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Chronic lower back pain.

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Hi,

My situation: I have had 10 years of lower back pain, stiffness, numbness on my legs and feet. Tried for 10 yrs ultrasound, physical therapy, tens, heat, cold, various annual nerve blocks, pharmacology (Neurontin, cataflam, skelaxin, lodine, lyrica,ultram,ultracet, Medrol,etc etc etc.) and finally L5 Laminectomy with No relief to date. Latest MRI shows no disc in S1. Spine Ortho Surgeon suggest I get a multi level Spine fusion from L3-S1 since L3, L4 and L5 since I have already too much damage and just getting fusion on S1 will make upper levels collapse eventually. This will bring me back to get more future surgeries.

My question: Since I have tried for 101 years all conservative options with no relief, is a multiple spinal fusion with instrumentation my ONLY option? I am really worried and scared of what this surgery entails. I am a 39 yr old female. No previous accidents, or falls. No one can explain how my situation was caused and how its progressed within 10 yrs. I have always had a computer sitting (sedentary) but mind stressful job. (not sure if that will make a diff).

Your opinion will be really helpful at this moment of total worry.

Thank you,
Lyn


Diagnostic: HNP L5/S1,L4/L5,L3/L4 with severe stenosis,radiculopathy,L5/S1 Nerve root, post laminectomy syndrome and Degenerative Disc Disease L3-S1.

Surgical Procedure: Laminectomy and decompression L3,L4 & S1, posterior spine fusion L3-S1 with instrumentation. Posterior lumbar interbody fusion, application cages, bone graft and allograft.

Category: Neurosurgeon

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Dr. Goutham Cugati
Category: Spine Surgeon
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 29 Doctors Online

Expert:  Dr. Goutham Cugati
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Hello Ms Lyn,

Thank you for your consult at DoctorSpring.com.

I have gone through your medical details and your MRI report. I too feel that all options have exhausted other than the surgery.

Laminectomy is required to give you relief. To maintain stability of the spine you need to undergo stabilisation with pedical screws. Though it is a major surgery, a good surgeon should give you optimal results.

I hope this helps, please feel free to discuss further.

Good luck.
Dr Cugati
Consultant Neurosurgeon


Patient replied :

Thank you for the reply. Would you consider that if I go with the L3-S1 fusion, I will eventually later in years need more surgery for L2, L1 and/or S2,S3 for adjacent segmentation problems? Also, my main distress at the moment is more of mechanical pain rather than neurological numbness in my extremities. Based on your opinion, and the evidence I have presented, what percentage of mechanical pain relief you believe I can expect from the L3-S1 fusion? Thank you again


Expert:  Dr. Goutham Cugati
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Hello,

Since the more mobile segments of the spine is from L3-S1, further degeneration above these levels should be minimal. As these is significant facet joint arthritis, it is resulting in mechanical back pain as you say. Stabilisation will address this problem as well.

I feel a good job on your spine should give you more than 80 percent relief. But this surgery may result in some amount of restriction of you spine mobility.

Hope this answers your query. Please feel free to get back.


Patient replied :

I was told neurosurgeons usually opt for different surgery approaches vs orthopedic spine surgeons. In my case, I'm not thrilled in having metal rods and screws in my back for the rest of my life.
As a neurosurgeon, would you believe taking a different (non metal)surgery approach help? For example, having an artificial disc replacement only with no metal rods and screws be best for me vs a multiple fusion? Also, artificial disc replacement will give me more mobility vs fusion, right? However, I am not sure if multiple Artificial Disc Replacements from L3-S1 will do the job of taking care of the mechanical pain without rods and screws.


Expert:  Dr. Goutham Cugati
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If you are having mechanical back pain which is the result of facet arthropathy and undergoing L3 to S1 laminectomy and discectomy, I don't think it is a wise idea not to put metal rods and screws. Instead if not fused with screws you might become more worse in the days to come. In your case, artificial lumbar disc at multiple levels is not feasible.

Take care

Dr. Goutham Cugati
Category: Spine Surgeon
Experience: 
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
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