peggyn Thank you for your kind words. I hope what I've shared will help with education about spine issues and help you with your decisions. I needed to know every detail I could, and I was dealing with surgeons who didn't recognize what I knew about the stenosis until I got to Mayo. I had stenosis in my C spine in the central canal, but not at the nerve roots, so my pain pattern did not follow the dermatome maps. It was causing loss of muscles and coordination, and I am so glad to be past the recovery from that. I think my muscle mass is still improving now at 3 years post op. Did you get a detailed explanation from your surgeon as to how surgery can help you?
We just got home a week ago from the Colorado Rockies and Rocky Mountain National Park. Usually altitude doesn't affect me as much, but I had some chest congestion when I got there, so my first couple days didn't feel so good because of breathing problems and incorrect dosages of my thyroid medicine, but I drank a lot of water. By the end of the week, I felt much better, and even though walking around in the cold temps at the altitude made my heart race at the time, we took it slow and I was better by the time we left a week later. I think it really takes about 2 weeks to acclimate and that is probably easier in summer when it isn't so dry inside. We were boiling water for humidity which helped a lot.
Jennifer, your reply provides a wealth of information for me. Yes, Andrew K. Metzger…he is the surgeon I am considering.
I too, have deep seeded anxiety over the surgery. Going to see doctors and talking about it is one thing. Actually committing to a surgery date is another thing. A simple thing I discovered recently is people on YouTube talking about their spine fusion experiences. That has been helpful.
I found your article on Myofascial release enlightening. I used to be a massage therapist so I am familiar with the technique and used to practice it myself. I gave up doing massage 16 years ago after I had my 3 kids. I have not started up again because of the pain.
So yes, I feel like I am on the right track to seek answers. Thanks so much, I will keep you all posted!