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L5 S1 fusion surgery

After having 20+ years (I'm 46) of back problems, sciatic pain, muscle spasms countered by painkillers, NSAIDs and a fair few injections, I might now have to succumb to fusion surgery. I saw a specialist on Tuesday and after a CT scan, he's giving me another steroid injection on Monday (i had one back in Jan this year too). If this next injection doesn't sort it out (which is likely as the l5/s1 disc is pretty much gone and there's a bone spur poking into the nerve), then he has recommended fusion, rather than a disc replacement. He said it would be keyhole surgery through the abdomen. Has anyone on here had similar surgery? I know people recover differently, but what can I expect after surgery? I'm in a job where I sit down all day, and need to sit, stand and walk on the commute to work. How long should I expect to need to stay off work? How long before I can get back to a reasonable level of activity? I go to the gym, play golf and tennis, as well as skiing; I realise I'll need a fair amount of rehab to get back to strength, but what's everyone's experience of the recovery time?

And most importantly I guess, I'd love to hear some success stories from surgery. I'm feeling pretty nervous about committing to surgery, but I know I can't carry on with all the leg pain, muscle spasms, severe restless leg problems at night and lack of sleep, so if its the only option, so be it. So many back specialists in the past have told me to avoid surgery whenever possible that I worry about the outcome.



  • aimlessaaimless Posts: 372
    edited 09/04/2017 - 9:25 AM

    I had L5/S1 anterior fusion 8 years ago, after a year of conservative treatments, and no regrets. I was mobile within a few days, and back to work in 8 weeks. I was SO NERVOUS about this surgery, that before taking me into the OR, my heart rate was 155 BPM - they had to really calm me down. However, best decision I could have made and my only regret was waiting to do the surgery. (In contrast, I recently had to fuse L4/L5 which had been bulging for years and finally disintegrated - and not nervous at all). One thing that helped with both surgeries was my confidence in my surgeons, and my absolute belief that the outcome would be positive.

    I'm almost 16 weeks post op from the L4/L5 surgery which was both anterior and posterior approach, and although I'm conservative at the gym, I'm pretty much back to normal.

    Re disc replacement versus fusion. The way my ortho surgeon explained it, we don't have a lot of range of motion at the L5/S1 level, so disc replacement versus fusion is less of a consideration than for other levels of the spine.

    Jan 2009 L5-S1 ALIF
    May 2017 ALIF L4-L5 with PLF rods added L4-L5-S1
  • memerainboltmemerainbolt IndianaPosts: 3,437

    Hi andyg
    Welcome to Spine-Health

    As aimless pointed out, will more damage be caused of waiting to do surgery? That is a question you need to ask your surgeon.
    Good luck tomorrow with the injection, I hope it helps you with the pain. Do some research, as we say here, arm yourself with knowledge. That way when you talk to your surgeon you will be able to ask the right questions. Go to the search box at the top right of this page and key in anterior approach or any topic. Make yourself notes and take them with you.

    Please click on the Welcome link below for more information.

    Welcome to Spine Health

    I'm sure other members will reply, give it time.

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  • Thanks aimless. It's great to hear your success story. I had the injection this morning; so far so good.

    The specialist was pretty sure I'd be seeing him again for the fusion op given the results of the CT scan. How long did it take you to get back to normal activities after your l5/s1 surgery?

    The specialist said he does the fusion arthroscopically. I'm hoping that improves the recovery time, as he said I should be back to work within a couple of weeks.

  • Hi andyg - I was able to walk about 3 miles/day about 3 weeks after the L5S1 fusion. I was back to work in 8 weeks, but mostly "normal" by about 6 weeks after surgery. Be patient with yourself though; activities like golf will need to come later (no twisting allowed post op). Follow the guidance of your surgeon for specifics. 2 weeks seems like a really short recovery for a fusion, but I don't know the specifics of your type of surgery.

    As for work, I have a desk job too but I get up about every 20 minutes. I commute in NYC so walking, standing, stairs etc all fine. My legs/quads got really weak after the last surgery, the hardest part has been building up that strength.

    Jan 2009 L5-S1 ALIF
    May 2017 ALIF L4-L5 with PLF rods added L4-L5-S1
  • Thanks again aimless. the doc said 2 weeks before returning to work, and 6 months for full recovery (by that, i think he means normal activity like sports, etc)

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  • I'm in the same boat. Have been putting off L5/S1 fusion for several years now.

