L4-L5 Laminoforaminotomy w/o fusion?

[paw]

Howdy - just thought I’d ask here.

Talked to the surgeon today - I have a cyst at L4-L5 which is causing (at best) some pain (and at worst much more). They got one of the steriod injections in the right place, but my pain-free days are greatly outnumbered by those that aren’t unless I take something…

The surgeon suggested a Laminoforaminotomy (basically, just removing the cyst). He brought up fusion, but as I still hope to actively ride and jump, I figured that would not be great (I’m only 55). I know there’s going to be more back surgery in my future - there’s already a spondolythesis and bone spurs. and both of my folks have had stenosis, so odds are good.

I guess I’m just wondering if anyone else has done this, and if so, how long was the recovery? I’m hearing 4-6 weeks - par for the course?

[Tackpud]

I had a cyst at L3-4 which was found during fusion surgery. I’d already done a decompression which didn’t relieve any symptoms. The decompression took about 4 weeks to recover from - the fusion about 8 weeks of very limited activity and about 8 months total to fuse and heal. Still have problems… But the last Myelogram/CT found another cyst at L2-3 so I’m headed to Duke tomorrow to find out the next step.

Honestly - the fusion hasn’t stopped me from doing anything I was doing before. The pain from the cyst has definitely altered my way of life however.

[paw]

Oh ugh - sorry to hear about the second cyst. They are really no fun at all. Best of luck!

[Personal_Champ]

Paw, I know you said you’re hoping to avoid a fusion, but I had one done at L5-S1 in 2013 @ age 30 and am THRILLED with the result. I still jump, and last year started doing dressage. I can do chores, ride in a car/sit for longer than 30 minutes, and sit the trot without becoming crippled.

That said, mine was fused due to a disc that herniated so much, it disintegrated, so YMMV.

ETA: I was back on a horse at the 7 month mark. The 6 months in a hard clamshell brace weren’t fun, but worth it.

[Tackpud]

Not thrilled with my visit to Duke - probably looking at fusing L2 - S1. :mad: But if it will get rid of the horrible leg cramps and red hot poker dagger shooting pain down my leg, I’ll go for it. Back troubles are no fun.

[paw]

Ooo - sorry the hear about the new fusion, but yes - anything that stops the pain is worth it.

I’m hoping to avoid the fusion at the moment since it’s likely to cause more problems elsewhere, at least in my case. I guess we’ll see.

[Horseflyer]

I am 11 months past L3-4-5 fusion and cyst removal at age 49. I did not have a choice - things were increasingly bad leading up to when it went critical - but when it went critical I could stand for maybe 3 minutes, sit for 30 seconds - go past either of those times and (I’m tough like most of us horsewomen) and the silent tears would start.

After surgery, the surgeon said the cyst was the largest he’s seen in 16 years of practice - go me! - and “we’ll take about riding” in 12 months, but he cleared me to ride at 7 months. He invented (and travels around teaching it) a new way of pointing the screws from inside to out - which decreases incision length and shortens recovery - if you want more info on that or anything else, just lmk.

Overall I would say that I was really happy with the surgeon and with Emory (Atlanta), but it was a good 4-5 months before I started to feel slightly human. Around month 3/4 hyperspasticity started as a lovely side effect, I’m still dealing with a mild form of it even today. The layman in me wonders if it’s because I waited too long/cyst got so big (one cause of spasticity is spinal cord injury), but I have no idea if doctors would agree. Stretching/Pilates should fix it long term. I am back to light dressage.

One other note - it helps if you are really fit especially with core strength (more than what you get from riding - stuff like Pilates) to recover faster… my PT said I did have that on my side. That being said, you will not exercise for a good 6 months at all (with my specific surgery - they vary widely). They cut through six layers of muscle, it’s a lot like a puppet having strings cut. You can’t hold your own dang trunk upright. Rather disconcerting! lol

Oh… and this is really key - my surgeon said he could remove the cyst, but it would come right back and require another surgery because my spinal column was too unstable, and that movement was causing the synovial cyst. Ergo, even though my discs were in pretty good shape - out they came, and I had the bi-level fusion. It’s always possible he was wrong, or shooting for the larger surgery, or what have you, but I had a good vibe about this guy, and it made sense. I could actually feel that my spine moved too much there, for some 16 years or so… so I went with his advice.

