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heading towards L5-S1 fusion after discectomy

New here and terrified. 36 years old and an otherwise very healthy male, I had a microdiscectomy performed in late February '12 after herniating my L5-S1. Surgery was deemed a success and my sciatica was a thing of the past, however it's now less than 6 months later and after the pain returned a new MRI confirmed the disc is degenerating. Like the disc I was crushed. At first I thought I may be able to deal with occasional bouts of pain and allow the bones to fuse on their own, but it's now a daily fight and I don't think I have any other option. My fear now is I'm destined to a life of repeated back surgeries, continual reduction of mobility and never again regaining 100% of my former self. Are my fears unfounded?

For what reasons are particular methods of fusion (posterior vs. anterior, etc.) chosen? Is one method more successful than others? I have so many questions yet don't even know how to ask them.



  • Did your surgeon explain the difference between your two MRIs, and the health of the other discs surrounding the one on which the microdiscectomy. Did your surgeon tell you that your L5-S1 would be fusing after the microdiscectomy? I could very well be wrong about the microdiscectomy, but with my discectomy and laminectomy there was removal of the herniated part of the disc and bony spurs affecting the nerves to relieve me of my sciatica. My husband had a microdiscectomy at about 32 and hasn't needed further procedures since. His weight is good, and he does exercises if his back starts hurting again. In my case, my other discs are not very good and my doctor did the d&l in hopes that it would alleviate the sciatica without "bothering" the other discs too much. After my surgery the symptoms got somewhat better and then they reverted to previous levels of pain and numbness or somewhat worse.

    You should be able to learn more about the posterior vs. anterior in other areas of the site. What is your doctor recommending for you? Also, even though one surgeon did your prior procedure, you could go for a second (or third) opinion.

    Take care,

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • My first MRI before the microdiscectomy was far worse looking; my L5-S1 looked like it had a pinky finger sticking out of it. The MRI I had a few weeks ago looks less severe, but it is bulging and the disc space is clearly narrowing and it is much darker, whereas the rest of my discs appear a healthy white color.

    Thus far he has not stated which particular procedure I may need, other than a fusion; that was at my last appt when he ran the MRI (the guy has his own MRI machine right in his office) and diagnosed the degeneration. Tomorrow morning is my first follow-up at which time I'm guessing we're going to move forward to surgery planning, as the pain has gotten much worse despite 3 Percocet 10mg and 3 Soma per day.

    I am seeking a 2nd opinion mainly for planning purposes; at this point I'm inclined to stay with the same NS that performed my discectomy.
  • Sorry you may be looking at a fusion. It is the last thing you'd want to have done as its invasive and takes a long time to recover from for most people. Everything you think about from now forward should be involved with taking care of your back. Get whatever problem you have fixed and then get on a core strenghtening program and stay on it not just when you feel bad.

    I see more and more surgeons doing 360 fusions which is where tey open up both the front and back of you. After they open up front they usually removed the disc removed, or some portion thereof and then a cage of some type is installed that is filled with some type of of bone matrix material whether it is your own or a man made product or a cadaver mix of some type.. The front part of the spine carries most of the spines weight and in many ways is the strongest part of the spine. Everyhing is closed back up and you are rolled onto your belly so they can work on your back. A general/vascular surgeon opens and closes you up for the front part and then orthro/nureo surgeon to continue on. You need to find a team of surgeons to do this as there is a lot of stuff that needs to be moved around to get to the spine.

    Once the front is done the surgeon can then start working on he rods and screws part of a fusion. Lots of areas can/are cleaned up and nerve passageways are oppened along with whatever else might need to be done. The 2 rods ans screws are put in and you are closed back up and start your road to recovery.

    There are a whole bunch of diffferent variations to be get a fusion done. Some work and some don't as well.

    You need to start doing a whole lot of reading and researching to find very good spine Dr.. Above all else you want to find a surgeon that is board certified in spine surgery and whose main pratice is spine surgery. You want to find one who does lots and lots of spine surgeries.

