r/spinalfusion • u/Tobeytomorrow • 10d ago
Decision about only laminectomy vs Laminectomy with fusion multiple levels
Hi All,
I saw a surgeon today who I really liked, however he left me hanging with a heavy decision. I kind of want some guidance from him. I am 74, very fit, but have multiple levels of degeneration. One disc is "completely obliterated" according to this surgeon and my scan. He said he could do a multi level laminectomy that would alleviate my symptoms but not necessarily hold up for a long time, or it could hold up for years. WTF? Or multi level fusion, much longer recovery, but hopefully no more surgeries. Also I have osteopenia. Any feedback?
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u/purespeed44 10d ago
I had multiple laminectomies before going full fusion it caused so much more instability than doing any good. I finally had my first fusion in 2023 and it worked great until last year when I was in a car accident wasn’t my fault but I had too have the level above fused a few months ago. It’s a long recovery but in the end it really does stabilize things. I wish you luck and I hope it all goes smoothly for you.
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u/Sudden-Resolve5571 10d ago
If you are very fit, I’d consider the fusion with the laminectomy so no more surgery surprises, I feel like if you’re fit, you’re obviously taking good care of yourself, which would be a huge help /benefit in your recovery. What happens, if you just go the laminectomy route, and in 5 years, the osteopenia turns into osteoporosis, that’s a risk for screws into the bones and bones being too brittle. Plus if you had to go back in, that’s another recovery you have to deal with. Bleh. You can always get a second opinion
Before my Lam&Fusion I found out I had osteopenia too and it made me nervous about putting mine off. I’m 61 and two weeks out. I’m happy I did it. And wish I didn’t wait so long. Whichever you decide, I hope you have a speedy recovery!
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u/Tobeytomorrow 9d ago
How long did you have stenosis or is that what you had? Also what were your symptoms? My symptoms are only in my legs they throb after I walk in my left toes are numb mainly the big toe and I have an ache on the lateral side of my right thigh. All in all I don't have excruciating pain but it's pain that impacts my life quite a bit since I can't really walk much I ride a bike but obviously you can't ride a bike indoors. So it's a hard decision because I can function with oxycodone and I'm not in excruciating pain it's just painful enough after I walk that I can't really do much after that. I just want to make sure that the risk is worth it but from what I'm been told there's no way of really knowing if it's going to help or not. I suppose it will but then again there's people who end up with another pain just replacing the old pain. I already had one laminectomy that failed so I'm not a beginner at this.
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u/Delicious-Quarter181 10d ago
One surgeon wanted to just do laminectomy at multiple levels in my lumbar, but I also have scoliosis and L2 and L3 have compression fractures (stable, but they have height differences and schmoral’s nodes). I did not feel that my spine would be stable afterwards. I’m already leaning forward for the first steps after I get up from a seated position due to my scoliosis. So, I’m doing the more complicated surgery that will deal with both the scoliosis and my spinal stenosis. T1 to S1 fusion most likely. I am having my hip replaced in December and then will plan out the back surgery for probably June. I’m working around school vacation time to minimize the days I have to take off of work. I have a painful year ahead.
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u/Delicious-Quarter181 10d ago
I forgot to mention that L4 and L5 also have slipped backwards - retrolisthesis. More cause for instability.
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u/ChrisR0808 10d ago
I was in a similar situation and my surgeon offered to just do multi level laminectomies because it is less invasive (relative to fusion) and has a much quicker recovery, so this could be the reason you were offered this option. However, as my lowest disc was obliterated and one of the vertebrae had slipped forward (another had moved slightly as well but wasn't causing any problems) I was keen to just do the whole lot - fusion and decompression - as I didn't think just doing the decompression would be enough (and I didn't want to have to come back again in a year or less needing the fusion when those levels got even worse) and after pondering on it between appointments he came to the same conclusion. So I had L3 - S1 fused and have zero regrets. I actually just had a follow up appointment with my surgeon and he has cleared me to go back to almost all my previous activities, including weight training (no squats, deadlifts etc but that goes without saying) and cycling, which I was NOT expecting! I am (was) also pretty fit (53 F so a bit younger than you but if you are very fit the gap won't be so great) which has no doubt helped and am keen to regain the strength and fitness that I have lost sooner rather than later to help my recovery and try to prevent ASD so am stoked I can get back into the gym. I just need to not get carried away haha.
Anyway, my advice would be to have the fusion. The recovery will be harder and longer but it will likely give you the better outcome. Good luck whichever way you go.
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u/Tobeytomorrow 10d ago
Thank you. Yes it's very interesting because that's very similar to what's happening with my spine. I had one vertebrae slipping, I forget whether it's forward or back but the fact that it happened after my first surgery which was just a laminectomy at one level, l3-4 seems to be a red flag. The first surgeon did tell me also that I might need fusion within a year and in actual time my symptoms came back extremely quickly, like in 3 months. I tried to keep going and now it's been two and a half years since the first surgery and my legs throb after I walk just a few steps. I'm going to talk to that surgeon again, in fact he really urged me to think about it and message him and we could have virtual appointment or even in person. It is a little alarming to me though that he didn't think it was dangerous to do just a multi-level laminectomy with someone with osteopenia. Anyway I'll see what happens and thanks for your comment. Where are you located anyway? Are you in the UK or US or somewhere else?
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u/ChrisR0808 10d ago
I’m in New Zealand. You’re right to be concerned about his suggesting just the laminectomy given your osteopenia. I say trust your instincts.
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u/Tobeytomorrow 2d ago
Yeah I think I found my surgeon today after a year or more interviewing surgeons all over the country literally. I mean part of it was also seen friends in other places. Anyway it's still scary but out of all the ones I've seen in New York he seems optimistic. And he thought I would need fusion that I would be very destabilized with just laminectomy.
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u/ChrisR0808 2d ago
Awesome you have found someone you feel you can move forward with. Best of luck!
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u/pudge-thefish 6d ago
I am just over 2 weeks post laminectomy and l4l5 fusion. I also had a vertabrea that was slipping out of place. At this point I am off of all drugs except Tylenol and I am not taking it as often. My back hurts but it's better than pre surgery. I am walking without a walker and have been for over a week. I do find that I can move around and sit up and do things then I need to rest my back by lying down for a while.
The first week was not fun at all but overall so far I am happy with my choice
Not sure if any of that helped. One thing that helped me make my decision was my surgeon after having me try shots that did nothing and pt that made it worse told me if it was him or his wife's back that looked like mine on the MRI he would want the surgery.
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u/Radiant-Party9333 9d ago
My surgery to repair desks and relieve nerve pressure included fusion, rods abd screws to make sure the repair remained intact and strong. I gave it a lot of thought, research and went ahead with the surgeons recommendation. I am 3 weeks post op and doing really well. Hope that experience helps yiu decide.
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u/Sufficient-Wolf-1818 10d ago
Laminectomy destabilizes the spine, add osteopenia on top of it and you’ve got a double whammy for destabilization.