Hi, I could really use some advice. My back isn't in great shape. I've already had a L4/L5 spine fusion and now my L3/L4 is herniated. I know I am going to need some type of surgery to help with the pain I'm experiencing but my pain is currently controlled with medication and a spinal cord stimulator. I am really wanting to get the gastric sleeve surgery before I have anything done to my back. I'm hopeful the pain will reduce some and recovery would be easier with less weight stressing my back. My concerned mother really wants me to take care of my back before I have weight loss surgery so I'll be in a better place pain wise. If someone has been in this scenario, I'd love your feedback. I'll also take any other advice y'all want to give me! Thank you!

I had severe pain with herniated disc L5/S1, resulting in microdiscectomy, laminectomy, foraminotomy last May. While I cannot tell you what to do, my 4 months of post op PT would have been much easier and more productive had I not had the extra weight to deal with. Additionally, recovery from back surgery contributed 27 lbs of added weight-which I’m told is quite common, steroids, limited activity, hubby getting carryout, etc.

Any way you schedule the 2 surgeries presents a challenge. Personally, if I had it to do over again I would likely prefer the order you are, WLS first. You will just have to be extra diligent in trying not to regain weight...they will likely use steroids, etc. In that sense, there’s merit in getting back surgery done first?

Big help I’ve been, eh?? If nothing else, I truly feel your pain. Have you talked with either surgeon about it?

I don't have this particular scenario, but I see these kinds of scenarios in the type of work that I do and I can tell you with reasonable certainty that your back problems and pain are directly affected by morbid obesity. When you're obese, not only are you carrying around a heavy load and putting stress on all of your joints, but you often alter your posture to accommodate the weight. This can lead to progressive degenerative disc disease, disc herniation, radiculopathy, etc. Also, it's not uncommon for the joints adjacent to the spinal fusion to develop issues like herniation.

It sounds like you're in a bit of a chicken/egg situation. The excess weight is definitely exacerbating the back condition, but it's hard to do anything about the weight because of the back issue. Losing weight will not "unherniate" your discs, but I have seen cases where a herniation sort of retracts a bit and no longer impinges on nerves with proper physical therapy. Of course, the likelihood of that depends on the severity of the herniation.

I would strongly encourage you to have this conversation with both of the doctors. Meaning, the bariatric doctor and the orthopedic/neuro-surgeon who is treating your back. Not just the pain management guy, the SURGEON. Flatly ask them which one they would recommend you pursue first. Then, ask them to explain WHY. Once you understand, you can proceed in confidence knowing the situation, the benefits, and the consequences.

<disclaimer>I am NOT a doctor, but I routinely work with individuals who have had back injuries, degenerative disc disease, herniated discs, sciatica, radiculopathy and the like.

Thanks for the imput, y'all! I really needed to hear other opinions. It really is a chicken/egg situation. ? The steriods are a big thing to consider. I will bring all of this up with my bariatric surgeon. I have had issues finding a good orthopedic doctor but I'll seek one out asap to get their advice as well.

There is no way shedding a ton of weight is not going to help your back issues!

Last week me and my two teanage boys were at the grocery store - I handed both my kids just half of what i lost 80 pounds of potatoes and ask them to carry them around the store, They could not do it. That is 4 20 bags and it wore them out after 10 minutes. Now to try and carry 7 20 pounds - That will not be good for the back - Bottom line less weight will help you back out

Edited March 5, 20206 yr by AJ Tylo

I have a lower back fusion and still have chronic pain in my back and neck. I decided the wls made more sense before I had any more surgeries on on back.

Oddly enough, I had my wls last week and ever since I woke up I had zero pain in my back and neck. I'm sure itll come back but a nice surprise.

2 hours ago, AJ Tylo said:

There is no way shedding a ton of weight is not going to help your back issues!

