How do you treat my symptoms in the best and least invasive manner???

The diagnosis is in...so now what? After several consultations with my surgeon there were two different issues that needed to be addressed:

• The spondylolisthesis that is present in the L5 - S1 vertebra (which is causing my back pain...my primary symptom)
• The degenerative disk disease (or ruptured disk) that is present between L4 - L5 vertebra (which is causing the sporadic numbness and pain in my right leg...but much less prevalent than the back pain)

Originally the surgical plan was to do a fusion at both levels. But at my final pre-operative visit it was determined that Dr Ghiselli could do a Transforaminal Lumbar Interbody Fusion (TLIF) at L5 - S1 and a Microdiscectomy at L4 - L5. Because of the location of the rupture of my disc (towards the back of my vertebra) they would be able to "trim" the part of the ruptured disc without removing the back of the vertebra to gain access (which is normal in a microdiscectomy).

The latter was a HUGE win because removing the back of the vertebra (the lamina) can, in and of itself, cause structural instability of the vertebra that might require future surgeries (up to and including a second fusion). But after reviewing my case for what seemed like the 10th time...my surgeon felt that he would be able to remove the source of the leg pain...without doing a second fusion AND without causing structural instability of an otherwise healthy vertebra.

I know this is a small nuance...but these changes came as a result of me constantly questioning the surgical techniques and seeking out the least invasive solution possible. At this last visit (which was mainly to sign the surgical consent forms) I asked the surgical team..."Why are two fusions needed...are there any other less invasive alternatives?".  Bottom line...educate yourself thoroughly about the surgical techniques being suggested and ALWAYS question them. No one else will be your advocate and seeking out the least invasive technique is always advised! This is not rocket science (well actually it is) but this is your only body...you get precious few chances to get this right. There are no dumb questions...only regret for not having asked them.

As a result of the changes to my surgical plan I will get the following benefits:

• The total time for surgery was reduced from 6 - 8 hours (for two fusions) to less than 3 hours (for one fusion and a microdiscectomy). I am sure my insurance company will be mailing me a check for the money saved on operating room rental!
• The success rate for a successful single fusion is significantly statistically higher...than for a double fusion.
• The recovery time is less.
• There is less pain.
• There is less reduction in spinal flexibility.
• The back retains more of its natural shock absorption (the fewer levels that are fused).
• There is less stress placed on the spinal segments (and discs) above and below the targeted fusion area because I will be removing one less "shock absorber".

A true case of less is more....I think you get the gist...and I am satisfied with the final MUTUALLY agreed upon surgical approach.

Four days and counting...and amazingly I feel less stressed than I did a month ago. I am, in some regards, looking forward to putting this in the proverbial "rear view mirror" so I can get on with the rest of my life. I have done my homework and I am ready to be healed and to start the rehabilitation.

Next....The day before and morning of...how will I feel then??