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Double Fusion anyone???

I've been suffering from severe low back pain and sciatica for over 8 months now, have had to microdiscectomy surgeries with a laminectomy during the second surgery and am still in pain. My surgeon says theres not much disc left at l5s1 and there is alot of pressure at l4l5. His PA says an l5s1 fusion would help, but I may want to consider getting the fusion from l4-s1. Has anybody had this fusion done before? If so, what are the limitations after the full recovery? The reason I ask is because I have a physically demanding, fast paced occupation and am wondering if I will be able to return. Any advice would help for I have until February to think it over. Thanks.


  • I commend you for gathering as much information as you can prior to having the surgery! If you need to do a lot of activity that involves twisting at the waist, you will probably find a multi-level lumbar fusion to be somewhat restricting. Otherwise, it seems to vary from person to person.

    Mine has not really affected me. I can still bend over and put my palms on the floor without any problem, something my husband and son could never do with an unaltered spine. I cannot bend backwards more than a slight amount, so my career as a trapeze artist is over. I do not play golf or tennis, so I don't know if it would affect my game, or not.

    There are people who have gone back to a very active lifestyle after multi-level fusion. I think the key is realizing that it can take a year, and sometimes a little longer for the bone to set up solid and develop strength.

    My question to you is what is the alternative? If you do nothing, will you still be able to do your "physically demanding, fast-paced, occupation?" Sometimes we end up not really having a choice, if surgery is really required. All you can do is find the very best surgeon for your particular case, follow his/her post-surgical instructions to the letter, and keep your fingers crossed.
  • I had a two level PLIF in Dec 2008. I had three discs torn, but decided to only fuse 2,because of the more levels you fuse at once the higher the chance of non fusion. Fusion went fine, took 6 months to see good fusion happening. But I never got over the pain. Took hardware out at 10 months, and still pain.
    After almost 2 years post surgery, after all other things had been tried, I had another dicogram that showed that my 2 levels above the fusion had torn discs. It does put pressure on the levels above and you risk having more problems down the line.
    But, after my last fusion in Dec 2010, I am recovering nicely and am having less pain all the time. So far ,so good. I will defenently limit me on motion from twisting to bending. But for the pain I was in, I dont care. I have suffered for 4 years, and been on heavy duty narcotics, so anything to get my life back was better than where I was.
    So many people wonder about getting fusions. Well, I guess I figure that when the pain gets as bad as mine you have 2 options. Fusion or pain. I was willing to take the risk. I had it min invasive and so no muscles were cut, and recoup is much faster than the PLIF was. I also had a incredible Dr, who was the only one that could ever diagnose my problems. I only wish I would have listened to him and had the first surgery with him and done 3 levels at once. Maybe I wouldnt have had the 2nd fusion. Who knows. At least I am on the right track.
    You will know when you have to have surgery. When nothing else conservative works, and the pain gets so bad that you walk like a 80 year old. Thats what my friends said. Now I walk straight and my smile is real, not hiding behind the drugs. Good Luck with your decision,.
  • I had a L4-S1 fusion in 2008. I work in production and have to do alot of physical work at times and work 12 hour shifts. I was out for almost 4 months after surgery.I have DDD and now my next level is causing pain and almost rubbing. Just had another xray this month and my dr compared the pictures with the last 2 years and you can see the disc getting smaller every year. He has also informed me since surgery that i should find somewhere else to work to prevent further damage up my spine but how can you start all over with less pay in these days. Don't know what to do anymore. Will be looking at fusing the L3-L4 within the next 2 years I'm sure. Still taking pain meds daily to keep pain level down. Felt much better after my fusion but after returning to work it all started over again. Just dealing with the pain and moving forward. Good Luck with your decision!
  • I really appreciate all of you guys taking the time to give me advice in the time I am having. I have came to the realization that although I did love my physically demanding fast paced job, I will have to find something less strenuous on my back so that I don't injure the other healthy discs I have. At this point I am willing to do anything to get out of the pain I've been having and be able to stop living on the heavy narcotics, it seems as though I have a pharmacy of medicine I have to take. I have a 17 month old daughter and in order to be able to play with her and be involved with her as she grows I have no other choice but to go ahead with the fusion. After all family and good health is more important than a high paying job that's going to break you down in a few years. Once again, thank you all for your concerns.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    please keep in mind that the surgery itself may not be the "cure all" to what ills you. I say this because I had the wonderfull family, the toys, the high paying job, and the world by the tail just some 5 short years ago. This was before a failed 2 level ACDF. I now have lost most all of that, have had major surgical revisions, had my work life go down the crapper right along with my marriage and mortgage, mental and physical health. I still require the hand fulls of meds and don't know how and when this tail will eventually end.

