[wannabemw]

Hi,
My DH has herniation of L1, L3 & L5. It's getting bad & he has been once again been referred for Spinal fusion (recommended 1yr ago). After 1yr of alternative treatments (pain management, steroid shots, PT) he is worse.

What is the best course of treatment? What should we expect in terms of treatment, recovery ect. He had herniation/repair 7yrs ago of L5, but as u can read he has had re-herniation. Last time he was off for 1m, but felt great almost immediately. He has significant weakness in his left leg & marked weakness in both. His siactica pain is down both legs & getting worse everyday. In addition to this he has numbness:worse in the left.

Thanks!
~MJ

-I also want to add I am a new NS student starting my program this fall.

[P_RN]

Welcome to the forums. I'm probably not the best to answer since I chose not to take the surgical route. Have you read about the artificial disk? How was the decision to refer for a fusion made? I know folks who did wonderfully (my sister) and some who didn't.
Since I really haven't given any answer, I'll just say welcome again.

[wannabemw]

Originally Posted by P_RN

Welcome to the forums. I'm probably not the best to answer since I chose not to take the surgical route. Have you read about the artificial disk? How was the decision to refer for a fusion made? I know folks who did wonderfully (my sister) and some who didn't.
Since I really haven't given any answer, I'll just say welcome again.

Non-surgical for my DH, as far as Chiro care isn't an option (he has spinuous, arthrictic growth in his thorasic region (one of the the worst his dr. has ever seen, she said). I have read about the artifical disks & am hoping that he will qualify for at least one for his L5 (they wk best on L4 & L5). There r some wonderful advances being made every yr that go by. His referral was made b/c his PCP has been working with him & his 1st MRI showed the herniations. He initial went to a spine dr, but hated the guy & frankly, the dr. scare the H-E double hockey sticks out of him. (this dr. had said fusion) So his asked his PCP for a new referral. His PCP knows how bad he is getting b/c he went in & told him: "I'm not sleeping, I am in constant pain, & I now have shooting pain from my sciatic nerve & numbness." He sees the new doc on the 6th. I'll post when we find out. Yeah, this surgery scares us, but he will not have it w/o feeling right. His co-worker had the surg & is returning for more (diff doc). so, u r right in saying that some do well, some don't. But for him, this pain isn't something he is will to live w/for the rest of his life.
Thanks for your interest!
~MJ

[s6182]

Did DH have his surgery? My husband too has had three lumbar laminectomies. I am a nurse on Ortho Trauma, started off in Ortho spine. I know some wonderful docs. Best suggestion is do not have an ORIF if at all possible. They cannot be reversed. Let me know what you have decided, if anything to do. I know how hard it is to see the one you love suffer. Good Luck!

[wannabemw]

Thanks for asking!
He's scheduled tenatively for 22 Feb: fusion of L5-S1 & disc replacement for L5 (?). His doc is top-notch & I completly trust him. (hope it doesn't come back to haunt me! )
He's getting nervous... esp since this PA in his pain management office keeps trying to tell him to live w/it on narc the rest of his life! W/his degeneration & pain! Agggrrrrr...
I'll try to let u know what happens...
~MJ

[jconn]

Hi,

I'm an PA in Ortho surgery. I work Trauma now but used to work spine surgery. Many questions come to mind with this case.

Has he had any relief of his symptoms with epidural injects? Even for a very short period of time following?

Has he had a discogram to try and confirm that the L5-S1 Disc recreates his symptoms?

Has he had EMG and nerve conduction studies to confirm where the nerve issues are coming from? (This can also point to the disc and level).

If yes to all the above...

The disc replacement is new and offers very promising results...but it was only studied with 2 year outcomes. We don't really know how long it lasts. Also, if it does wear out, what do you do next? This question has not been answered in the research.
Also, it is not indicated for sciatic pain, although many surgeons use it for this with good results. It's FDA approived indication is for mechanical low back pain, one level and a virgin back (no previous surgery). But, many spine surgeons in my area have used it for "off-label" uses.

Sounds to me like he is mentally ready for surgery however. Bottom line, knowing what I know and have seen, if it were my back, I would try the disc replacement (if the above questions were all yes).

[wannabemw]

Hi jconn,
thanks for replying! Yes to all your q's. His exact location of repair is actually going to be L-5, S-1 Fusion & Replacement of L-5. He had repair of L-5 w/PL nearly a decade ago (significant calcium build up from past injury). So I hope it dosn't complicate his repair & recovery. His sciatica pain is not like it was then luckily.
He has a permanent surg date of 1 Mar now. They promise him it won't change. He still smokes (3-5 ciggs a day) but is well on his way to quitting. I found him a great book on tape @ Barnes & Noble. And he is anxiously awaiting the final CD because he is now finally ready to completely quit (3rd time is a charm!). I have told him if he doesn't quit I don't want him to have the surg. Period! I don't need him to have an extended recovery period.

It's going to be hard enough to have to go to school... our 15y/o daughter is homeschooled & able to be home w/him while I am out. The MIL will possibly be out too (she's retired). Asking her to come out was a hard decision for me though, b/c I had to tell her I was in NS. She's being great though, so I'm not worried.

Thank you! Your reply really has helped us both to feel a little more at ease. In his pain management office the PA keeps trying to talk him out of it. Well, his pain is getting worse & we both noticed he's gotten a little more shorter, so his compression is getting worse.
I'll let you know how it goes!
MJ
Dreaming Nursing dreams... and living the life of a fulltime wife/mom/& student

[wannabemw]

Hey all,
well DH had the surg last wk & all is fine, surg went well & yes, he did finally kick the butts habit with "The Easy Way to Quit Smoking." He has no desire to go back after listening to the 6hrs of CD's. He flew through surg, only prob was he needed to have a larger incision (about 6' midline lower abdomen) b/c of his "round belly" (doc's words, lol). He had the surg on Weds 1 Mar & was released 3 Mar. Poor guy had the hardest time passing the gas though. Had an enema to get him moving & out of the hospital, but was miserable all weekend. Today he appears to be feeling better. I am so glad I asked his mom to come help she has been a tremendous help!
I'll keep you updated as I have time. Thanks for caring.

~MJ
Dreaming Nursing dreams & participating as a nursing student.
Only 24 weeks to goto pinning!

[TracyB,RN]

glad to hear he's doing well.
I was fused 2 months ago, tomorrow & it as THE best thing I could have done for myself. Almost completely pain free, waiting for signs of actual bone fusion so I can get on track to get back to work in the form of work hardening ( GOD, I MISS MY JOB)...
Worst part of being post-op is dealing with all the restrictions... can't lift this, can't do that. UGHGHG....I should have been sedated, restrained, & put in a round room with rubber walls.... I AM BORED TO TEARS. Did I mention, I miss my job? LOL

I must be feeling really great, or seriously insane to actually miss being on call!?!?!?

[P_RN]

My dd had cervical fusion 6 weeks ago and you'd never know she had anything. Scar is almost gone and she feels great.

Y'all remember though that allnurses cannot give medical advice OK?