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One-level spinal fusion @ L4-L5

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:24 AM in Back Surgery and Neck Surgery
:S

Diagnosis:
I have a small tear, smallish herniation around the degnerative disc along with some spinal stenosis.

History:
After several epidural steroid injections, 1 round of P/T, and several acupuncture treatments, I kind of had it when my back went out this last time. I was laid up for a week, unable to work or care for my 1 and 3 yr old kids.

Problem:
I got an epidural after my back went out in August and have been feeling great since, almost like nothing is even wrong. But this has happened before, and I know it's only a metter of time before it starts getting sore (before the shot I was icing my back every day all day and in ongoing pain)

Action:
I met with 3 different surgeons, 2 orthos and 1 neuro, and once I fell in love with the neuro went ahead and scheduled myself for a fusion on 12/9. The surgeon recommends 3-5 nights in the hospital followed by 6 weeks at home. He is not sold on physical therapy yet. He plans to go in through 2 small incisions on the sides of my spine, use a cage with protein powder and 4 screws - possibly titanium and possibly a newer kind that has a little more give (forgot the name if anyone knows it). He said the spine starts fusing between 3-6 months and at one year is as good as it will get. He said I will not need to wear a brace.

Dilemma:
Now I am reading all these posts from people who have had fusions and getting petrified into possibly canceling the surgery.

Advice:
I would love to hear from people who have gone through a similar surgery. I'd like the reality of what I'm looking at in terms of post-op pain and healing. What and when can I lift heavier objects? If there's no brace worn, how does the spine stay in place? How do you sleep? Do you need help dressing, showering, etc...? Please, any input would be appreciated.

Thanks in advance!
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Comments

  • Jen,

    The surgery your surgeon proposes is different in technique than what I had, as I had a posterior three-level fusion with two titanium rods and eight screws. So I can only tell you about my experience. Personally, I could not be happier that I went ahead, as all my pre-surgical symptoms (leg pain, stiffness, foot numbness) are gone. Don't let some of the posts scare you, there are many of us who had successful surgeries and are happy that we did as we are now so much better. Read as much as can about your surgery, ask your surgeon what kind of recovery you can expect, and take it from there. For me, surgery and recovery was easier than I expected, but then everybody id different. And yes, at first you have many restrictions, but you get used to them, just learn to do things differently than before. As you recover, the restrictions get lifted, e.g, at first I was allowed to lift 5 lbs, then 10, now almost 6 months after surgery my limit is 15 lbs.

    If you have any questions, just post it on this site, many people are eager to help you.

    Good luck,

    Kin
  • I had a fusion at L4-L5 on Sept 26, 2008. My surgeon went through the front and the back, using bone morphogenic protein and plastic cages, and in the back, metal rods and screws. I stayed 4 days in the hospital, and started feeling much better as soon as I got home. I have to wear a soft velcro brace every day except when sleeping. My surgeon does not believe in putting extra strain on the spine after a fusion, that it's not stable enough with out some form of brace, and then I will have physical therapy in a few months. I only have to wear my brace for 8 weeks, but I love it. I feel SO much better with it on. I needed help showering for about a week and a half. I'm almost one month post op, and I do everything myself now except lift anything heavy. I don't need help, unless I am like, looking to move furniture, Lol.

    The spine stays in place with hardware... Screws and rods. It's much more stable with a brace, and there is a higher success rate, but it varies by doctor. Some think that the core muscles lose their strength while in a brace, but for me, I've experience that to be false. My stomach muscles and back muscles are not losing any strength at ALL. So it's personal opinion and experience, I suppose. Post op pain first couple days is ridiculous. But they generally give you a PCA Morphine pump. I was on Dilaudid pills every 4 hours and Valium 3 times a day for the first 10 days home. Now I'm back on my 8 to 9 Percocet a day and then just one Valium at bedtime. I sleep on my back. It hurts to sleep any other way. Sometimes I sleep with my heating pad, since my staples were removed almost 2 weeks ago. First week or so home I was waking up in the middle of the night to take pain meds, and after that I was fine sleeping through the night.

    Oh, also, some surgeons say 12 months is the best it gets, and others say 24 months.

    Personally, I can't imagine NOT doing physical therapy after a major back surgery. Can't really see the downside to it. I'm glad my surgeon will be sending me. I think once fixing the actual physical issue, building your strength even more and getting back into pre op shape is a great idea. I couldn't imagine doing it any other way.

    Well, that's just my experience. There are sooo many people here with sooooo many different experiences and stories. Everyone has their own opinions on meds, braces, surgical approaches, types of doctors, pain, how long out of work, etc... Basically everything. There really aren't any definitive answers.