    So in summary ... proceed with caution, ask many questions, convelese appropriately, and avoid assumtions. You daughter is young ... nothing is more important than that time with her in the best health you can be in.

    Warmest regards and in my prayers,

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • Metalneck,

    It's devistating to hear the trials and troubles you've been through since your surgery. Most people don't understand how an injury to any part of your spine will debilitate you not only physically but mentally too. I feel your pain in that I felt like I had it made in life, as if nothing could stop me, invincible so to speak. Untill that one day while loading heavy material into the back of my work truck. My partner and I had already put close to 400lbs worth of material in the bed and on the last item I lifted it felt as though I got hit in the back with an electric shock that went down my leg. I fought through the pain and didn't say a word to my partner because I didn't want him to think I was weak, for I was only 22 at the time. I worked all that day in agonizing pain, thinking I probably just pulled a muscle. I went home and the pain seemed to get worse. I told my wife I thought I may have hurt myself severely at work and I was going to rest that weekend and see what happened. I applied cold/ice packs and on Monday I tried to get out of bed to go to work and support my family, but I couldn't I was in so much pain, I could hardly walk. I made my wife call my supervisor immediately and tell him what happened. She asked if we needed to fill out an injury report and he said we done all we needed to do, so I figured he'd just fill it out for me. I went to the doctor and she wrote me out some pain medicine,ordered a lumbar mri and diagnosed me with lumbar radiculopathy and put me on a 50lb weight restriction. The next day I told my supervisor what she said and asked him if I should fill out an accident report and he said I had done all that was needed to be done. I worked that day and the next day I handed him the restriction and worked the whole day. He then tried to get me to throw the restriction away and act like nothing ever happened and told me everything would be fine, he'd take care of me. I told him no way and he told me to take some vacation days to think it over because with the restriction I had I couldn't work. That pissed me off because before I got hurt I was the man and then I was like scum or something. I had my MRI done and found I had a severely herniated l5s1 disc. My doctor took me off work immediately and put me on a higher dose pain medication. A week after I called the supervisor and demanded to fill out the report and when I got to the office he had one of the big wigs there. It was an awful experience, they questioned everything I wrote down, harrassed me about how and why we loaded the material how we did and why we didn't do this and that. So I was so mad at that point that I just started to walk out. The big wig shook my hand and told me he hated to see me hurt, that I was a very hard worker and he hoped to see me back as soon as I felt better. I worked my tail off while I did work, gave 110% everytime I did anything. Needless to say the following day, the big wig wrote me a charge letter of rules violations trying to fire me and schedule a hearing, my supervisor told him he knew nothing of my injury. So right now I am in a major obstacle with my employer because they don't want me back. I found out they don't have compensation, so you have to sue to get anything. And the money you do get you have to pay back when you go back to work or pay it back out of your settlement. So it's pretty bad. I've also had a few fights with my wife over my injury because it seems all I can do is think about it, be in pain all the time, and to think about how hard I worked for my employer and them do me the way they are doing me. It's just humiliating. I know where your coming from. Sorry for the long story, it just helps to get the anger out sometimes. If you need to talk or release any anger, I'd be glad to help you out. I've found though that the big man upstairs has a plan for us all, that all things happen for a reason and I think it's why I got hurt. I believe he didn't want me doing the physical work I was doing for I was very smart throughout school and could have done anything I wanted, and still can and more than likely will once I get back on my feet. Once again thank you for your thoughts and concerns.
  • I've had the double fusion done and I am now 12 months post op (apart from another fusion I had done in my neck in Oct 2010) and I have only just started physiotherapy at the gym and in a heated pool. All up, I have had 5 spinal operations since 2006. It still hurts a lot!

    I don't really know if surgery is the answer, other than it MAY alleviate your pain. "Pain management" is probably going to help also. I think that once you have a spinal condition, you end up suffering in pain and you just have to learn on how to deal with it. I don't believe that surgery will make you "pain free, like I used to be in the old days." That's one thing that I have had to learn. Its no longer "like the old days" and my spine isn't that good anymore, despite having more steel in me, compared to a modern car.

    I just have to learn how to do things. It makes it a bit difficult at times as I live on my own and don't get a lot of help. I have to push myself, otherwise I would starve, live in filth and untidy conditions and probably give up. Thank god for pain killers and weed!

    Just teach your brain in small steps to tolerate the pain. In time, your pain threshold will increase and hopefully alleviate your pain. Again, surgery will not make you pain free, unless you are extremely lucky.

