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ALIF L5-S1 fusion finally done! Progress report

I finally got my fusion surgery completed this past Monday. Since I have been on the forums for about a year dealing with this pain, and I have found so much support and good advice, I thought I would pass on my experience for others to learn from. I also have a few questions.

My main problem was DDD at L5-S1. I had a successful discectomy there 3 years ago. I have always been very active and my career has always been in the automotive industry so a lot of heavy lifting involved.

My pain recurred late in 2011, and it was incapacitating. I went through all of the usual: oral steroids, physical therapy, all types of pain control meds; then graduated to ESI's, facet joint blocks, rhizotomies. Then my physiatrist told me bluntly that I need a fusion and there was nothing more that he could do for me.

I saw the neuro who has operated on nearly my whole family, who first agreed that I need a fusion, then backed out. Saw another neuro and he declined altogether but recommended me to an ortho who would probably help me. I saw him and we agreed on the fusion, which he would do ALIF and insert hardware from the rear.

The procedure was done this past Monday, and I was home Thursday.

I was in the operating room for 2 hours, and recovery for 3 hours. The whole time I was in, they were fighting low blood pressure (I think it was around 85/50 when I got to my room). The pain control wasn't nearly enough; I got better pain control when I had the discectomy! I think it was because of the blood pressure problem. Any thoughts? They had me on a morphine pump but it barely took the edge off, and after a while, I suggested maybe the morphine was dropping my blood pressure and recommended they remove it and put me on oral meds. They did but only gave me what I had been taking before the surgery (Percocet 5/325). After that didn't help, they increased it to 10/325. They refused anything stronger. I did eventually get them to add Flexiril but I was still in considerable pain.

But the good news is that my leg pain is gone. The only pain now is lower back where th incision is, and down to the hip. They sent me home with the 10/325 Percs, Flexiril, and Neurontin (also one of my regular meds). When I left the hospital, I couldn't walk from one side of the bed to the other, and cold barely make it to the bathroom. But I just wanted to go home. I knew I would be better there.

Since home, I am walking around 1 block several times a day, then reclining the rest, with a nap during the day. As of yesterday, I am taking about 7 Percocets a day, 2 Flexiril, 4 Arthritis Strength Tylenol, and vitamin supplements. I am still uncomfortable at times but it is tolerable for now. I have my first post-surgical check up on the 18th.

I am very hopeful that the decision to have the surgery was a good one. A lot of people in my life are skeptical, but I couldn't take it any more, and want to be off the meds completely, and get back to doing the things I love. I know I will have to tone it down a bit but I want to be able to function without narcotics!

I will continue to post throughout my recovery in case someone else can benefit from my experiences!

Thanks to all previous posters who helped me make my decision!


  • I am so glad it is over with now and you can concentrate on healing horselady21. I also have always had problems with my BP dropping very low after surgery. When I had my microdiscectomy in May my BP was at one time 70/40 and they were having a fit but told them it always happens and it does not make me feel bad but had to stay an extra day in 2008 after spine surgery because is was so low. They did not want me in room by myself so daughter came and stayed the night with me to help me up incase I passed out. I think it is the anethesia because every surgery I took different meds. They brought me Percocet after last surgery but can't take as it causes severe vomiting. They had me on Dilauded pump and 50mg Nucenta, Flexiril which kept me comfortable and Xanax to help with sleep and anxiety.

    I just can't believe all the problems I have read of people being in horrible pain after surgery because they don't have the medications and dosages they need. I hope you continue to heal. Even though I have had good and bad experiences from surgery, I have never regretted my decision. This last surgery was a failed surgery but one out of 11 was pretty good odds.

  • I'm glad I'm not the only one who had/has pain control issues. If I had the energy, I would have been angry that they leave people with such pain! I guess I could never be a nurse...I'd be calling the Dr.'s every 5 minutes to get patients more pain meds.

    Yesterday was about the same. I did manage to walk around the block 2 times during the day, and a couple of times just around the yard. I woke up around 2 am and had to take a Percocet. And realized this morning that they didn't give me an anti-inflammatory, and wonder if that might help. I will call tomorrow.

    All the steri-strips are off the incisions. They said to let them fall off by themselves but they were making me itch so I gently removed them anyways. The incisions look good.

    I might try going to the store today (I went to the convenience store yesterday for just a minute) to get some Tylenol and aspirin. It has only been a week but I am already bored at home!
  • ouch2oouch2 Posts: 1,270
    edited 12/09/2012 - 1:05 PM
    Glad to hear that you are on the other side of surgery.Sorry to hear about the lack of pain control after surgery. I faced the same thing after my adr surgery, and it was just unbelievable pain.

