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L5S1 fusion

MerylTMMerylT Posts: 26
edited 06/11/2012 - 8:55 AM in Recovering from Surgery
Hi. I had L5S1 fusion surgery last Wednesday to correct end stage degeneration of the disc and to stablise the area as my muscles kept going into spasm when I lay in bed or flat, I was also bone on bone. I was out of hospital by the Friday evening and have only had to take paracetamol and the occasional diclofenac. Started using the treadmill by Saturday and did 1 mile in 2 sessions plus the physio exercises. Since then have increased the mileage and am continuing to progress. Have been able to sleep in a bed through the night for the first time in 5 years, having had to sleep in a recliner. I'm hoping this op has worked and wanted people to know that I found that the fusion surgery and recovery so far has been much better than I thought would happen with very little pain.

I did do a lot of preparation before the surgery - lost 13 pounds, walked 7 miles a day on the treadmill or used a stationary bike and also did 40 mins - 1 hour of cardio boxing and toning on the X box to get my arms, legs and buttock muscles stronger. I reckon this did a lot to aid my recovery and the physios agree. Hope this gives hope to anyone considering fusion surgery for this type of problem and who is worried about what might happen.


  • Hi,
    Glad to hear of your successful recovery. I know from having 3 fusions that being in good shape definitely helps your recovery. I am fused L1-S1 with L5/S1 being done in march. I had a longer than expected recovery for that surgery as once they got in the disc wasn't any good and they had to put a spacer in and separate the vertebrae to do that so I had a little more pain after surgery. I have been pleased with all my fusions as they fixed the problems I was having - vertebrae slipping forward for 2 and spine collapsing in on itself for one of them.

    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.

  • I wanted to share my experience of recovery after PLIF L5/S1 I had in Jan 2010 in the hope it will help someone else as I know I found this forum really useful when I was researching my surgery.

    My disc had degenerated at that level and was bone on bone, I couldn`t walk/sit/stand more than 10mins without burning sensation in my lower back and sciatic pain down both legs so opted for surgery after much thought and consultation as alternative was to be partially disabled for the rest of my life. I had been off work for a year(I did a desk based job) and knew I couldn`t continue like that.
    I prepared myself as much as possible physically by keeping as active as my pain allowed me (gentle yoga/pilates/walking), keeping weight down, stopping smoking & eating healthily. Mentally I was prepared as much as I could be for the long recoup period and knew I had to have alot of patience - doesn`t come naturally to me!

    I had an excellent surgeon (Jason Harvey) who explained the whole procedure and I was confident in his abilities as he came highly recommended...you have to feel happy with your surgeon when having such major surgery. After 24hrs stay in hospital (Queen Alexandra, Portsmouth, Hants UK) I discharged myself being strung out on morphine pump I thought that was best idea to just get home and recover there...turned out was not the best idea I`ve had in my life...at first! The hospital let me go as I could just about walk, do a few steps, eat/drink, go to toilet ok and that was minimum requirement. Really they should have insisted I stay for a few days at the very least. My pain management wasn`t under control even though I had liquid morphine and tramadol tablets to take home. Anyway, after a horrendous first 48hrs at home which was pretty traumatic due to the extreme pain I experienced and could have been avoided had I stayed in the hospital longer, I did manage to get my pain levels sorted with medication and started my recuperation...slow as it was. I was off morphine within 4weeks. Mobility improved quicker at home I believe than it would have in hospital. Started my exercises within a week after surgery, gentle stretches & leg pulls and would really recommend everyone is really diligent doing this, now matter how crap you feel, as its so important to get mobility in back/legs as soon as you can. I was pretty scared about the numbness I felt down my left leg into my foot and now, 18months on, the numbness has receeded to just my left foot now so it really does take that long to heal and is such a gradual process.

    After 3months I started physiotherapy through the hospital programme with lots of exercises at home and increasing gradually over the weeks. I also did hydro-therapy at a local swimming pool which was so helpful aswell. It was lovely to feel supported by the water and be able to move relatively pain free so this I would also really recommend. Once you get your confidence & strength its great, I was initially so worried about slipping at poolside but you get over that.I also returned to my yoga class after 4months and then pilates a few moths later once I was strong enough. Each form of exercise works slightly differently but compliment each other so again, I would recommend both for recuperation from spinal fusion. I am amazed at how much mobility I do have and I`m sure that these classes have been the reason why. Clearly, I can`t flex like I used to be able to from the lower back as I have 2 metal plates and 4 screws holding L5/S1 together. Cycling took a little longer to return to but once I had adjusted my bike to a different sitting position (not racer) and got an extra, comfy gel saddle, its much better and my physio advised this was the best form of exercise for me to try and undertake. After check up xrays at 6weeks, 3months, then 6months, my surgeon was confident all was fusing ok and discharged me from his care. My physio discharged me after 8months and I still had a programme of exercise to do longterm.
    Gradually I was able to sit, stand, walk for longer periods, still needing to rest lying on my side to relieve the pressure at regular intervals. But the object of the surgery was to decrease my pain levels from what they were and this it has done, but I know I will never be completely pain free.