I now ride with a Hit-Air vest every time. It has a larger cervical collar, and since I had a single C-spine fusion in 2001… oy. I need a helmet for my spine for sure!

[paw]

Thanks, Horseflyer. I don’t think my cyst is that big, and from what everyone’s saying, the disk is fine and the spine isn’t that bad (yet, apparently). My surgeon offered the fusion, but seemed to think that that would bring on its own set of problems, so… Pre-injection life was pretty bad, but not to your level.

My core is pretty strong, so with luck recovery won’t be too long. I’ve got a youngish horse coming along I’d hoped to show this year, which is yet another reason I want to be better and back in the saddle ASAP. Might wind up being the wrong decision, but time will tell…

Glad you’re back to riding again! I just do hunters, so don’t have to have the Mad Bad Abz that dressage folk do!

[Horseflyer]

Good luck!! And anyone who’s dealing with back issues - my inbox is always open. I’d always heard L-spine surgeries were bad - and they weren’t kidding. Good to support each other because as great as many doctors are, they don’t always have all the answers.

And “just do hunters”… ya gotta be kidding me. I lose all grace over fences so I did eventing for a long while, but fortunately I was one of those weird eventers who loved dressage, so when I had to give up jumping (sob) it was only half-awful. I have plenty of respect for how hunters make it look so easy and graceful.

[Where_sMyWhite]

@Horseflyer

He invented (and travels around teaching it) a new way of pointing the screws from inside to out - which decreases incision length and shortens recovery - if you want more info on that or anything else, just lmk.

Horseflyer, curious when you mention the “inside to out” what you mean? Screws pointed into spine or ? Do you have any rods?

I had a significant fusion, T10-S1 4 1/2 years ago to fix a slowly deteriorating spine with scoliosis. Downside is I continue to have chronic nerve compression in the T2-3 area . But, the pain I was in is gone . Knock on wood, I don’t even have any issues with all the hardware when it gets cold .

[Personal_Champ]

My hardware doesn’t bother me in the cold, either - and I honestly thought my single-level lumbar fusion was a piece of cake. I was in the hospital 2 days, when I woke up from the surgery the area they harvested bone from my hip was the most painful. AND I can’t take painkillers, so I took regular OTC Tylenol for pain. I was back to work and walking a mile a day in a week.

I had 2 incisions - one in the stomach and another in the back - which my doctor said gives superior results to a back-only approach. Between that, my brain surgery, collapsed lung and 2 accidents, nobody will ever have a hard time identifying my body, if necessary. Scars everywhere!

[Horseflyer]

@Where'sMyWhite

Horseflyer, curious when you mention the “inside to out” what you mean? Screws pointed into spine or ? Do you have any rods?

I had a significant fusion, T10-S1 4 1/2 years ago to fix a slowly deteriorating spine with scoliosis. Downside is I continue to have chronic nerve compression in the T2-3 area . But, the pain I was in is gone . Knock on wood, I don’t even have any issues with all the hardware when it gets cold .

No rods. A cage was inserted - maybe two cages, one per level? where the discs were removed, then the screws were put into the cage with the tips heading outward, if that makes any sense. My surgeon was quite proud of himself for developing this, said without a doubt my side effects would have been ridiculously worse with a larger incision etc etc. Now, I’m no fool and realize he has every reason to say that - but it all made and still makes sense. The only potential question I have is whether a fusion was necessary, and even that, I really don’t question given today’s medical knowledge status. I have long, long, long complained that it felt like “my caboose is not quite correctly attached” ever since I had a crack’n’quack chiropractor in the 1998-2001 timeframe. I thought he was great at the time, and he did keep me patched together for awhile (neck) but in regards to low back, I think the repeated hard cracking actually did damage. I’ve been pooh-poohed by doctors for this, but hey, that’s what I feel happened… and my surgeon basically confirmed it saying that section of my back was horribly unstable.

