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Contemplating L5-S1 Surgery

tcjones1985ttcjones1985 Posts: 7
edited 06/11/2012 - 8:54 AM in Back Surgery and Neck Surgery
Hi all,

As the thread title says, I am contemplating L5-S1 fusion surgery and would welcome and appreciate comments and advice, particularly from those with a similar background to me in terms of motivation for surgery, age, symptoms and condition.

Firstly, I am an otherwise healthy 25 year old male who does not smoke and leads a fairly healthy lifestyle.

I have Grade 1 Isthmic Spondylolithesis with a bulging disc at L5-S1 and bilateral pars defects. PT and work in the swimming pool has worked for me in the past and I was able to get back to playing football, but the old tricks do not work anymore. I've also tried steroid injections / epidurals and they didn't work either.

I am never in agaonizing pain - it's more a case of finding myself in constant discomfort - usually mild, sometimes moderate, and occasionally extreme. Sitting at a desk all day and communting on the train makes it difficult for me to overcome this. I can walk as far as a normal person would in any normal day, but I start to get nerve pain in my hamstrings if I go on particularly long walks in the woods for eg.

However, for me, surgery is not about overcoming pain, or even discomfort - it is about getting back to doing all the things I love to do but can't anymore - running, playing football, tennis, long walks etc. I was always such an active and sporty person and it kills me only being able to watch sport on the TV.

The main reason I cannot partake in these activities is not so much pain IN my back, but referred nerve pain in my hamstrings and tightness in my hamstrings and glutes. I cannot seem to shake these problems, no matter what I try.

I am terrified of surgery. I won't have laser eye surgery out of fear that they could blind me. I've heard a lot of horror stories and the idea that the surgery could have complications that cause me pain and misery for the rest of my life is horrible to think about.

My prevailing thought has always been that, unless I am actually in agony or constant pain, then I shouldn't have the surgery. However, the idea that I will never be able to do all the things I love makes me miserable.

I have been seeing John Sutcliffe at the London Spine Clinic for 2/3 years and I trust him. He is extremely reputable and experienced, a lovely bloke, and a leader in the field. He has always stressed that surgery should be the last possible option and has, in the past, persuaded me against surgery.

Now that all the other options have failed, he has recommended L5-S1 fusion across the whole level. He has said that, were he in my position, he would have the surgery. He also said he has performed the surgery on a close personal friend of his.

In 2,000+ surgeries, he has never caused paralysis. The success rate of his fusions is around 90%, considerably higher for people of my age / health. In only three instances has the operation been a complete success and the patient suffered constant pain, the source of which cannot be ascertained.

I know that the recovery can be long. In an ideal world, I would be back to work in 4-6 weeks, starting part time and working back to full time. After three months the fusion would take and I could start physiotherapy and retraining the back muscles. However, I know it might not be that simple.

From everything I have read and following discussions with my surgeon, I have ascertained the following; that the operation is much maligned because it was performed indiscriminately in decades gone by for anybody with back pain. Unsurprisingly, many operations were unsuccessful. Furthermore, people are far quicker to come on to the internet for support when they are suffering, than after having a successful operation.

These days, with new techniques and better diagnosis, fusion is actually a reliable procedure with good success rates, both in terms of pain relief and successful fusion. However, like all things, there can be unforseen complications.

Has anybody been in my situation? Namely, considering surgery not for pain relief but in order to regain fitness.

I would generally appreciate any advice or comments anybody has and would be interested to see if anybody disagrees with anything I have said.

I have spent months debating whether or not to have surgery and I still have absolutely no idea what to do.

Cheers guys,



  • It's always a hard decision to make when you're facing surgery, and good to see that you're looking at all the pros and cons. I wasn't in your situation where you're considering surgery to regain fitness - I was in 24/7 severe pain.

    I had spondylolisthesis and my fusion is successful and I'm very happy that it was done. I had an ALIF and an uncomplicated recovery. However, recovery takes a long time and requires lots of patience because you think when is this pain and discomfort ever going to end. I was fused by 6 months but it took much longer for the fusion to feel really strong. It was 6 months before I started to feel "normal" again.

    My surgeon didn't fix the slippage, but put in a large cage which jacked open the space between the vertebrae - in my case L4-5. You would need to find out if your surgeon is going to correct the slippage or do something similar to my surgeon.

    My surgeon aims for 80% - 90% pain relief, and that's where I am.

    Being young and healthy is very much in your favour. There are bending-lifting-twisting restrictions following surgery and your surgeon will let you know when you will be able to do more

    Check with your surgeon as to whether he is proposing to perform your surgery from the front or back. Generally, recovery from an ALIF is easier because no major back muscles are cut. There will be a lot of pain and swelling in the tummy because abdominal muscles are cut.

    At the top of this section, there's thread on Post-op Must Haves - this is essential reading. You won't need everything on the list. Good preparation prior to surgery is essential. If you're on your own, meals for about 3 months will need to be prepared and frozen, and you'll need domestic help. As well as friends helping me, I had a cleaning service once a week for 3 months.

