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l4-l5 l5-s1 spinal fusion

mommatialuvmmommatialuv Posts: 269
edited 06/11/2012 - 8:34 AM in Back Surgery and Neck Surgery
Hi All,
I am new here, site looks great.
I am scheduled for a l4-l5 l5-s1 spinal fusion on 8/31/09.
I have constant low back pain with primarily left leg pain numbness tingling. Pain/tingling never stops sometimes i cannot get out of bed or walk. I still work, secretary, but have to wiggle or get up often due to the leg symptoms.Cannot stand or walk for more than 15-20 minutes without severe pain in back and legs(mostly right)
my ct myelogram showed:

Bilateral pars defect l4 and l5

anterolisthesis at l4-l5 and l5-s1

disc bulge/psuedobulge at l5-s1 lightly contacts the s1 nerve root sleeve left>right

Bilateral neural foraminal stenosis at l5-s1

Bilateral facet arthropathy and adjacent subarticular cystic changes at l3-l4 and l4-l5.

My understanding is that the fusion will "fix" the L4 thru S1 problems,but what about the facets and cyst at the l3-l4.
Is it possible to safely have a triple level fusion?
What is the difference in post op mobility from 1-2 or 3 level fusions.

Has anyone had multi level fusion and how long/ severe was your recovery.

I am 45 years old with and active 4 year old boy at home. Looking form "normalcy" again, you know playing on the floor, walking through the zoo etc.

Thoracic findings were:
Multilevel degenerative spondylosis.

Schmorls node at the t7-t8 with a 2 mm left posterior lateral disc- osteophyte at t7-t8. this mildly effaces the ventral thecal sac without spinal canal stenosis.

Left posterolateral disc protrusion at t11-t12 without spinal canal stenosis.

I find very little info on thoracic spine issues, any info or experiences will be appreciated. Doc seems to think these findings are normal wear and tear. I often have arm pain and a feeling like a band is being tightened around my chest/back. Have made several trips to the ER thinking it was my heart, but the heart is great ... woo hoo :)

I look forward to responses.
Thanks in advance.



  • The reason that fusion is being recommended to you is because of the pars defect that you mention, and the resulting slippage that is occurring at L4-5 and L5-S1. This slippage results in a narrowing of the central canal, and there is also foraminal stenosis at L5-S1. All these things contribute to compressing the spinal nerves that are causing your leg pain.

    Apparently your surgeon does not feel that the issues at L3-4 are causing you any pain. Surgeons will usually fuse as few levels as possible as the success rate goes down as more levels are fused.

    Where you are being fused, there is basically no difference between fusing one or two levels. The L5-S1 level is required to move very little even when completely healthy. If you were to add L3-4 to the equation, you would notice more stiffness and lack of mobility. But fusing L4-5 and L5-S1, you shouldn't notice much difference, if any, from your normal level of mobility.

    I cannot comment on thoracic problems...but the report just looks like generalized wear and tear that we all start to get from our twenties on....sad, but true. :O

    Just one further comment about fusion: you will be disappointed with the outcome if you expect the surgery to restore you to the way you once were. In most cases, back surgery of any type will not restore the patient to the condition he/she was in prior to injury or onset of pain. Fusion is done because there is instability in the spine. It is a fairly brutal surgery and requires a long recovery period. The outcome of any back surgery is not guaranteed. The surgeon can only give you statistics.

    So be sure to do your homework. You might want to get several opinions so you know what is being recommended is the right procedure for you, and that the spinal specialist you select is very well-qualified for the procedure you will be having.

    Please post often with any comments or questions. Many of us have had fusion and will try to help you as best we can.

    xx Gwennie :H
  • I have a three-level. If you can get by with less, I'd say go that route. Perhaps they can remove your cyst and remedy some of those problems without having to fuse you. I call my recovery from the three-level fusion a long, slow crawl out of hell. It was grueling and, at times, gruesome. I still have difficulties trying to do many of the things I love. I can't walk very far without getting all tensed up. I'll never run again. I can't really lift and carry groceries or anything else. I can't sit for extended periods. I am in lots less pain and I can walk without my legs catching and sending extreme jolts of pain down my legs. I used to get "locked up" and would be left holding onto a wall (or a cane) until I could let the pain pass and finally attempt to move again. Life is a lot better, but it's definitely different.


