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Hello
I'm new to the board but I've read many articles on this message oard for the last few weeks. I've lumbar stenosis and disc bulge and herniated disc throughout my lumbar spines since 2007. I also have lupus and RA and other autoimmune diseases. The chronic pain on my lower back has been manageable until last October(2015).

I started having numbness on my big and 2nd toes on my right leg and shooting pain from right hip all the way to front of my shin, mostly intense while sleeping. When I touched top of my right foot, it will send a sharp pain to my toes. I didn't know what it was until late Jan 2016 after talking to my Rhemy. She advised me to neurosurgeon ASAP.

During the waiting I've seen an acupuncturist on my leg pain/numbness/tingling. It has helped a lot on the numbness but I still have constant tingling of my right foot and pain on my outside thigh to shin when I walk or sleep. My PCP tested out my reflexes on both ankles and knees and they were non-existent! He finally referred to see a neurosurgeon.

The neurosurgeon ordered flexion/extension x-rays and together with my June 2015 MRI, he told me I need 2 levels fusion from L4-S1. He told the surgery won't make me feel better if my pain is NOT severe but he cautioned me NOT to wait until foot drop/drag or leg weakness. I am most scarred about losing mobility and internal functions(bowel/bladder) when nerves were permanently damaged.

So I'm not sure if I should wait as my pain is not unbearable(BTW I have very high tolerance of chronic pain with years of practice!) except when I walk and sleeping. Tingling is always there but pain on leg comes and goes.

Here are what I'm doing now:
- started PT last week and my PT said my spines are very loose and not recommend to use inversion table or traction table. I was prescribed to do pelvic tilt with different modifications
- will continue my acupuncture treatments but it seems it's not as effective as when I first started???
- waiting to see a ortho. spine surgeon soon for a 2nd opinion.

my questions to my fellow spondy:
- do I have to time to wait it out?
- should I opt for 2 level fusion if 2nd opinion concur with 1st?
- what other non-invasive treatments I can try WITHOUT causing permanent nerve damage?

any advices and suggestions would be greatly appreciated.

gabby

Here are my MRI and x-rays impressions:
MRI done 6/15/2015:
L4-L5: Grade 1 anterolisthesis. Left more than right facet arthropathy.
Broad-based disc bulge and oesteophytic spurring
Mild foraminal encroachment on right more the left
Anterolisthesis and degenerative change worsened prior study

L5-S1: broad-based bulge and osteophytic spurring.
Moderate foraminal encroachment on the right mild on the left
L5 root displacement mile degree on the right

L3-L4: no neural compress seen.
Right paracentral and foraminal disc protrusion and fissure
Facet arthropathy

X rays findings done 3/11/2016:
Grade one anterolisthesis at L4/L5 in extension.
This is accentuated in flexion by approximately 4mm.
Calcific density projecting within the spinal canal/neural foramen L3-L4.
Best seen extension
[QUOTE=gabrielalo;5420375]Hello folks,

I went to see my neurosurgeon the 2nd time for a detailed description of the 2 levels fusion and decompression yesterday and here are the recap and questions:
1)he is doing a PLF instead of PLIF, he said the success rate are about the same.
But I read online PLIF has a higher fusion rate. Any opinion of that?
2)my current complaint is mainly numbness in legs and feet but little pain if not walking.
the success rate given by him is about 95% for a 80% recovery of mobility-such as walking.
is that success rate given by him a bit high with 2 levels and OA and DDD?
3)He said no/little improvement on numbness of legs & feet as they are neurogenic claudication which is permanent upon surgery
would numbness on legs/feet get worse if no surgery?
any experiences regarding improvement of numbness after fusion surgery?

4)From the comments on expectation of fusion patients after surgery, most of them still have
- pain and numbness and they will NEVER go away, just learn to live with it
- still on pain management and pain medications long term
- regain some mobility, but NOT total recovered
any feedbacks and comments would be greatly appreciated.

also how critical is if the neurosurgeon is not a fellowship trained?

thanks for all the feedbacks and comments...it has helped tremendously!
glo[/QUOTE]

When I finally got my MRI with contrast before my L5 S1 PLIF, lamidectomy. It said L5 S1 grade 1 anterolisthesis with bilateral L5 spondylosis. There is severe left/moderate right neural foraminal stenosis with compression of the left L5 nerve root and contact of the right L5 nerve.
L4-L5 mild neural foraminal stenosis.
I know that the surgery helped my nerve that was being crushed. I don't regret the surgery because it truly did help. I still have back pain and now I have been diagnosed with failed back surgical syndrome...Arachnoditis..and sacroliitis. My surgeon was worried that the nerve damage was permanent because I waited so long.
Hello Teteri66,
thank you for reading my post so quickly. You are a guidance angel of this forum!
Yes, just a few weeks ago, I was in very little pain, mostly local lumbar pain and occasionally numbness on my toes. It might have caused by overworked and stress from work end of July that it triggered the onset of sciatica nerve pain on the opposite leg, actually the left side has always been hurting due to the lower back pain.
Yes, the pain level has been a full 10 especially when I changed position from sitting to standing or VV. the worst is getting out of bed and up the first 45 minutes in the morning. I totally cannot stand up and cannot walk as the pain is excruciating. But once it passed an hour or so, it will ease up. But then I will have to continue to rest on my bed throughout the day to avoid more sharp pain on any movements. Standing and walking can really worsen the pain. I just started water therapy over the weekend and it seems to help. At least I can move freely (slow walk) in the pool. The minute I got out of the pool, my whole back and leg gone into spasm and I have to jump into the water tub(spa) to warm up and relax the muscles.