    Good luck :)
  • Jen,

    I had my fusion at L5/S1 done on 8/18, so I'm still in the recovery phase. To answer some of your questions:

    Post-op pain/healing: Everyone is different. I found myself being able to decrease from 8 percocets/day to 2 in a gradual process over the first 6 weeks. I've switched to Darvocet, but seem to have hit a plateau and still take 2 pills/day.

    Lifting: You will need to consult with your doctor to make sure what he/she wants you to do. I was limited to no more than 3-5 pounds for the first 5 1/2 weeks. Now, my limit is 10 pounds. Lifting is to be done from waist height - no picking up from below the waist or above the shoulders.

    Brace: My doctor had me in a hard brace for the first 5 1/2 weeks, now I am in a soft brace. You will get different opinions from different doctors about this. For the first few weeks when there is a lot of swelling, it would be difficult for you to bend anyway. If your doctor doesn't think a brace is necessary, I would trust them. My surgeon is not going to have me do PT, while most doctors seem to want patients to do it. He says I can do a home program and I trust his judgment.

    I sleep on my back with a pillow under my knees. If I switch to my side, the pillow goes between my knees.

    I did not need help dressing or showering, but did need help drying my legs and feet after a shower for the first 2 weeks.

    As you read posts on this site, remember that most of them are from people who have experienced some difficulties from their surgery. Currently, 95% of fusions are successful in the US and most of those people don't take the time to post their stories on the internet. So, while you are reading horror stories about complications, they are from a minority of fusion cases.

    I used posts on this and other sites for information, so I knew what I may possibly have to deal with. However, I took a positive approach to my surgery and recovery. I figured there was no reason to worry about things I could not control.

    Good luck with your surgery. I hope it helps.
  • and welcome to SH.
    Now you said you saw 3 surgeons, so what did the other 2 recommend?
    It just seems that a fusion is a big op for what you have (I'm not negating your pain at all as I know it is real) but is there any other surgery of a lesser kind that could help you.
    Also you dont say if you have tried PT as yet or had other treatments like accupuncture, chiro etc.
    Personaly I wouldn't head down the fusion track until I had exhausted all options and you will hear that from MANY of us here.

    With a fusion, you will not lift anything heavy till you are completely fused! You will need help getting shoes and socks on but other dressing is fine. Sleeping is an issue for nearly all of us at some time of another, lots of pillows and your own bed. No kids crawling into it.
    If you dont have a brace (I dont) your spine is supported firstly by the rods and screws then by your own muscles so it is really important to have PT to strengthen them as much as possible..

    I hope this helps you a bit.

    Blessings Sara O:)
  • HI!
    I had a TLIF at L3-L4 on August 5th. However, mine was not minimally evasive likes your's will be. I had both autografting and allografting, so my situation is different from yours in those respects. I was in the hospital for two nights, and was released on the third morning. I was required to wear a brace, which I could take off when I slept and when I showered. I was told to wean off of the brace at 8 weeks, and was given 4 weeks to complete the weaning process. At first my upper back would ache, but I actually was weaned off of it in about two weeks. I did need help showering, as I was not able to bend or twist, so I could not get the shower turned on. However, I was able to start bending slightly at the knees at about 4 weeks, and gained a measure of freedom from help in that respect. As far as dressing myself is concerned, I have been able to dress myself with the help of my "grabber" and the "thing that you use to put on socks". I actually used a walker to help me get up and down, and I did purchase an elevated toilet seat. I have not taken any pain medication since the third week. However, I do have a high pain tolerance. Actually, it was my hips and groin area that had the most discomfort, but acetominophen and a moist heating pad helped me.
    Since night one after the surgery, I have slept on my back with a pillow under my knees, and have had no discomfort from it. I guess I am lucky in that respect. A few weeks ago I wrote a post wondering if I was ready to return to my teaching job full-time next Monday. After starting physical therapy at 8 weeks, I feel much stronger, and have been teaching 5/8ths time. My superintendent has allowed me to keep my sub until Thanksgiving, however, and she does the bending and lifting for me :)))
    Only once have I had a reoccurrence of my post-op pain, and that was because I twisted when getting into the car. I still have the no bending, twisting or lifting rule in place. I have felt so much better since my fusion. But, I have been very careful and have tried not to overdo it.
    You are fortunate to have found this site. There are so many people here that can share their knowledge and experiences with you. I know that there have been many times that I have asked questions and received help. Just remember, however, that we are not doctors, and that everyone is an individual with their own unique experiences.
    I am sorry that I have rambled on, but I was eager to share my story with you. Good luck!