    You may get away with another Micro but going forward you will need to protect your back even though you are pretty young. A surgeon will pick what type od fusion and why so you will need to speak o a number of sureons to get different opinions, or maybe they will be the same.

    My first fusion they cleaned up he nurve passageways, did a lami from the rear. They lais bone matrix into a area called gutterway and then added the screws and rods. It did not work for me as I broke a screw and another one loosened. I ended up have to have a 360 fusion done 3 years later. Keep in mind that almost all the 3 year time I was on pain pills and was in agony.

    If I had known then what I know know I would of skipped the first fusion part as it wasted 3 years of my life.

    Good luck in you travels.
  • Hello Hikerbuddy,

    I had a similar story. I herniated my l5-s1 really bad December of 08. I had a microdiscectomy a few months later. The pain went away for awhile, maybe 3-4 months pain free. Then it slowly came back. I struggled with it for a couple years. It re herniated for a second time march 2011. Pain was even worse then the first time. I spent months researching every possible option and spoke to everyone I could. Even to a well known UFC fighter who had been fused at the same level. Long story short I decided to go with a Minimally Invasive TLIF. I spent equally as much time finding the right surgeon, the guy is absolutely amazing and im sure much of my success is contributed to him. I am 9 months post op. Ive had some ups and downs but i am overall doing very well. I was extremely active before the surgery. I exercise now daily and feel much better then before surgery. I still have muscle tightness and pain if I have to stand or sit for long period. I was told that it takes about a year for the healing process to be complete. By the way im only 27. There is hope for people in your situation. Just try and research and educate yourself as much as possible about all your options and if you have any questions I might be able to answer just let me know. Good luck

  • you wont be the same .ALIF tend to be more invasive then PLIF as your abdominal iarea s opened up so you have a abdominal would and a spinal wound to deal with {PLIF } is performed from the rear .all fusions are massive and the more leaves you have done the longer it will take to heal .i was told to allow up to 2 years for my ALIFa to heal so far its been 7 months and i am no better .i have recovered from the surgery [that was hell ] and took me at least 4 months .i an still in pain and on loads of oxycontin and oxynorm {the instant version[] sleeping is a 2 hour thing ..if i am lucky .and life is very restrictive .only have a fusion as a last resort and make sure you have a top end consultant doing it ..good luck and read as much as you can about it .
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • tran92ttran92 Posts: 183
    edited 07/15/2012 - 12:24 PM
    I've been through what you are going through. I herniated my l5-s1 in November 2009. Had the microd. and hemi-laminectomy in June 2010. Herniated the disc a week after the surgery. confirmed with a new MRI couple of months after surgery. Back in for a repeat October 2010. No major improvement after the second surgery. but i just dealt with the sciatica.

    fast forward a year and a half. (and a cervical fusion to boot.) sciatica has miraculously gone away (or at least mostly) for about 6 months, but the back pain is constant now. I finally got to the point after a 2.5 month long flare in my lower back, that i was going to finally correct the problems.

    I had the fusion at l5-s1 just under 3 weeks ago. sciatic pain kicked up right after surgery, but i expected that since the nerve is in such bad shape. the worst of that is definitely starting to fade out though now. each day gets a bit easier. low back pain is mostly incision pain right now, although i'll get a better idea once thats really gone. but i'm up and moving, and while my flexibility is still pretty bad, i'm thinking this might have finally done what i needed it to do.

    of course this was surgery number 4 in just over 2 years. if i knew then what i know now, i might have said no to the 1st surgery and lived with the constant tingling in my leg. (well, maybe not...) i do know i have a really high risk of needing another fusion down the road. L4-l5 is in lousy shape, lots of DDD and an annular tear with a bulge. but so far, 2 years and holding like that. i just hope i don't herniate it now that i've got the fusion below it. but if i buy myself a bunch of mostly pain free years, i'll take it in a heartbeat. Because the last 2.5 years have been absolutely horrible.
    Microdisectomy / hemi-laminectomy 6/2010 and revision 10/2010
    Cervical fusion C4-5 and C5-6 9/2011
    Lumbar Fusion L5-S1 6/2012
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