As far as the 3 surgeons I had seen, the first one-neurosurgeon, who recommends 2 levels fusion(L4-S1) seems to be very quick to this decision. My husband thinks he might be watching his own pocketbook.
The 2nd one(ortho spine)is the young guy and he told me I am not as bad and can wait a bit, fusion will be a single level(L4-L5). But I saw him 2 months ago without my sciatica pain. I was in the least pain when I saw him so his physical exam might not be accurate anymore.
The last one(ortho spine) I saw twice, is the oldest and in practice the longest.
- First visit - told me no surgery yet, ordered the 2 new xrays , we thought he is a good & honest surgeon
- 2nd visit 2 weeks ago with my sciatica pain - he still cannot provide any diagnosis as to what cause my new pain. he asked me to wait it out for another 4-6 weeks as sciatica will go away on its own.
we lost faith in him as he kept saying "I don't know" on whatever we asked such as cause of pain, nerve damage, injection, etc

So bottom line, I don't have one surgeon that I preferred or have trust in what his diagnosis and treatment plan!!
I do have a 4th referral to see another neurosurgeon but my first apt is not until end of September. I don't know if I could wait that long! She is also been in practice longer than the first 2 but not as longer as the 3rd one.

I looked up the MRI from 7/7/16:
T12-L1:
focal paracentral disc protrusion does not result in spinal stenosis or neural foraminal narrowing
L1-L2 and L2-L3:
spinal stenosis or neural foraminal narrowing
L3-L4:
mild disc bulge with right foraminal disc protusion. Facet arthropathy is also noted. no evidence of spinal stenosis or neural formainal narrowing.
L4-L5:
facet arthropathy and degenerative spondylolisthesis with disc bulge. the neural foramina are mildly narrowed bilaterally.
L5-S1:
Focal central disc protrusion does not result in spinal stenosis or neural foraminal narrowing.

here are the results from the last 2 new xrays taken 8/2/16:
XR Lumber Spine 2/3 view:
Grade 1 anterolisthesis of L4 on L5. Straightening of the normal lumbar lordosis. Trasitinoal segment representing a partially scralized L5 vertebra. Rudimentary ribs at T12. Disc space narrowing at L4-L5 and L5-S1. Minor marginal osteophytosis. The vertebral body heights are maintained. No acute fracture. Multilevel facet arthropathy, servere at L4-L5. Pedicules are intact.

XR Pelvis less than 3 views taken on 8/2/16:
Bones: Visualized bones are intact. Bone mineralization is normal. Degenerative changes of the partially visualized lower lumbar spine are seen. There is hemisacralization of the inferior most lumbar vertebra, which articulates with the superior right sacral ala with mild degenerative changes of the articulation.
Joints: Articular alighment is anatomic. Mild degenerative changes of the bilateral hips are present, left appearing slightly worse than right. Mild degenerative changes of the bilateral SI joints and pubic symphsis notes as well.

My husband is strongly against any fusion surgeries as he was told by his HR director who administrated all medical leaves that the employees DID not fare well after fusion surgeries, their success rate is about 50% and even with the good 50%, they still have lot of pain(old and new) years after surgery. My husband does not want me to be rushed into any fusion surgery just to get rid of the pain.. he wants to make sure the surgery is to correct the underlying problem. But so far, none of the surgeons we'd seen seem to have a definitive diagnosis on my underlying problem.
As you'd indicated with your experiences. Your first fusion was only on L4-L5 but still have pain after surgery, and 2 years later, you had your 2nd fusion on L3-S1. Did this 2nd fusion resolve most of your underlying spine issues? and for the last 5 years with diligent and mindful about activities and limitation, you had maintained your pain-free condition without new adjacent vertebrae diseases?
what is your 3rd surgery? is that after the L3-S1 or before the L4-L5?

So is it true that spine ailments normally can take more than 1 fusion to resolve? It is not the end of the world that one needs another fusion couple years later? The surgeon recommending 2 levels said if I don't do 2 now, I will need to go back in 6-12 months for the 2nd fusion on L5-S1. Since I'm partially fused on that segment, do I really need a full fusion on L5-S1? I will be seeing this surgeon this afternoon to decide if I need only 1 level instead of 2 levels.

sorry about this long drawn reply. I hope I answered the questions you asked and hope to get more feedbacks from you and other fellow gurus.

thanks
glo





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