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Questions Concerning Anterior Lumbar Fusion

caburdet78ccaburdet78 Posts: 6
edited 06/11/2012 - 8:46 AM in Back Surgery and Neck Surgery
I am considering having a Anterior Lumbar Fusion in a few months at the L5-S1 level.

I have had the laminectomy procedure twice ('02 and '09) on the disc and the neurosurgeon said that a 3rd time was a 50/50 shot and perfers not doing those surguries with those odds(I only got 3 months out of the '09 operation). Before my second operation and after it started again I have tried PT, cortizone shots,and acupunture with no success

My concern is the fact that I am a very active person, I teach Spinning at the Y and started doing Triathlons in '08 (have had to sit out the past two summers '09 and this year).

Because of this I am leery about the whole fusion and was hoping the Neuro would want to do a disc replacement but he does not like that. This is I need relief...have been dealing with this for a year and a half (including the 3 mo. period after my surgery end of June '09)...I have not had a decent night sleep w/o being medicating and have consistant tingling/numbness/shoting pain in the leg.

sorry about the long and probably meadering post...but thoughts?


Just looking for feedback and


  • You may want to discuss with your Dr. what you might have to alter in the future for your spine. Regardless of whether you have a fusion or not, from personal experience I can tell you that you will need to take special care of your spine. Just the idea of running and the force to the spine make me cringe.

    I have had both a PLIF (L2-L4) and an ALIF (L4-S1). Being a "spiney/neckie" for quite a few years now I have had to make many concessions in my daily life for the sake of my spine. I have no regrets on having the surgeries, they were necessary to stabilize my crumbling spine.

    There are many helpful people on this site, I'm sure you will hear from them. Keep asking questions! We are here to help and support.
  • Hi,

    Lisa gave you good information in her first paragraph.

    I have read that they generally don't do disk replacements on the lumbar spine because of the loads involved.

    I have not heard of doing just a anterior approach fusion. Usually when they do a anterior approach they also do an approach from the rear and put in rods and screws. Doesn't mean it can't be done but I've not heard of it.

    I would think you will need to alter your activities in regard to your spine. Did you notice that you started slipping into more pain once you stated the triathalons? I would think that would be extremly hard on the spine, especially the lumbar region. You need to get your answers from the surgeon you are seeing. He should be able to tell you what's what. Lots of people have more problems, even after having a surgery done, further down the road. For me I wish my surgeon's had said no more of this or that so I would understand what was taking place was a life changing event. A lot of surgeons paint a very rosy picture in my opinion.

    It would also pay to get a couple more opinions, from fellowship trained surgeons, before you decide what to do. You don't mention your age but I'm sure that will also play into what happens.

  • You have a great thought process and are thinking of the right questions. It may be time to seek out a few alternative opinions.

    I've had 2 microdiscectomies on L5-S1. The 1st got me very little relief (I either reherniated in the 1st 2 weeks or a piece was left behind). I've heard some doctors will do a 3rd MicroD but the odds do drop significantly as you are saying.

    If mine fails again, my options are
    - live with this an hope over time things get better.
    - do TLIF (my surgeon does minimally invasive fusions is possible...incision/muscle impact is small but rods/screws still make it a big surgery).
    - ADR which my surgeon doesn't support (I knew this when I picked him for the 2nd surgery).

    My surgeon is hoping this last surgery works indefinitely. But if not, he's hoping to buy me enough time so that I have other options and ADR is more 'reliable' in his mind.

    ADR is a big procedure. They need a vascular surgeon b/c it is done through the front and they are unsure what to do if it wears down.

    I'll be back later.
  • thanks for the feedback so far...

    I am 32 years old

    I got 7yrs from the first procedure and was hoping to get the same from the second one last year.

    going to the neuro is my second opinion because I felt my ortho had given up...but my neuro and ortho work together so they are going to consult together about my case

    I don't think this is going to clear up on its own
  • Sorry to be short before but I was at work.
    I would recommend getting a distinct opinion.

    Meaning...find another practice to get a 2nd opinion from. Don't laugh but I got 7 opinions before my 2nd surgery. 50% said fusion and 50% said revision. I knew I could potentially face a fusion at some point and my initial surgeon was out of network. So I thought...I should do my homework.

    My initial surgeon told me..."go get another opinion. I'm human so I think it's important you feel comfortable with what I'm telling you."

    Anyhow, surgeons in the same practice will, in general support each others recommendation.

    I'm not saying it will clear up on its own but you may get different opinions on approach - ALIF (axial/front) vs. PLIF/TLIF (back). You can also ask them about ADR and XLIF which are less 'accepted' in the US really b/c they just don't have enough statistics in the US so some insurance companies don't take it.

    Each doctor is different as well as your situation. For me, no doctor would even do an ALIF b/c while it leaves your back muscles in tact, it's a big surgery for your other organs. Also, for me, my spine is stable except for the DDD and very little remaining disc.

    Visiting several doctors gave me a chance to take a breath and ask questions about

    - the procedures such as how long, what could go wrong, how many days in the hospital, how long recovery before they'd clear me for work. What material would they use to help the bones fuse. What the success rate was, how was success defined.

    - it let me consider/ask how my lifestyle would change

    - I asked what about the future...20 years from now?

    - what about domino effect? how sturdy was my disc above it?