    Good luck & I hope that things work out for you.

    More titanium steel in me than a modern car.....
  • Just to add a few comments. I'm a 60 year young female, and I had a double fusion on L 3/4 & L 4/5 in July of this year. I had a cage, rods and screws and bone stimulator put in. I had been working in the government at a good paying position plus benefits, and supporting my hubby who is on Social Security Disability. I couldn't go back to my job, so I had to let it go. One of the things I had to do on my job is lift 80 lb bags. Doctor said that wouldn't be happening any more. I applied for Social Security Disability a few months back and was approved. It's very hard for me to accept the fact that I cannot work any longer, but I have to do what's best for "me" and my body, and my family. If you have the opportunity to change to a less stressful job, I highly recommend that.
  • Hi Richard!

    Sorry to hear you are in so much pain even after the 2 surgeries. I too suffered a work related injury (lifting a patient on a gurney as a paramedic) in 2006. I was told that if I got pregnant, my back wasn't strong enough to bear the added weight of a baby and I'd be bed-ridden for the length of my pregnancy. So I found another job as a 911 dispatcher. I think the new job made it worse since all we do is sit, teathered to a desk for 8+ hours, but that's another story.

    Every step for treatment has been an uphill battle with Worker's Comp and it is just so discouraging. I have injuries to the exact same area you do. I saw a surgeon in 2006 right after the injury. He told me that if it was manageable with oral medications and cortisone/epidural injections then I should avoid surgery. I was able to do so for 4 years. At first I did the epidurals twice a year, but last year I had 4 rounds of 10+ shots in my lower back and hips (to try to help the leg pain, numbness and weakness). That, plus an aggravation of the injury in August, put me back to square 1. The Dr. increased my oral pain meds and sent me to a surgeon. The surgeon was initially perplexed because my herniation at L5/S1 is on the right side but all my deficits were initially on my left side, they have since progressed to the right side so now I have problems on both sides. He took my case before a board of spinal doctors, 2 of which were fellow surgeons, and they all agreed on the same thing. He says there is another bulge at L4/L5 that will surely herniate if I fuse only L5/S1 and that's why he suggested the ALIF multi-level fusion. At this point, I think that if I can get rid of the hip pain and the leg pain, numbness and weakness then I can handle the back pain.

    Currently I am waiting for WC to approve the surgery. I am a little discouraged that people haven't had stellar results, but that is to be expected with surgery and individuality. Surgery may help and it may not. Its going to be a crazy recovery but if you have the support you should be able to make it through. People may or may not realize it, but chronic pain does change your personality. It is something else to consider when weighing the pros/cons of major surgery. I am hoping for the best for you (and for me!)!! Good luck!!

  • I want to thank you all for your suggestions and thoughts regarding my spinal condition. My heart goes out to each and every one of you, including anyone that has any type of back problem. I didn't realize how hard it would be, but it is the hardest thing I've ever been through in my life. I realize that surgery is not for everyone and sometimes it doesn't help, but I think if my surgeon suggests it on Feb. 11 I am going to go with it. I've missed out on almost 10 months of my daughters growth and am willing to try anything to get out of the pain so that I can focus on her, for she and my wife are my world. Without the support of my family I would probably lose my mind and I don't see how some of you have made it thus far. I commend you! I do have questions to you guys about pain management though. Do you mean the high dose narcotics or the epidural steroid injections/nerve root blocks? The reason I wonder is because I've tried the ESI's and the doctor who did them said I had spinal arachnoiditis, whatever that means, they never eased the pain though. I am truly incompetent with all the terminology, so any help would be appreciated. Thank you all, and I wish you all the best of luck!
  • My surgery wasn't the "normal" double fusion, but my recommendation is to get multiple opinions, and ask a lot of questions.

    Ask doctors you trust who the best surgeons are, who the most conservative surgeons are, etc. Consider getting an opinion from at least one surgeon known as "consdervative" to see what he/she says about the chances for surgery to improve your situation vs. more conservative treatment.

    5 weeks out from my surgery, I'm still far from 100%. Back surgery is a major undertaking, and there are only specific situations in which it is effective. So, making sure that the diagnosis and analysis is right on is key :) There are also less invasive options and other options that not all surgeons will offer you, so looking around and finding out what all is available to you is a good thing :)

    I like this article about how to avoid failed back surgery: http://www.spine-health.com/treatment/back-surgery/failed-back-surgery-syndrome-fbss-what-it-and-how-avoid-pain-after-surgery

    and specifically this paragraph:
    A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain after surgery.
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