Last week me and my two teanage boys were at the grocery store - I handed both my kids just half of what i lost 80 pounds of potatoes and ask them to carry them around the store, They could not do it. That is 4 20 bags and it wore them out after 10 minutes. Now to try and carry 7 20 pounds - That will not be good for the back - Bottom line less weight will help you back out

Congrats on your awesome success! Your reasoning makes complete sense to me, thank you!

2 hours ago, Xx1jpt5xx said:

I have a lower back fusion and still have chronic pain in my back and neck. I decided the wls made more sense before I had any more surgeries on on back.

Oddly enough, I had my wls last week and ever since I woke up I had zero pain in my back and neck. I'm sure itll come back but a nice surprise.

This is so encouraging! I know my experience won't be identical to yours but I have hope that I'll be making the right choice if I have wls surgery first. Congrats on having the surgery and I REALLY hope your pain stays far, far away!

Following. I am in a similar situation. Severe low back injury last may and not yet treated with surgery. Only at home therapy, some injections that didn't help. Trying to get insurance approved for the stimulation device. I had VSG ten days ago, post op and happy to fine this forum and thread. My question for you..... What can you tell me about the good or bad about the stimulation device. The unit my pain doc would use is the Nevro. I have been declined for two different pain patches by my insurance company and now post op sleeve I cannot use ibuprofen. Horrible because I was using it daily. I have) 4,5 herniated with deep pain in hips and sciatica going down leg with bad calf cramping and numbness in my foot. I am 47, SWM, and currently 215. I can only take the gabapentin and tylenol. Suffering every hour, and have regular job and all that. Can't just lay down.

What is your opinion of the stim devices.

On 3/5/2020 at 9:04 PM, ShortBuddah710 said:

Following. I am in a similar situation. Severe low back injury last may and not yet treated with surgery. Only at home therapy, some injections that didn't help. Trying to get insurance approved for the stimulation device. I had VSG ten days ago, post op and happy to fine this forum and thread. My question for you..... What can you tell me about the good or bad about the stimulation device. The unit my pain doc would use is the Nevro. I have been declined for two different pain Patches by my insurance company and now post op sleeve I cannot use ibuprofen. Horrible because I was using it daily. I have) 4,5 herniated with deep pain in hips and sciatica going down leg with bad calf cramping and numbness in my foot. I am 47, SWM, and currently 215. I can only take the gabapentin and tylenol. Suffering every hour, and have regular job and all that. Can't just lay down.

What is your opinion of the stim devices.

I apologize for just now responding. The stimulator has been a blessing. Without it I wouldn’t be able to work. I did have an issue with one of the leads in my spine slipping down and my stimulator batter implanted in my left buttock migrated all the way up to near my love handle. I honestly think my surgeon wasn’t the best. Now that the lead has been replaced & the battery moved to the right buttock the stimulator is doing its job well. I still have pain everyday but it’s not nearly as bad as it was.
I hope you get insurance approval soon. You’ll go through a trial run first & I suggest going about life as normal during that time to see how it’ll help you in your day to day life.
Bit of advice, after spinal stimulator surgery really follow the doctors orders about bending, twisting, raising hands above head, & reaching. My lead slipped because I got a little to active about 2 weeks out. Your body has to heal & scar tissue needs to form to keep the leads in place. That was a looong response. Sorry!
Big congrats on your VSG! I can’t wait to be post-op! The very best luck to you.

