Spondylolisthesis and DDD

Posted by red3 @red3, Nov 5, 2019

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?

The surgery may require a blood transfusion …Prior to my surgery, I gave 2 pints of my own blood to use in the operation…

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@jenniferhunter

@red3 Thanks for the nod, Ruth Ann. It sounds like you have found your path and are taking charge of your future. This is a very big decision, and all the things you are doing to learn all you can will surely help. I know for me, I needed to understand in detail what the surgeon can do, and also what I can do that will help achieve success. That is a good way to overcome the stress, and gratitude will also help you overcome the fear. It helps you find your way from the fears of an unknown, and then to find a plan for your future and the doctor who can give you that. It is a team effort, and I viewed my own situation as being a part of my surgeon's team to solve a medical problem. That gives you some sense of control and a positive outlook. Recovery and rehab will be part of this, and believing in a positive outcome and a successful procedure will help you recover. Make sure your surgeon knows how much you appreciate their help. They can have very stressful jobs, and the same other life stresses that anyone can have. Expressing gratitude to your surgeon will help them focus on you and getting everything right. Right before I went into surgery, I held my surgeon's hand and thanked him for helping me, and reminded him that we had agreed on no hardware for my single level fusion. That would be an easy thing to miss if most of his cases involved hardware. Making that effort on my part gave us both peace of mind and I could relax knowing that I was in good hands. You need to have that level of trust when you are the patient on the table.

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@jenniferhunter, thank you. I'm an understanding, appreciative person in general. How did you have your cervical spine fused if the surgeon did not use hardware?

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@red3

@jenniferhunter, thank you. I'm an understanding, appreciative person in general. How did you have your cervical spine fused if the surgeon did not use hardware?

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@red3 Ruth Ann, that's a great question. I think there are many surgeons who will only do spine procedures with the insurance that hardware instrumentation gives them. Hardware does increase spinal fusion rates, but isn't always required. They used to do cervical fusions without hardware as a normal procedure, but after the hardware and plates became available, it gave surgeons a chance toward better statistics. Non-fusions can happen even with hardware, and then it is the hardware alone that is holding it together and that can fail. There can also be problems with hardware if screws become dislodged or if the implant becomes displaced or if there is an immune reaction to it. Here is some literature that I found.

Misplaced screws
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400184/
Here is a lab that tests for implant material sensitivities. I had these tests done, but then opted for no hardware instead because a patient can develop an immune problem later even when testing prior to surgery indicated no issues.

Orthopedic Analysis
https://www.orthopedicanalysis.com/
My surgeon would do this surgery without hardware because it was only one level; if I needed more, I'm not sure what the answer would have been. I know someone who did have 2 levels done at the same time without hardware, and only a bone graft and neck brace, and she did fine and has no issues even 15 years later.

My surgeon said a fusion shrinks as it heals, and the length of a plate on the front of the spine can cause issues if it is too long and contacts the adjacent disc which would lead to damage and adjacent segment disease. My surgeon had to trust me to be careful to not screw up the work he had done during my recovery. I promised to stay 3 months in the neck brace, and it did take that long for the fusion to begin. The bone graft spacer is also tight enough that he could tug on it during surgery and it didn't move and the bone surfaces would be rough because the bone spacer is milled to a specific height before he gets it, and the prep during surgery is to grind the end plates on the vertebrae to have a straight surface so the spacer will fit properly. There is also tension in the neck muscles holding the spine, and I had to avoid any bending or twisting movements. You get used to doing things without looking down or turning your head.

Your health also affects fusion rates, and I did everything to optimize my health before my spine surgery. I took multivitamins. I had my thyroid function tested and made sure my dose of thyroid hormone was correct because I have a thyroid condition. My vitamin D3 levels were tested and optimized. I am also on bio-identical hormone replacement which helps with bone healing by essentially turning back the "aging clock" just a little bit. I don't smoke or drink. I walked for exercise to get my body's available oxygen levels higher. I ate a healthy diet with enough protein. The bone graft also had a space in it to accept the bone spurs that were removed during surgery, and those seeded bone growth for healing. My body had been doing a good job growing the spurs in a bad place, and it was good to get them to do something helpful and in the right place.