    After 12months I was getting increased sciatic pain down my right leg and this was very worrying as my pain levels had decreased so much following the surgery. So, I went back to my physio who went through all my history and checked what I`d been doing since she last saw me. In a nutshell, I had been over extending by back, i.e. having too much of a lordosis, or curve, in my lower back therefore, the metalwork was pinching on the sciatic nerve and caus
    ing the pain. So she gave me some more exercises to counter that and basically, she gave me permission to `slouch` from the waist down, i.e. to push my pelvis forward and create more of a flat back in my lower back so the metalwork doesn`t pinch the nerves. After a few weeks of revised exercises, I felt so much better and realise that as the whole mechanics of my spine have changed, I`ve had to adjust to that. Its keeping awareness of your spine condition long-term that is quite hard work, but if you have that in mind, you`ll be careful to do things the right way the to assist maintaining low pain levels.

    After 6months I did try to return to my full-time desk job but had to give up after 2months as sitting is the worst position for me and clearly you can`t be having a `lie down` for 10mins every hour in a busy office! I was fortunate to get a part-time job, working from home doing short shifts at my desk so I manage ok with that now, still not the best position for me but over the past 9months it has gradually improved. I have to set my alarm for every 30mins so it makes me get up and walk about for a few mins and that helps. My rest position is still lying on my side and that relieves the pressure really well and I do this anywhere I need to...park bench, back of car whatever...I do get some funny looks from passer bys sometimes...but needs must!

    Having said all the above, mentally its been quite tough and I was on anti-depressants for a year but have got off them now and seem to be coping better. During the whole period sometimes you can`t see light at the end of the tunnel, but if I can say anything, it`s that it DOES get better, just be strong and try stay positive and focus on the good things. I am still on small doses of tramadol each day but am gradually reducing that. I don`t beat myself up over still taking meds though as everyone is different and if you can manage you pain well, you can manage each day better and every day counts towards a better future.

    Hope this is useful to someone and am happy to answer any questions you may have. Overall, I`m glad I had this surgery, the benefits have far outweighed the cons in my case for sure :)
  • Hi. Now I am 2 weeks after the fusion op. I am doing up to 4 miles a day in 2 sessions on the treadmill plus the physio exercises. My right leg aches a bit if I do too much but otherwise I am only taking 2 paracetamol a day, one in the morning and one in the evening. The nurse checked my wound yesterday and took off the dressing and steri strips - I had dissolvable stitches so nothing to remove. The wound has healed really well with a couple of scabby bits but otherwise is a little bit sore if I lean on it or lying down to do my exercises. The physio has told me I should bend and twist as I am doing that with the exercises anyway and the only restriction is not to lift anything heavier than half a kettle of water and not lift anything heavy if I bend down. I have no pain in the op site but get tired sometimes during the day. The best thing is I am getting hours of uninterrupted sleep in a bed for the first time in 5 years! This procedure definitely seems to have worked for me although it is early days so I'm keeping my fingers crossed I progress.
  • Wanted to welcome you here to spine health. Congrats on be on the other side of surgery.

    You sound like you are doing fantastic. It is wonderful to read posts like yours, from people that are doing so well. Please continue to keep us updated on your recovery.Make sure to listen to your body when it tells you that you are getting tired during the day. Please don't over due it.

    Great that you are getting a good night sleep back in your bed.

    All the best to you, and wishing you a solid fusion and full recovery.

    >:D< Karen
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • Thanks Karen. I'm lucky I had a really good surgeon on the NHS. I was supposed to have a Wallis ligament to help support L4L5 but they decided the rest of my discs were in a very decent condition so it was better not to inflame the disc by adding the ligament. I was surprised at how fast I was in and out of hospital and at how little pain I have had, having read how others have got on. I suppose I was lucky I had no nerve or leg pain as the disc problem was probably hereditary so there was little disc to herniate, my problem being muscles spasming to try and protect the lack of disc. I will definitely update on a regular basis if possible.