    - how the doctor approached therapy and pain mgmt

    Long story short...it gave me a chance to run through the what ifs and what next so that I could understand how my surgeon would approach my future if I continued to have problems.

    I also reached out to get a remote opinion from a well known spine clinic. You might want to check into it. As long as you are under the care of a surgeon, some spine clinics wil allow you to ask for a remote opinion. I found it to be very useful.

    Good luck.
    (I'm 41 and the surgeons I spoke to felt I was too young for ADR. But I've known others on here that had it done younger than both of us. My biggest concern is what will they do if if the Artificial disc fails....do they know how to remove it? Is it safe to try to fuse around it? etc. I think ADR seems more logical...it just seems that in the US, they need more information about what to do when the ADR 'fails' or is at 'end of life'...like 20 years from now).
  • That's really good feedback you've been given.

    I had an ALIF on L4-5 last year and it's successful. I fused within the 6 month period. However, it takes 12-15 months for the fusion to become really strong.

    I'm much older than you and haven't participated in triathalons, but when I was young, I used to do a lot of jogging and high impact aerobics. Over the years, I've had to modify activities, and since fusion, modify them again, and I'm happy with the changes. I'm enjoying life again but at a different pace.

    If you decide to go ahead with the fusion, then there will be a long recovery period and you will need to take special care of your spine for the rest of your life.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • How limited could I be? Seeing as it is the L5 which is the issue one would think it would not limit flexibility too much.

    If I go withn the surgery I would want part of the recovery to be oriented towards a Sports PT direction
  • We all heal differently, so can't say how your flexibility may be limited. Only your doctor can help you with that.

    With L4-5 fused (and the degeneration of the adjacent levels), my flexibility's pretty good, but it soon lets me know when I've done too much or stretched too far. Because of all the years of pain, I don't push my limits now, but I do enjoy being active every day.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Hi Caburde78,
    I struggled with the same feelings for about 5 months before I had PLIF L4/L5 spinal fusion on May 19th. What I found comforting was the power of information. I read all I could, got (4) consults, (3) from different ortho-spine surgeons, and (1) from a neuro-spine surgeon. All said that same thing after seeing my history and MRIs, x-rays etc... So that was good, but they all had a very different story about the recovery. I did end of going with the surgeon that was most optimistic. I also took into consideration, my very good health, non-smoker, gym-rat 5 days a week even in the considerable pain I was in, relative youth (46 yrs old), and the fact I had never had surgery on my back before. Plus over (4) years, I've tried modality under the sun that was conservative. I do pray alot, and had faith in the surgeon that did the surgery. I called it my very calculated risk. The flip side of no surgery is more pain, more disability, more sitting on the side lines, more very low key vacations and an inability to really take part in life with my two kids ages 16 and 13 and my husband of 18 years.
    It's a journey. I did it, I have no pain what-so-ever, the recovery is long. I am still in recovery, waiting for my 3-month visit and hopeful semi-release from surgeon's service to start out-patient PT. I would say being a (A type) person, the hardest for me was asking and receiving help. The key is help. I was so lucky to have (5) weeks of family in home to really deal with the nitty-gritty of life and let me heal slowly with no demands or time constraints. Following the rules (NO BLTs) bending, lifting, or twisting is harder than you think. At 10 weeks, I have considerable flexibility in my back and extention. I walk about 3 miles every other day, and go to the gym the other days and lift very light weight while sitting and get on a recombunt bike for 30 minutes. I'm working myself back up. Sorry to be so long about this message. I hope it helps you. PM me if you'd like to talk some more. Take care. Best, mel v.
  • I am going to try and get an appt with the Sports Med Dr at the practice where my ortho who did my last surgery if nothing else just to get his an opinon as an MD and athlete
  • One of my concerns after both of my surgeries was being able to play golf again. No, that's nothing compared to triathlons, but it can be a problem for spineys with the bending.

    After my cervical surgery, I was back on the course in six months but then began having lumbar issue. So then I had a TLIF at L4/5 and started PT six weeks after surgery. One of the things I specifically told my surgeon was my concern about again, not being able to golf again. He talked to the PT and part of their therapy was teaching me how to golf, taking into consideration the rods in my back and the plate in my neck, and not hurting what had been done.

    I started golfing four months after surgery and not play a couple of times a month. The PT did a great job of teaching me a new swing that can accommodate both my cervical and lumbar issues and my hubby thinks I'm actually hitting the ball better, even though my swing definitely looks like I'm favoring my back.

    So, PT can do wonderful things to help you get back into sports, but I'm sure there will be limitating you'll be facing for the rest of your life. Jarring your spine will probably be one of the most difficult things you'll be facing with running and such.

    Take care the good luck with everything. Please keep us posted.

  • I now have an appt with the Sports Med Dr who works with my ortho surgeon...hopefully he can give me some additonal feedback on my situation
  • Like you I was a very active person, ran 3 miles a day, played volleyball, and many activities with my 5 children. I had anterior lumbar fusion and disc replacement of L4-S1 in May of 2009. My surgery was damage control and like others have posted, you need to take care of your spine before and after surgery. My doctors were very up front about their concerns of my active lifestyle and told me that running and other physical activities were out!!!Walking and light water therapy(no swimming) are about all the physical activity I get and believe me, sometimes thats even to much. I had to come to terms and accept my new lifestyle, which Im still ajusting to. I know this is not what you probably want to here but thought I'd give you an opinion from someone who has had ALIF and ADR.
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