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • correction to my first post, most of my pain etc is on the left not right.
    I dont expect to be able to do all the things i used to, just some basics, like walking for more then 30 minutes.
    I have gotten a second opinion with the same recommendation.
    I was told a couple years ago that i would eventually need the fusion. it has just increased from 1 level to 2 in only a couple years.
    It has been very frustrating to me to loose so much of my independence, i never thought i would miss standing at the stove to make dinner or bending over to pick something up off the floor.
    sorry, I dont mean to whine, :''( but some days it is feels like i waste all my "good time" working and by the time i get home there is nothing left for my family, i have to just take meds and go lay down.
    Im hoping after healing from surgery things will be better.
    I currently use a walking stick for a walk around the block with my son, it is a 20 minute trip that causes extreme pain and completely wears me out.
    Have most folks been able to return to work?
    thanks again for your insight. ;)
  • I had a 2 level fusion over a year ago on L4-S1 due to problems such as recurrent herniation from a previous microdiscectomy, retrolisthesis, S1 nerve compression, and severe DDD in those levels. Unfortunately for me, I didn't get any relief and scar tissue formed which caused me additional pain and grief. I already had nerve damage in my right leg.

    Anyway, I totally agree with Gwennie about spinal surgery. And you're not guaranteed 100% pain relief either. My surgeon told me that I'd feel better, stay the same, or get worse post op. I one of the few who felt worse afterwards even though some of my back problems were fixed. Once you have surgery, you back will never be the same again. I'm not familiar with ADR or 3 level fusions. All I know is that the more levels they fuse, the more complicated it is.

    To this day I suffer with chronic lower back pain and sciatica. My right leg is weak so I use a cane all the time to avoid more falls. I'm hoping to have surgery to implant a pain pump in order to improve my quality of life.

    I hope I didn't scare you off or anything. There are success stories around and many have been able to lead next to normal lives free of having to take pain killers. The best thing you can do is research all you can and maybe seek a second or third opinion so you know that you're getting the best advice.

    One more thing I want to add is that you will need plenty of help after you have a fusion. It's best to round up help from everybody you know because you will need it. I couldn't take a shower without help for a few weeks. Doing chores and cooking is very difficult early in the recovery. You doctor may let you drive short distances in around 2 weeks but this varies between doctors. Be weary of overly optimistic recovery times and time periods of returning back to work. It may take more than 6 weeks to return to work. From my experience only I would say in the very best circumstances that somebody could completely recover in 6 months. Often it's more like 12 months, and the nerves can take up to 2 years.

    I hope your surgery goes well and you fully recover from it all. Take care
  • Meydey - Nice Post! I had a spinal fusion on Feb 13th, 2009. I am so very frustrated a majority of the time....the disc pain is gone though. I just have some other lingering issues that are pushing me to the edge. Has anyone given you any advise of the sciatica? This is one of my chief complaints right now....I just cant take it. Are they offering you any options??? I was back to work part time at about 8 weeks. The sciatica flared up once I went back to work and it is making work VERY hard to handle. I was just wondering if you were given any options regarding the sciatica??? pghkim
  • i have not heard anything from the docs about what to expect post op except a long recovery 3-4 months to go back to work but at least a year to be fully fused/healed. I have an appointment 3 days pre op to "go over details" this site has been very helpful. I dont think i will be talked out of surgery, just praying for a good outcome. I have constant pain and poor quality of life now so hoping for improvement.
  • Hi - I had this same spinal fusion back in February. Was trying to figure out how to chat with you online but cant seem to figure it out eventhough I am an IT Manager??? I wanted to offer you my other contact info in case you need to chat before or after your surgery. I would have been so happy to have someone to talk to back then (and now)Over all surgery is worth it.......it is a LONG and VERY tough haul. I was not prepared for it.... I am from Pittsburgh PA and would be happy to talk with you at any time.... You just may need a spinal fusion friend! Hope to hear from you.......~Kim
  • I'm about a year out since my PLIF L4-S1. I can honestly say my Low Back feels great. I still get sore/tired after a long day on my feet but what 5 minutes would do to me last summer I have all day to do it now.

    One of my friends said at 2 years I should feel even better. It is a brutal. There were days that I wondered why I did it. My NS was great and kept me in pain meds till I didn't need them any longer.