Now that we’ve completely hijacked Paw’s thread… point is, cysts are not good. If you have one, do everything you can to genuflect to it. Try to keep it from blowing up to become a monster like mine. Once that happens, you will probably not have a choice about fusion, and, Personal Champ’s awesome experience notwithstanding, lumbar fusions ain’t for sissies. Every single day I think about selling my horses and having a mini as a pet and that’s it. No. Bueno.

[Where_sMyWhite]

PC… I sympathize with the hip bone graft. I think I had one but I would have to go back and read the surgical reports.

I had 3 incisions… one anterior for spacers L3, L4, L5, one XLIF (I believe it was called) under right ribcage for spacers L1 and L2. One posterior for the rods/screws T10-S1.

My only area of “pain” and rarely is where the screw head is sticking out a bit on the left side of the S1 fusion.

Mine was definitely a case of better living through pharmaceuticals… I lost about 2 1/2 weeks but I also sure don’t remember any post-surgical pain which I guess is a good thing.

HF, the x-rays of the cyst are cool. The last x-ray looks similar to mine other than I had the rods (no “cages” but yes “plastic” spacers between each vertebra L1-L5). The cysts sound like no fun at all (for all you vertebra cyst sufferers).

[paw]

Wow - those images are amazing! I ought to get hold of mine - never occurs to me to ask.

Still no word on when the surgery will get scheduled. Haven’t been riding much because it’s been too wet - maybe that’s for the best?

[Horseflyer]

@paw

Wow - those images are amazing! I ought to get hold of mine - never occurs to me to ask.

Still no word on when the surgery will get scheduled. Haven’t been riding much because it’s been too wet - maybe that’s for the best?

I found that riding actually helped my back for a long time, seemed to keep it looser and happier. My note above is a warning to everyone with a cyst to not do anything stupid - like move to Florida for winter training without any help whatsoever for the move itself. That, and a quick move back north because husband had an accident is what did me in. We’re all such tough “I can do that” ladies, and it seems shameful to ask others to lift things for us - but once you have a cyst, you really do need to ask others.

(Says the person who shifted a thousand pounds of hay and five stall mats from the bed of the pickup this past weekend because she didn’t want to bother neighbors… Some of us never learn!)

Regarding the MRI images (the first three)… I took a picture of the computer screen at my doctor’s office with my phone, that’s how I got those. The last is an X-ray printout they gave me.

[Where_sMyWhite]

Even more off-topic. Any time I get imaging done (ultrasound, MRI, x-ray, CT, mammo, etc), I always ask for the images on digital media (usually nowadays DVR). The software to “read” the images is loaded along with the actual images (no, they aren’t JPGs or anything so easy :). As long as you have Windows, you should be able to view the images (at least I have been able to). I don’t know anyplace that does imaging of any kind that actually produces “film” anymore unless it is requested.

This is also a good “catch-all” if you switch Drs or move or anything. Yes, they can request the images but you can also just make copy of the DVR.

I’ve printed images before on my personal printer using images that were loaded on DVR. Just ask at the time the imaging study is done. You might have to follow up to get the radiologist read on the images but you have the “originals”. The MRIs that I’ve gotten copies of are cool as the software to read them also did the same “rotation” and stuff that the Drs see Many places will also make the copy at the time of imaging at no charge but will charge after the fact so remember to ask.

[paw]

Ah. The '“as long as you run Windows” is a killer for me.

[Where_sMyWhite]

@paw

Ah. The '“as long as you run Windows” is a killer for me.

It is what it is. Different imaging producers are going to use different software apps to display the images. That’s why they load the actual software to read the images on the same disk as the image files themselves (the images are not usually anything “useful” like jpgs. In this case, while it would be nice to have both Win and Mac executables, I am not at all surprised that isn’t the case. I have an inexpensive Win laptop that ends up being useful for things like this as I use primarily Mac at home.