    I had another RFA last Friday and if it doesn't provide significant relief, I will likely finally give in and have the fusion.

    I have an appt with surgeon on the 14th to discuss surgery further. What method is he planning to use. What does he plan to do (if anything) about the bulge atL4/L5 that's pressing on the L5 nerve root. How long of a hospital stay? How long will I have BLT restrictions after surgery. Those are a few of the questions I want to discuss with him.

    I also want to address my specific things wrong. Everyone always says you only have a fusion to fix bad nerve pain, not to relieve lower back pain. If you get relief of lower back pain, that's a bonus. I don't like that. The majority of my pain is in my lower back and butt. Lots of irritation in my legs, but that's less of a concern to me. L5/S1 is pretty much bone on bone. What little disc material left is bulging and pressing on the S1 nerve root. Due to the collapse of the disc, the facet joints are enlarged and are rubbing against each other. It seems to me that opening up that disc space with a cage and securing it with rods and screws would help with my lower back pain. Opening that space up should also give some room to the facet joints.

    Am I making any sense? Lol

  • star0210 - your problem sounds pretty identical to mine. i have had lower back, muscle spasms in my lower back and butt for years. but, in the last couple of months, after some long haul flights, i have near constant nerve pain in my left leg. not the traditional sciatic pain in the back of the leg, but more like what people describe as restless leg syndrome. During the day, i can kinda cope with it, but at night its awful. i feel like i want to stab my leg with something sharp. its like the worse possible itch you can imagine that you can't reach to scratch.

    the doc says that the disc space has collapsed (the CT scan showed nitrogen pockets, which implies there's no 'gelly' left), l5/s1 pretty much bone on bone like yours, the nerve space is impinged, and a bone spur is pressing on the nerve, which is probably what is causing the leg discomfort and numb toes. i asked about a disc replacement but he said the level of degeneration & the bone spur rule out the efficacy of that; and the best bet for me would be fusion.

    you make a lot of sense! good luck with the appointment on the 14th! i have heard of a few people who have had the fusion surgery, and all seem to have benefited from it.

  • I know exactly what you mean about the restless leg symptoms. It constantly feels like it needs to be massaged. For me, it's the front of the thigh, the back of the thigh, deep in the butt cheeks, and the outside of my calf. More on the left than on the right. At night it gets crazy...not every night though. I have yet to figure out what triggers it. The last time it happened really bad, my husband said I looked like I belonged in a straight jacket. Couldn't keep still, couldn't get comfortable for anything. It can drive you literally crazy I think. I have a prescription for ropinerole (generic for requip) that I take when it gets crazy bad like that. It works wonders. I'm pretty anti med, so I only take stuff when things get really bad. today I'm very uncomfortable. I gave in and took tramadol and tizanidine. Hoping I can get comfortable to get be able to get some work done.

    I had a laminectomy and discectomy in 2011 for a blown out disc at L5/S1. I still had good disc height at that time. Woke up completely pain free, but unfortunately, 10 months later I re-herniated it. It's no longer herniated, just bulging but wreaking havoc on my S1 nerve root.

    The last few months I've developed numbness in my left leg and foot and also my butt. It used to be only in my toes of both feet when I'd walk a lot. I recently had an EMG but it showed no active or ongoing large fiber nerve damage. It showed old damage. Doc that did EMG thinks I have small fiber sensory nerve damage.

    I'm praying my RFA kicks in soon and helps. It usually does help with the butt and leg irritation.

    I hope your injection works for you.

  • There are many approaches to lumbar spinal fusion surgery, and all involve the following process:

    Adding bone graft to a segment of the spine.

    Set up a biological response that causes the bone graft to grow between the two vertebral elements to create a bone fusion.

    The boney fusion which results in one fixed bone replacing a mobile joint - stops the motion at that joint segment.

    Spondylolisthesis Symptoms and Causes Video.

    Spondylolisthesis Video.

  • So the injection worked...but only about 75%. I'm sleeping through the night now which is a godsend but I still have near constant leg pain, albeit significantly less than before the injection. The niggling pain is a constant reminder that the surgery option isn't far away unfortunately!

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