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L5/S1 Fusion or NOT

Hello All,

I have had an issue with my spine for about 5 years now - herniated L5 and grade 1 spondy (L5 over S1) due to pars defect. For the most part physical therapy has kept me away from surgury, but I have started a new job that is a little more physically demanding than the last (active military) and my symptoms have increased with much more frequency.

I consider myself very lucky that I don't have a lot of specific back pain, but what I do have is nerve pain with tingling and numbness down my entire right leg. My latest MRI indiciates that the slippage is stable, but there is severe stenosis of the L5 nerve root. I am 42 and the Doc believes this will progressively get worse over time as what is left of the L5 disc will only continue degenerate - so they believe surgury is in my future.

My question is should I continue tolerate this until it is no longer tolerable and avoid the fusion until I am really really bad or just go ahead and get this fixed now while still young.

I greatly appreciate all opinions and experiences as well as what finally pushed those that have had surgury into having it and what has kept those that have not had it away.

Thank you in advance. All the best, Mike


  • Each person has different circumstances and decision making process. Much discussion was had on when is pain enough to warrant surgery.

    For me it was ongoing nerve damage with loss of muscle motor function (partial drop foot) and indication that there was high risk that it would get worse and be permanent. Nerve damage was quantified by an EMG study. May be useful in your decision making.

    You may be able to stay away from surgery with core strengthening PT.
  • a fusion is a massive operation and even with a good outcome you will need many months off work {you may even need to change your job or stop work completely] i had ALIF that's where thy go through you tummy and its the best way for the consultants to get ;;eyes on;; and they can get a better fix .but its a 845T47D to recover from and i am proof of that ,its been 9 months and today as with many days i am on my recliner as another day slips by .i sleep for only 2 maybe 3 hours a night even with strong sleeping and pain meds .{i had had 2 previous spinal surgeries} i have given up work as its any possibility for me to even consider work .i can't wear normal pants and foot wear as i can't stand anything on my legs and feet due to nerve damage and swelling .a fusion is done to stabilise the spine and not for pain relief ..if you get pain relief that's a bonus . the PLIF that's from the rear is another way of fixing the spine and as i have not had on i can't comment the 360 is mega massive !! that's ALIF/PLIF combined i was scheduled for one but the consultant was happy with the ALIF part as i have already has work done on the rear part of my spine .......
    the fist week in hospital is a week of hell i needed industrial amount of pain killers to get from a 10 to a 9.9 the anesthetist and consultant were staggered at just how much pain killers i need to take the top of the pain {that's because i already take a lot of pain killers every day] i was so ill on the night of the operation they kept me in the recovery ward with my own team of helpers they were fantastic and very kind as i thought i was going to die {at one point i wished i would due to the unbearable pain } they were unable to get the diamorphine in quick enough and i also needed ketamine an other IV drugs ,when i returned home i was zombies on my recliner for 6 weeks and my wife had to do everything form me including shower me as i was exhausted and the slightest thing would defeat me .as time as gone on i have been able to a little more and my consultant is happy with my recovery even though he told me it would be around 3 years to get to be as good as it will ever be .i find life hard work and spend most of my time on my recliner .even showering is hard work and i find myself holding on to the safety bars in the shower as i am so tired .even going to the loo requires me going to the shower to get ;;;clean;; .sex is no longer possible due to damage done from the PREVIOUS surgery not the fusion {the previous surgery was a disaster}and if i had seen the consultant i saw for the fusion 6 years ago maybe things would have been better for me now ..my surgeon had very little to work with ..dave ,.if you think you can find an excellent surgeon and you are prepared for a long haul and maybe unable to do stuff that you can do now for ever post op then go for it .remember its a big decision and i fo you get a poor consultant to do the work you could end up paralyzed and incontinent .i have given you the worst case and another will give you a better point of view .but its only fair that you should have all the facts .one last point should you have the surgery you genitals will swell and your going will be painful as if you have a hernia for many month this is normal ..but they don't tell you this i has to ask my doctor !! good luck dave and keep up up to date with whatever you decide to do
    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
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