    I recently started having Thoracic/Cervical issues again. Not quite sure what is going on yet.
  • well i have been reading threads every day and have been through a wide range of emotions the last 2 weeks. I have just 1 week to go and feel like i have a fairly good concept of what to expect. i have read the good the bad and the ugly,and even some pretty funny stuff. my outlook is positive, yet realistic. I have a few questions for the doc on Wednesday when i go for my pre op appointment. You all have helped me more than you can know. Thank you. I will continue reading daily as well as keep you all in my prayers. Happy healing to all.
  • I hope things work out for you...
    Stay positive and about any proceedure.... U never know until you try.
    Hope u get the relief u need.
  • Yeah it's finally here. I go to the doctor tomorrow to discuss my surgery. I know it will hopefully be sometime in September. I know when I talked to his nurse about a month ago, she said all of sept. is open, he just has to make sure a neurosurgeon is available. Please wish me luck. Good luck to everyone else on here. :)
  • good luck wildcat, keep us informed/ updated
  • Well I had my appt yesterday, and the doc wants to go ahead with a two level fusion.When he saw that the L5S1 was also a problem, he said he was surprised, he knew that L4L5 was a problem, so thats when he talked about the two level fusion. Its workcomp related so once they approve it which wont be long according to my lawyer then they will schedule the surgery. I was wondering how long the surgery will last, if anyone knows. He told me I would at least be in the hospital 4 days, if not longer, and said I wont be able to bend, lift or twist for three months. He also wrote me an order for a handicap hanger for my car, which helps out a lot, especially when I have to go out and about. Since having my discogram 2 wks ago, I am no longer able to drive, which is depressing, but a good thing, I am taking dillaudid for pain. So it wouldnt be a good thing if I drive. :)
  • It can be depressing, but hopefully, you'll have a fairly good outcome and you'll eventually feel lots better. There are lots of success stories here. You don't read a lot of them because most of those folks bust out of their pain and don't come back here to talk about it. They get on with their lives. I figure for as much surgery as I had (and believe me, some have had more levels and more painful times than me), I've done fairly well. I keep coming back to check on how others are doing. Compared to how I was before surgery, I have very little pain. I have a lot of stiffness, which is one of the major problems with multi-level fusions. It's one of the reasons a lot of doctors won't do more than two levels at the same time.

    Hang in there!

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Today I spoke with the surgeon's nurse and I had asked her if she knew about when I would have my surgery, and she said around the first part of October. I was like what and she said this certain doc was booked full for the month of September. He only does his surgeries on Mondays and Wednesdays. She also told me that two weeks prior to surgery that I would go up for testing and meet with the anesthesiologist. Then it wouldnt seem like a long time til surgery. I am kinda glad it wont be until then I am really not looking forward to it. Plus my daughter's bday is in November and I would like to get her shopping done, and some Christmas shopping beforehand.
  • Man i cant believe that in two weeks i will be having a 360 fusion L5 S1, and I am getting scared. I found out from the doc's nurse that my mom cant stay with me after all due to the hospitals protocal, the only way she can is if I get a private room. And I wont know til after surgery. I am getting pretty nervous. My mom is going to let me use her IPOD, in case I get bored. Any suggestions would help. Monday I go in for my pre surgery appt. Thanks
    L4L5 lami and discectomy in May 08
    Reinjured March of this year, found out that L5 S1 is also damaged
    Mom of two kids
    Lives in NW KS
  • Well I had my appt for surgery. I was there for 3 hours, it was crazy. I met with the doc's PA, and he was such a jerk. He kept asking me if I wanted to go thru with the surgery, I was like would I be here if i wasnt. Im glad I was able to get the presurgery paper work out of the way. And I found out surgery is scheduled for 7 15 am next friday. Thank goodness, at first I thought the nurse told me it was at 9, Im glad I found out the real time. I'll be glad when this is all over.
  • Ok i am just tring to find out any information i can on this kinda of opeartion. He said that he may go in from the front and the back but was not sure yet .He did tell me that risk and that the one from the front will have better chances of not losing as much leg strength, BUT i am lost kinda dont like the idea of two incesions. I have already had two previos back opeartion but did not take care of the issue so now we are going to do a fusion. Can anyone tell me ANYTHING about this .What to expect he said i would be in the hospital about a week and then he may keep me there up to Two weeks for therphy before i can go home but maybe less . He is a very great doctor
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