I found this literature that describes and compares procedures with and without instrumentation if you read the section on "Anterior Cervical Discectomy with Fusion" and it shows some imaging for comparison.
http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2012;volume=60;issue=2;spage=201;epage=209;aulast=Muthukumar
Another study
https://www.ncbi.nlm.nih.gov/pubmed/17414911
Here is a guide from Vanderbuilt Health that also mentions cervical fusion without instrumentation.
https://prd-medweb-cdn.s3.amazonaws.com/documents/spinecenter/files/anterior-cervical-fusion-guide-01-2019.pdf

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@red3 ..my ex-wife had a spinal surgery without hardware and it turned to be a disaster in a subsequent surgery that required extensive hardware to correct a scoliosis that occurred after the first surgery. ..she has been in pain ever since.

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Jennifer and Ken, I thought you guys might like to know that I am scheduled for Posterior Lumbar Interbody Fusion on Dec. 23rd. I really got to thinking and realized if I didn't do it soon I would have to redo all my appointments and tests (MRI). Also the fact that the pain is just getting worse. So thank you for all the dialogue around this process. I will let you know how it goes, keeping my fingers cross that it is very successful!

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@red3

Jennifer and Ken, I thought you guys might like to know that I am scheduled for Posterior Lumbar Interbody Fusion on Dec. 23rd. I really got to thinking and realized if I didn't do it soon I would have to redo all my appointments and tests (MRI). Also the fact that the pain is just getting worse. So thank you for all the dialogue around this process. I will let you know how it goes, keeping my fingers cross that it is very successful!

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@red3 I'll be thinking about you, Ruth Ann and hope you have a great recovery. You might want to get any chores done now that need doing and get your laundry done and organized so it is ready so you won't need to do that for a while, and stock your pantry. You might also want slip on shoes, or put elastic laces into gym shoes so they will just slip on since there will be no bending, leaning or twisting after you have surgery. It's OK to have others take care of you and let go of having to be the responsible one for awhile. Thanks for keeping us in the loop as you begin this new chapter in your life.

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Good Fortune should smile on you this Holiday season.. let us know how you are doing .. In preparation strengthen your mind and body.. I'm on the beach this month..think good thoughts..ken

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Jennifer, yes, I'm checking off the tasks…not to mention Christmas shopping for my family. And YES, I just might get used to being taken care of instead of being the caretaker! Thanks again. Happy Holiday!

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@ken82

Good Fortune should smile on you this Holiday season.. let us know how you are doing .. In preparation strengthen your mind and body.. I'm on the beach this month..think good thoughts..ken

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Ken, I will keep you guys updated. And yes, I have been thru the gamete of emotions. My "athlete" mentality has now taken over. I am calm (mostly) and know that it will work out fine. Trying to fit in my last walks with the dogs, pilate and yoga classes for a while. Happy Holiday and enjoy the beach!

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@red3

Jennifer, yes, I'm checking off the tasks…not to mention Christmas shopping for my family. And YES, I just might get used to being taken care of instead of being the caretaker! Thanks again. Happy Holiday!

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@red3 Merry Christmas, Ruth Ann. I hope you find some peace and relaxation among the busyness, and enjoy the people in your life.

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@jenniferhunter

@red3 Merry Christmas, Ruth Ann. I hope you find some peace and relaxation among the busyness, and enjoy the people in your life.

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Enjoy this time of year & be careful not to over-do yourself.

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Hi Guys! It's done and over with and I'm doing great! I stayed 2 nights in hospital. I couldn't tolerate the heavy drugs so went on a schedule of Ibuprofen and Tylenol 2 days after the surgery and that's all I need to manage the pain. I'm already walking well, dressing myself, and taking care of bathroom duties. The surgeons say the surgery went great. They fused L5-S1, laminectomy, spacer, and titanium rods and screws L5-S1 as well as my iliac crests. The material for the spacer came partly from bone from my hip and a donor. The donor thing was a surprise. They gave me paperwork to fill out and send a thank you note to the family. So glad it's behind me, thank you so much for your encouragement and support through my decision making process. You don't know how much I appreciate it.

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