    Good luck and let us know what you decide to do.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Hi Trish,

    Apologies for such a late response and thanks for taking the time to reply.

    That's great news about your surgery - I'm genuinely very happy for you.

    I myself have decided to go ahead with the surgery. However, work is such at the moment that I can't have it until October.

    I must say that every week that goes past makes me want it more and more. You work hard all week looking forward to the weekend, only to spend it stuck doing nothing because you can't do any of the things you really love. Even if this operation doesn't get me back to full fitness, at least I did what I could. I'm 25 and not ready to accept a completely sedentary life.

    My symptoms are caused by a combination of the slippage and the disc bulging. My surgeon will seek to correct both issues by fusing the whole level. He will make an incision from the front and remove the disc, sprinkling some of that magic bone graft powder. He will then make an incision in the back and insert the rod and screws before sprinkling some more magic dust.

    He is a great exponent of the combined anterior and posterior approach, as well as the fusion procedure in general. He says that his fusion operations generally have excellent results and by accessing the spine from both sides, it gives him more freedom to manouevre and to ensure the best chance of success.

    I'm not looking forward to the recovery - it sounds as though it will be brutal - and reading the "must haves" scares the crap out of me!

    I'll definitely be back on the site to let everyone know how I'm getting on.

    In the mean time, I welcome some more comments.


  • Good that you've made the decision to go ahead with surgery in October because now you can start to prepare. I absolutely agree, at 25, you shouldn't be accepting a sedentary life - there's so much out there to enjoy.

    take care


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Just to add my 2p's worth.

    I don't think any surgeon would recommend such surgery unless there was a genuine need, well, I would hope not anyway.

    It is a huge decision to make. We've all been there, unless of course some people don't have the choice as they may have been admitted as an emergency etc.

    Part of your decision must also include the question: What if the surgery doesn't work 100 per cent. There are no guarantees of course. The most important thing is that you have 100 per cent faith and trust in your surgeon and that you have explored all the pro's and con's.

    My decision was based on the fact that I was just living to work. I was trying every conceivable treatment I could to avoid fusion surgery - all to no avail in the end. I was on strong medication for the pain in order to get me through the working week. Come the weekend, I had to do all the jobs I couldn't physically do during the week, so it felt like I had no social life at all. I also felt that I declined to do lots of activities I would have enjoyed, purely because it 'might' adversley affect my back and so I wouldn't be able to work.

    Only you can make the big decision to have surgery. You are very young and I believe that will be a positive thing to aid your recovery. You have to be prepared to do exactly what your surgeon advises (even on the days you start to feel great). It is important to adhere to the no bending, lifting and twisting rule as this can undo the good work of your surgeon.

    For me personally, I will admit to being totally stupid sometimes. You know how it is, sometimes you feel absolutely great, without pain, and try to push yourself just that little bit too much. The effect for me was to increase my back pain - sort of 3 steps forward and 4 back.

    It needs lots of patience and good family/friends to support you. Hopefully, though, if you do everything you should then there is no reason why you cannot have a good outcome in the end.

    I'm sure you have already chatted to your surgeon about what, in his opinion, is a realistic expectation for you after surgery and what activities you can resume again, and when.

    As for me now, I MUST STOP doing silly things (like going on a trampoline last Monday whilst at work and thankfully only damaging my glasses as they made contact with my face - because I fell on it whilst trying to show off to the kids. Big mistake - I've had to up my pain meds as a result!!!). I realise now that it could have been much much worse!

    Good luck and let us know how it all goes.
    2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!
  • Welcome. I just had L5/S1 fused in march. It was my 3rd fusion. I am now fused L1-S1. I am so glad I had the surgeries. I had problems with pain and weakness, vertebrae slipping for the first and 3rd surgeries and my spine collapsing in on itself for the 2nd one (I was knocked unconscious by a snowboarder which started all my back problems). I have had both 360 and front and back separately.

    For my L5/S1 the surgeon preferred to go in the front since it is easier. Not so many muscles to deal with. I have always returned to work 3 weeks after my surgeries and started PT about a month out. As soon as my incision healed I got back in the pool (I swim with a masters group). In the past I was able to get back on my bike but am still not riding yet after the latest fusion. The disc was so deteriorated that it had to be replaced after they got in and the vertebrae were stretched so that added a little discomfort and time to my recovery. I did get back to running after the 2nd fusion. Like you I am very active. But I was in a lot of pain before the surgeries.

    I completely trust my surgeon and he is excellent. I always have a lot of questions for him. And I have done a lot of research on the procedures. I have had both bone graft powder and a graft from my hip which was worse than the surgery itself.

    Be sure you plan ahead and get a grabber and a long handled shoe horn. I had a safety bar put in on my bathtub but I am short and it is a jacuzzi tub/shower. Things that you need frequently need to be put on counters and top shelves so you don't have to bend. Easy to pull on elastic waistband pants are the most comfortable. Socks are over rated.

    I was in good shape before my surgeries and that helped. I have done core strengthening for years and years and continued right up to surgery, as pain allowed.

    Good luck and let me know if you have any other questions.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
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