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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I sure hope so Ken!
Jennifer, my doctor recommends starting P.T. 3 months out. But yes, I am already thinking of how I can do some stretches without compromising my back. By the way, my yoga practice has gotten me thru this with flying colors. I was able to dress myself right away as well as the dreaded "butt wiping" my husband didn't have to go there….hahaha.
@red3 Ruth Ann, Yoga is a form of fascial stretching and it helps maintain normal movement and flexibility. I think all my fasclal work before and after my surgery helped make it more successful by maintaining movement, and my neck was looser and more pliable for the procedures during surgery. It sounds like you are doing better than a lot of patients who have the same surgery, and attitude helps a lot and believing you can and will have a great outcome. Make sure you clear anything with your surgical team, and make sure you do not fall. The incision usually takes 6 weeks to heal (per my doctor with cervical surgery), and after that is when it can tighten as the scar tissue tightens. MFR can help that with just a gentle push/pull on the skin, but only after it is healed. Those 3 months will go by faster than you think, and by spring, you'll be ready for walks outside. I'm glad you are doing well.
@jenniferhunter, Jennifer, I started walks outside right away because that is what my surgeon told me to do. And also, I would have went crazy just staying inside. You can do that in the southwest because of the lack of moisture and ice. I'm not really up for stretching yet, I'm in too much pain. I was being overly optimistic when I wrote that. Another negative is that I have a lot of nerve pain in my legs at night. I hope that diminishes with the passage of time. Otherwise, I feel I am doing fairly well. It's fun to be able to read novels as much as I want and not feel guilty. 🙂
Ruth Ann, I'm glad you are able to walk. A lot of patients talk about sleeping in a recliner after spine surgery. I didn't need that with my cervical surgery, but it might be something to try if it helps your leg pain. You might want to ask your surgeon about that too, and why it happens at night. Is it the position when you lay down that causes the pain, or is it the fatigue at the end of the day? Is there anything you can do with pillows to support your body or legs that helps? Maybe a pillow between your legs to keep your pelvis straight inline with your legs? Maybe cooling with ice packs? It's very tiring to recover from major surgery and your body is directing its energy into healing the trauma from the procedure. You will have swelling and inflammation, and that kind of ramps up any other inflammation you may have. Inflammation is needed for healing and fusing bones, so that is why patients need to avoid anti-inflammatories post op. You probably knew that, but I mention it for anyone else. For me, the post op inflammation made my thoracic outlet syndrome worse for awhile, and I had to just be patient and it kind of made me crazy waiting until my physical therapist could help. The 6 week mark made a big improvement for me, and I suspect you will recover faster because you were in good shape and conditioning before your surgery.
Jennifer, THANK YOU SO MUCH!!! I DID NOT know that about anti-inflammatories after surgery. Ibuprofen is what I have primarily been taking, round the clock! Combined with Tylenol for 10 days. Since reading your message my husband and I have looked it up. Sure enough, they say studies have shown that it is particularly important NOT to take anti-inflammatories in the initial stages after surgery! This is how this came about. After the surgery my friend came and visited me the day after in the hospital. My friend is an infectious disease doctor. She saw that I was experiencing a lot of nausea from the Hydracodone. She recommended I change to Ibuprofen and Tylenol…she even talked to the nurses about making the change. She obviously should not have done this and I'm not sure why the on-call doctors did not check up on it! I'm pretty upset and have a call in to my surgeon's office but have not heard back yet.
Your suggestions regarding the leg pain at night are good ones. The recliner and the ice pack are my good friends, also the pillow between or under my knees at night.
Thanks again for sharing your knowledge. If you had not said anything this might have gone on and apparently it could really set back the success of the fusion, I hope it hasn't already.
@red3 Ruth Ann, Fusion is a very slow process and really takes at least 3 months to begin. When your body creates bone, first the inflammation sets the stage, and the first thing created is a matrix with cartilage cells, and later the cells are converted to bone cells that start depositing minerals. The matrix has to grow through all of the space first to link it to existing bone, and then that matrix tissue will be converted to bone. The bone matrix that comes from donor bone is what has been deposited by the bone cells, and those bone cells will have been removed from it in the sterilization process. Your body will repopulate that matrix with new cells that later become bone cells that will take over maintaining the bone. My X-Rays at 3 months showed a fuzziness as mineral was starting to deposit between the vertebrae where the bone spacer was placed. At one year, it showed a transparent line linking the outer edges of the vertebrae together, and still transparent because minerals had not deposited yet. That really takes a couple years post fusion to complete and become solid on an X-ray like the other bones.
Important lesson…. always check with your surgeon to make sure that anything you take as far as medications or supplements will not jeopardize the healing of the fusion process. Supplements like turmeric are powerful anti-inflammatories that can interfere in the fusion success. I asked my surgeon's nurse about that and was advised against it. I felt lousy from Hydracodone too, and they also gave me anti-nausea medication. I opted not to take any pain medicine after I left the hospital from my surgery, and I found I could tolerate the pain without. I just stayed as calm and relaxed as I could. Maybe not everyone can tolerate it without pain medicines, but it gets better. The first 2 to 3 weeks were the hardest for me. I'm glad you responded and shared this so everyone else can learn too. You do have to take charge and ask. Doctors are just too busy to be thinking about what you might be doing, so you have to take responsibility and ask about everything. The nurses to ask are the surgical nurses who work directly with your surgeon. They handle things so the surgeon is not overburdened, and they should know. (They are the ones who gave you pre-surgery instructions.) If they don't know the answer, they should ask the surgeon directly and relay that answer to you.
Ok, good lesson on the fusion process. Once again, very impressed by your depth of knowledge. My surgeons office got back to me with encouraging information. Dr. Metzger said that in his experience he had never seen the use of ibuprofen inhibit the success of a fusion. If it works for me "take it" since there are downsides to everything you take. So that is good to know. I might have thought twice though before I put that tablespoon of tumeric in the lentils I have been making today.
When I had my L4, L5, S1 fusion in Oklahoma City it was winter, I had to use a cane for 4 weeks after surgery, but we went to a mall where we could go to a movie … certainly helps get ones mind off of self… I went to the beach in Santa Monica New Year's.. When you can drive … Santa Fe would be my great diversion.. Basque Del Apache Wildlife Refuge south on the Rio Grande from you is a favorite of mine as well…
That sounds nice Ken…I love Santa Fe and wonder every time I go there why don't I go there more often?? I am also a nature lover and have lived in Albuquerque for 20 years and have never been to Bosque Del Apache. I guess I've just been raising kids for the last 17 years. I also don't mind hanging out at home. We've got the Sandia Mountain foothills 5 min. walk from our door so that's where I get my nature fix. 🙂