    Ann
  • You are obviously much younger than I so your recovery may well be much faster - however, I think some things are pretty standard. For example the restriction on bending, lifting and twisting lasts for several months - I am not sure how long but I do know that at 3 months post-op I am not yet allowed to lift anything above 10 pounds. The "no bending" is really the most difficult restriction for me - getting things out of low cupboards, the lower shelves of the refrigerator, the washer, dryer and dishwasher, if I drop something on the floor, etc. is a "no no" unless you are flexible enough to bend from the hips without bending the back. For some things you can use a "grabber" but it obviously won't work for things that will spill, etc.

    I also believe that most people, regardless of age, need quite a lot of help at home for the first couple of weeks after being released from the hospital. My surgeon did not even allow showering for 14 days after surgery (that was AWFUL) and even then no bath because sitting in a bathtub is too hard on the spine at that point.

    The pain of recovery seems to differ quite drastically depending on the person - I did not have much pain after the first 2 weeks. Some people do. But even without pain it is long and slow - partially because it is so important not to do anything that might prevent fusion from occurring.

    I would advise anyone considering this surgery to talk to doctors about all the conservative options that can be explored before going ahead with surgery. If there are no good options then go into the surgery as prepared as you can be for the recovery period and all that it entails. For example - the list on this site of "Post Op Must Haves" is excellent and quite accurate.









  • I'm getting a 2 level Fusion (TLIF)on December 4th and I'm also scared to death, not about the actual surgery, but about the results. I personally think you need to go into this surgery with a positive attitude otherwise you will be a basket case by the time everything is done (hopefully for the best.) I have also noticed all the bad stories on here about bad results but you have to realize, everyone is different. Since this is your first surgery and they are doing minimally invasive, I think you have a good chance at a good recovery. My Doc told me just about the same things in regards to recovery, he also said the first two weeks after surgery will be the worst pain wise. Hopefully you have someone around that can help you the first few weeks, because he told me to pretty much do nothing during that time. He also said nothing about a brace (maybe that has to do with it being minimally invasive?) Good Luck!
  • The reason you see all these horror stories is those who have great results are busy going about their life and not posting. I am scheduled for a 360 degree fusion L4-L5 11/10/2008.
    I am not the least bit freaked out by the forum, I look for the experiences and advice and don't dwell on the individual results. Technology has improved as well as surgical procedures so please try and stay as positive as you can. Attitude is a great indicator of how well you will do. Remember, not all surgeons are equally skilled and educated. As far as post-op, getting someone to stay with you for a week or two would be great, you will need it. I will not need a brace and can walk some within the first two weeks. Showering shouldn't be an issue if your shampoo and stuff is at the proper height. Have lots of pillows for comfort since you will be resting a lot. Follow your doctors instructions and the nurses recommendations. I will let you know how I do after my surgery.
    Best wishes
  • I am just 4 weeks out today of a level 2 ALIF on L4/5 L5/S1 with cages and BMP with screws and caps.
    Every day is a challenge, don't get me wrong. I got a hospital bed for home, as I had 2 levels. I was in the hosp for about a week cause of bowel issues, but other than that, I would have been home after 3 days.
    I needed help dressing the first couple of days, but I really just stayed in my pj's as I slept most of the time. I had help showering the first couple of times, mostly for washing of the back and legs.
    I squat instead of bending, and I do not have a back brace which I think is better because you are using your muscles and it will heal faster.
    They went through my stomach for my surgery, so I kinda am assuming that your recovery might be easier if they are going through the side with 2 small incisions. I have a 9 inch incision on my stomach, so there is a huge difference. Either way though, it is major surgery so never take it lightly. Fusing also goes at different rates too.
    Also, everyone heals at differnt rates and has their ups and downs. No one 2 people heal the same way at the same pace.
    I am having issues right now that I am going to post, but don't ever get discouraged just because someone else is having problems.
    Listen to YOUR body, and do what it is telling YOU and only YOU to do! Just because some have had issues, doesn't mean you will, and there are a lot of people out there who have had very successful fusions, but don't keep writing on the forums. I wished that they would for some of us who do get discouraged, but they don't.

    Well, I hope I kinda helped you out.
    Take care, and keep me informed! I'm here for ya!

    Kim >:D<
  • I didn't have the same surgery you're thinking about having, but I'm not sure I would put too much trust in the "6 weeks" thing. It is a long road to recovery. I'm at 4 months now and, if I had a job, believe I could think about returning now. That said, if you go to the "Good News" section here, you will hear a lot of success stories. Best wishes to you, and keep us posted, ok?
  • I didn't have the same surgery you are contemplating, but don't think I'd put much trust in the "6 week" advice. It's been 4 months for me and I have just gotten to the point where I can think about going back to work.