  • I've been reading your posts and you seem to be recovering so well. I really hope everything goes well and that you don't overdo it.

    I'm sure I read that your physio has told you to bend and twist - I find that hard to believe. For me personally, I have understood my surgeon as saying I CANNOT bend, twist or lift until the fusion is 100 per cent stable. I also understand that everyone gets differing advice and that we all heal at different rates. But I'm so pleased to read that your recovery isn't as bad as you thought it would be - and I'm sure your experience will help so many other people who are facing similar surgery.

    I also had my 2-level PLIF through the NHS (in Stockton on Tees) and had the surgery on Wednesday and was discharged on the Friday! The only reason they didn't discharge me on Thursday was because I lived too far away. I was up, walking and using the loo TWO HOURS after leaving recovery - I hated the thought of using a bedpan, ha! I also had complete faith in my surgeon and his team and still do. Their aftercare support and investigations have been excellent (although we do have to wait a little longer for our appointments through the NHS, which is understandable I suppose). Anything that's happened to me since, I believe, is of my own doing.

    For me it's been a year now since the surgery. I can say that for the first 6 weeks I was doing brilliantly and thought the whole surgery was a complete breeze. I felt great and then started doing things without thinking (because I was in no pain at all). Please be careful. When you start to feel like you're 100 per cent better, that's when the littlist of things can set you back.

    For me it was driving. I dutifully waited until the 6th week before I started driving. When I reversed however I completely forgot about the surgery and twisted around to look behind me, as you do. That was it. Sharp back pain, radiating down my leg. OWCH! Suffice to say, if you read my signature details, I'm now back to square one almost. It's so disappointing after everything I've tried to help myself - but it's so easy to make one little mistake. I'm only saying all this to try and help you avoid doing similar things OK.

    At the moment, I am being investigated for sacro-iliac joint problems that might be responsible for the continuing pain I experience. I don't know.

    Take very good care of your back. If doing something starts to hurt your back, even a tiny bit, STOP. Don't end up paying the price for it by having at least 3 days of markedly increased back pain, time off work, extra pain meds. etc. etc.

    Perhaps you can keep us all updated on how you're getting on from time to time?
    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 !!
  • Hi Sue. Thanks for your reply and advice. I was also surprised that the physio said I could bend and twist as I had kept 3 months free in the diary to recover, assuming I would be unable to do much at all. She said that the exercises they'd given me made me bend and twist anyway. Obviously I'm not supposed to lift anything heavy or bend and pick up something weighty but otherwise she said I could walk as much as I liked (I'm up to over 5 miles a day in the treadmill). I still find sitting for more than 20 mins painful but I have just stopped taking the 2 paracetamol a day I was down to and the only other pain I get is a bit of an ache in my right buttock and leg if I walk too far.

    Sorry to hear of your troubles. I am going to be very careful especially when it comes to lifting. I play in a country dance band and the difficulty will come with forgetting and trying to lift speakers or other band equipment! I hope they manage to find the source of your new problems - trouble is the NHS tends to be very slow moving in making a diagnosis!

  • I am shocked they are telling young bend. After 2 surgeries 24 years apart( fusions l4 to s1) both times, I was told absolutely no bending from the waist. In fact, I have to wear a brace every minute I am not in bed for 3 months. I do not start phys therapy for 3-6 months. I know every one is different, but fusions at that level are not so very different. I would def call doctor and check it out. The first time I had surgery, the phys therapist tried to get me out of bed to walk and I was in screaming, excruciating pain. She hadn't properly read the notes. The doctors specifically wrote that I should not be moved from bed until my custom made brace was prepared. That took 10 days, so therefore the PT screwed up big time and could have done some permanent damage to me. Please just verify with Dr again. Better to be safe than sorry.
  • Hi. I did ask the physio why I was advised to bend and twist whereas everything I'd read said this was a no no for several months. She said that the main thing was to try and get the area back to normal and the only restrictions were on carrying anything too heavy and being sensible about bending i.e. bend at the knees rather than have a straight back. She has now signed me off as she feels I can carry on with the exercises myself. I only get a sore feeling if I sit for too long or sit/stand and stretch too far. I am walking around 6 miles a day on the treadmill and have little or no pain. I can sleep for 8 hours in bed without any pain. I have asked to see the before and after scans to see what they did. I was told by a doctor before the op not to worry about the vertebrae fusing as they would! They seem pleased with my progress and I've just received my follow up appointment which isn't until almost 4 months after the op so they obviously are worried about needing to see me before then.

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