First, so sorry your having this issue. I literally feel your pain as I have these issues. I’ve had 3 lower back surgeries, epidurals, disectimy, PT. You name it I’ve had it with my back. This was all done before my sleeve surgery. In 2014 I was able to have the sleeve and while I knew my back would never be normal I was hoping to at least get some relief from losing the weight. I was 252 lbs before surgery and 5 yrs out I’m currently 155. I can honestly say it has helped with my back pain. While I am never pain free(I expected this), it it’s much more tolerable. However, I will not lie and say I don’t still have issues. About 2yrs after surgery, I was walking in my driveway and my legs just went out from under me and I felt tingling and numbness. An MRI was done and the result was that my L4/5 & L3/4 disc were now bone on bone and the little bit of disc I did have left at L4/5 was herniated which is what caused my fall. My only option is to have a fusion. There is nothing else that can be done. I was about to have the surgery, but something in my gut told me to wait. That was in 2016. I still haven’t had it done and my doctor cannot explain it, but my pain is very manageable. They honestly don’t know how I’m walking around, but I am. I do have sone pain and I watch everything I do. From time to time the bones will hit and it takes my breath away, but so far I can handle it. I know it eventually will lead to a fusion, but I’m holding off as long as I can. Sorry for rambling, but in my opinion your back problems will still be there after your sleeve and I honestly believe if you lost the weight your recovery and success would be better when you have back surgery.

4 hours ago, mgt3boys said:

First, so sorry your having this issue. I literally feel your pain as I have these issues. I’ve had 3 lower back surgeries, epidurals, disectimy, PT. You name it I’ve had it with my back. This was all done before my sleeve surgery. In 2014 I was able to have the sleeve and while I knew my back would never be normal I was hoping to at least get some relief from losing the weight. I was 252 lbs before surgery and 5 yrs out I’m currently 155. I can honestly say it has helped with my back pain. While I am never pain free(I expected this), it it’s much more tolerable. However, I will not lie and say I don’t still have issues. About 2yrs after surgery, I was walking in my driveway and my legs just went out from under me and I felt tingling and numbness. An MRI was done and the result was that my L4/5 & L3/4 disc were now bone on bone and the little bit of disc I did have left at L4/5 was herniated which is what caused my fall. My only option is to have a fusion. There is nothing else that can be done. I was about to have the surgery, but something in my gut told me to wait. That was in 2016. I still haven’t had it done and my doctor cannot explain it, but my pain is very manageable. They honestly don’t know how I’m walking around, but I am. I do have sone pain and I watch everything I do. From time to time the bones will hit and it takes my breath away, but so far I can handle it. I know it eventually will lead to a fusion, but I’m holding off as long as I can. Sorry for rambling, but in my opinion your back problems will still be there after your sleeve and I honestly believe if you lost the weight your recovery and success would be better when you have back surgery.

Thank you so so much for sharing your experience with me! You've put my mind at ease on a few things and gave me valuable insight. I'm glad you've been able to put off the fusion for this long. I hope when you do have the fusion done that it provides you with relief. Thank you again!

I also will have to have back surgery at some point. My L5-S1 disc is badly deteriorated and was causing me a great deal of pain. I decided to have WLS first and the pain has greatly subsided. It's still there but not nearly as severe, and my weight loss journey just started. I think I made the right decision.

On 3/9/2020 at 7:37 PM, SINISTER said:

I also will have to have back surgery at some point. My L5-S1 disc is badly deteriorated and was causing me a great deal of pain. I decided to have WLS first and the pain has greatly subsided. It's still there but not nearly as severe, and my weight loss journey just started. I think I made the right decision.

I'm sorry to hear about your disc and the pain it causes. It's fantastic that your pain has greatly subsided! I hope my pain will diminish for at least a little while after my WLS. Like you said, we'll probably have to have surgery at some point but the longer we are able to postpone it the better, especially until we've healed from WLS and have healthy eating habits established. Congratulations on starting your journey!

46 minutes ago, RainbowBrite57 said:

I'm sorry to hear about your disc and the pain it causes. It's fantastic that your pain has greatly subsided! I hope my pain will diminish for at least a little while after my WLS. Like you said, we'll probably have to have surgery at some point but the longer we are able to postpone it the better, especially until we've healed from WLS and have healthy eating habits established. Congratulations on starting your journey!

Thank you and same to you! It's really nice to get up in the morning and after a long trip in the car (I have a long commute) without pain.