    Be sure to check out the Good News section on SP...you'll hear about a lot of successful surgeries.

    Best wishes to you, and keep us posted.
  • Hi Jen,

    I had a 3-level fusion and laminectomy at all levels in mid-June, and I am STILL healing. I'm still sore! I have fatigue (somewhat like the flu) in low back and both legs at times - at others, I don't feel so badly. I'm now in PT - two steps forward, one step back. Very slow process, and one that you cannot (and should not) push. I don't always have pain, per se, but discomfort and fatigue. I have difficulty communicating my physical and psychological states to my surgeon, to my wife, my kids, etc., but that is because I don't fully understand it all myself. It all can be very confusing.

    I had a similar experience to yours, went through a diskectomy and foraminotomy, epidurals, spinal stimulator, etc, etc...one gets very tired of trying to find the "right" solution.

    My advice: I got to the point where I KNEW that I had no other alternatives to fusion. Believe me, when you're at this point, you really do know it. In my situation, I was fearful that I'd lose my job, because I was so distracted by pain, I was having trouble functioning - both physically and mentally (always both at once). When health concerns like these adversely impact your activities of daily living (even the simple things like walking) you do what you need to do. BTW, 3-5 days in the hospital is not that unusual. I was hospitalized for 3 days - but that is because I convinced my doc to let me go home. :) The recovery is painful and challenging, but with the right meds, you will do just fine. For me, it was truly amazing how quickly I was able to get up on my feet and begin walking (I can tell you that the day after surgery, I honestly thought I'd never walk again)!!!

    I wish you the best decision, and fast recovery. Everyone has their own journey with spinal fusion - I have read many posts, and have learned that many share my experiences and sentiments - and many others have different ones.

    God bless,

    Mike
  • Hi Jen:

    I had a one level TLIF L2/3 with hardware just over a year ago. I did not experience severe pain after surgery. I fused in 6 weeks. I wore a brace for the first 6 weeks when I was up and when I was walking. I also wore it in the car through the first 6 months. The doctor ordered PT at 6 weeks.

    This is a long recovery process. I have had many other (unrelated) surgeries over the years and this was the hardest and longest to recover from. It just takes a long time and you have to let your body heal. If you overdo it at any stage you will know it. You will need ample help for several weeks when you come home from the hospital.

    Ellen

  • I had a ALIF at L5/S1 on 10/2/2008 with hardware.

    the first few days post op i felt great, i was in the hospital until about 6pm on oct 5th. I had a self medicating pump thingy and percocet for breathrough pain in the hospital and i hardly felt a thing until i moved around but i had a cath in and didnt have to move if i didnt want to. lol.
    Physical therapy ppl came and got me up and walking after the first day, and it hurt but it wasnt horrible. Once i got home and all the pain meds wore off i was really hurting the first day i didnt even make it out of my bedroom. just in bed and to the potty. the second day during the evening i came out and layed on the sofa for a few. thoes two days were really the worst and once i got through the first week i was feeling pretty good.
    The vascular surgon told me i am not supposed to lift anything heavier than a jug of milk for 6 weeks, which is ok because back dr said no lifting bending or twisting for 3 months
    I have a soft brace that i have not worn for about a week and a half, i was told i needed to wear it for 2-4 weeks.

    Everybodys expieriences are different, so im not sure how yours will be if you have any questions you can message me. Good luck :) Kristi
  • I'm about 8 months post L4-L5 fusion, and happy to share my experiences with you.

    I was fully fused about a month ago; the x-rays show good bone growth around the facet joints and in the other areas where it is supposed to grow.

    My surgery was a TLIF, done by an orthopedic surgeon who completed an additional year of fellowship training in spine surgery. He does spine surgery exclusively, around 300 procedures a year.

    Was the recovery painful? Yes, the first few weeks were tough, but the pain medication controlled the pain pretty well. My surgeon has his patients walk a mile a day from the day after surgery. Painful, but necessary to prevent blood clots and promote healing. I wore a brace for the first 8 weeks, but have come to find out that surgeons get good results without them: My sister had a PLIF at L4-L5 just a few weeks prior to my surgery, did not wear a brace, had no requirement to walk, had limited PT, and she, too did well. Different surgeons, different training, 1500 miles apart.

    More on pain: After I was off the pain meds, there was still pain for several months as I underwent 6 weeks of PT, 3 times a week, to rebuild my core muscles. I had lost about 8 pounds of muscle in the core area while in the brace. (So having a surgeon who doesn't put you in one may be a positive in speeding your recovery!)

    The PT was painful, because the muscles and nerves were reawakening and being pushed and prodded around. In addition to the PT sessions, I worked out on my own every day, walking 2 miles (Doctor's orders), and doing the stretches and exercises the PT taught me. The pain was tolerable, but the muscle spasms in my back were bad. My surgeon put me on Soma, a muscle relaxant, and that helped a whole lot.

    Restrictions: Nothing heavier than 5 pounds during the first 8 weeks. No bending or twisting. No housework. Wear brace while standing or sitting. No sitting for more than 20 minutes at a time. Showering ok with assistance.

    Your specific questions: I got clearance to lift up to 20# after PT (14 weeks postop), and had no restrictions except good sense as of Oct 2. As I said, I wore a brace, but what really keeps your spine in place are the screws and rods the surgeon installs in your spine. You'll find sleeping on your back will be most comfortable at first, but you can turn onto your side as the pain decreases. You can dress yourself in loose clothes with the help of a "grabber." Having one is essential! You'll need help to put socks on at first, but then can use another handy tool that helps you slip them on without bending. I don't remember what it is called, but ask the folks in your surgeon's office. I had a walker, but did not use it except to hang on to as I log-rolled out of bed.

    Bottom Line: I am essentially pain-free, can do pretty much whatever I want to, and really glad I had the surgery. The pain of spinal stenosis just ground me down. The two keys, I think, are the surgeon and really working on recovering and getting strong again. You have to feel comfortable with your surgeon. If you have any reservations, see another surgeon. My surgeon gives each of his patients a looseleaf binder full of information, does and don'ts, and what to do to speed recovery. My wife is an RN, but the surgeon still arranged home health nurse visits for the first 4 weeks. He and the people he has around him arranged everything, made me feel like everything was going to be done right, and were always available by phone or email.

    Please feel free to ask any other questions. You can get a lot of information on these forums!

  • Jen, as you can see from all the replies, we all have different experiences. I had fusion L4-5 for spondylolisthesis on Aug 5. I was in the hospital for 5 nights. I had the PCA dilaudid pump, then Norco 20 mg every 3 hours. There was a lot of pain, but the meds did help. I had a catheter for 24 hrs. I walked the day of surgery. I had help at home for 1 week. I used a walker for 2 weeks, mainly because of fear of falling. I was in a hard brace for 8 weeks, then weaned over 2 more weeks. My muscles are notibly weak throughout my entire back. I am going to pT to try to strengthen them. I have been off work for 11+ weeks and think I need a few more before I can return. I am a RN doing bedside care. My restrictions were no BLT for 8 weeks, now I have no restrictions, but am using good sense and being careful. I also have been doing aquaPT on my own since 4 weeks post-op. The water is a great place to rehab a bad back. If you have tried conservative measures, and all else has failed, then I would consider surgery. You can read my signature to see all I had tried pre-op. My first 3 steroid injections gave me temporary relief (2-6 weeks), but the last one did nothing for me. The major deciding factor on top of this for me was my spine had become unstable per flexion/extension xrays.

    Good-luck to you on your decision. This is great place for support. >:D< Sue
  • Jen
    Hi I wanted to give some in put on my surgery. I am 26 when I was 14 I had real back problems and got sent to a nero surgeon and they wanted to do a 1 level L4 L5 spinal fusion but because of my age my parents decided against it. I have something called degenerative disc disease and at that time it was only one disc now at 26 I had 3 bad disc with all 3 bad joints so once again I went back to the same office and they told me no surgery this time around I had to sux it up and deal with the fact i have a bad back. I went to another nero surgeon and he told me I need L4 to L5 fusion with removal of the joint I had that done 11/26/08 its been 3 weeks almost pain free I take my pain meds maybe once to twice a day if that its been a good recovery I do recomend the muscel relaxer at night it does help with moving around at night but I got sent home with 5mg felxeral and 7.5 lortab the felxeral has been a god sent. the lortab I could take it or leave it. After the surgery I had 100% of the back pain and leg pain gone all I had was pain from the surgery. I have to wear a brace for 3 months any time out of bed. I have a high rise seat for going to the bathroom which was a good idea and i have a walker when i go out but i use it to get up from my bed. I had my surgery at a great hospital and I really liked my surgeon I think that plays into account. The only other treatment I have had with my back is a few years ago I dropped about 50 pounds and when to pt a few times.
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