    Sounds like you are doing great with your walking so early post op. I know for myself, I was only able to do small laps around my house often for the first few weeks, with breaks in between. Great that you are doing so well.

    Please just be careful with the percocet and tylenol arthritis. They are now recomending to not exceed 3000 mg of acetaminophen a day, so if you are taking 7 of your percs a day, be careful of adding the tylenol as they are each an extra 650 mg. Maybe talk to your surgeon when you ask about anti inflammatories, which some
    Doctors don't like patients to have post fusion either. Sorry, enough of that, I used to be in nursing and old habits die hard.
    I hope that you heal quickly and that your pain decreases quickly as well.

    LooK forward to hearing how your recovery goes.
    >: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
  • horselady21hhorselady21 Posts: 174
    edited 12/11/2012 - 1:30 AM
    ouch2- Do you mean Dr.'s don't like fusion patients to take additional Tylenol, or Tylenol altogether? They refused to give me ANY anti-inflammatory in the hospital, which I think would have helped.
    Progress report-Walked about half a mile yesterday and felt pretty good. Mid-morning seems to be my best time of day. That being said, sleeping is not going well. After my evening pills, I sleep for about 4 hours, then after that, wake up every hour . I have been taking half a Perc. at that time, a whole one if pain is beyond imagining. I might try increasing my nighttime pain pills to see if I can sleep through the night.
  • And nightime pain, I can definately relate to. When I was first post op, I had to take my meds right on schedule, even during the night. I still have a rough time every night, waking up every hour or two. For me, best position is on my side with pillow between legs, alternating sides throught the night.

    Sorry, about the meds, it was two different things. With the tylenol part, they are now suggesting to not take more than 3000 mg per day, which you can quickly get to if you take tylenol arthritis on top of percs. I would talk to your doctor about adding the tylenol.

    With anti inflammatories and fusion, the jury is still out and many doctors have differing opinions about giving them post fusion. Some will prescribe, while others will not, due to it possibly inhibiting fusion. I would ask your doctor about this as well, before taking any.

    Is any of your pain from muscle spasms?

    Please keep us up to date on how you are doing.
    >: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
  • I finally decided I just couldn't stand another night trying to sleep and waking up in such excruciating pain so I called the nurse, and she prescribed a sleeping pill and gave me another script for Percocets. She said not to add any Tylenol because of the dosage max. So you were correct about that. She did say I could add Aleve, which I got yesterday. And she seemed surprised (and concerned) that I was walking too much.

    I suppose Itreated this procedure like any other minor procedure, which it IS NOT! This is NOT a minor thing, like a tonsilectomy or a broken leg; this is serious stuff, and even though I had read up on it in this web site, I acted like, ok, I am out of the hospital, now I have to push to get back on my feet.

    I think I WAY overdid it, and I can tell the difference already. Yesterday, I only walked back and forth to the kitchen and bathroom, and once or twice around the inside of the house. Granted, I slept a little bit better last night with the sleeping pill added; I still woke up in a couple of hours and in pain, not not the stabbing, burning pain that makes you wake up suddenly with your heart in your throat. This was a gradual wakening, and a "oh, it sure hurts, time for another pill" kind of pain.

    I am going to keep this routine for the next few days, until my first recheck appt. and talk to Dr. about it.

    Anyone reading this, preparing for this surgery, who is also a type A personality: be prepared to REST, and your life WILL CHANGE for a while! Don't think that you will come out of the hospital and start "training" to get your old life back!
  • NurseTippyNNurseTippy Posts: 5
    edited 12/14/2012 - 8:10 PM
    Hello all! I am new to this website and forum(s). I like all the info and reading the personal stories! I had my L4-5 ALIF on 11/6/2012. I am doing better than I had anticipated - pain is more tolerable than expected although it is certainly present. I tend to hurt the absolute worst first thing in the morning when I wake up. Some mornings it takes all I've got just to sit up on the side of the bed and get to my feet. I take 1-2 7.5/325mg hydrocodones first thing when I get up in order to get moving around better. Thereafter, the rest of the day isn't so bad.....until the evening/night. Then the pain/muscle spasms kick up. Is or has anyone else experienced this? I can usually go all day without any pain medicine until the evening time - then it's more hydrocodone and robaxin and lying on the heating pad when it kicks up bad. Any comments/suggestions would be greatly appreciated!
  • backache99backache99 Posts: 1,338
    edited 12/15/2012 - 6:14 AM
    you said that you had ALIF but then you said they put the hardware in from the back ..wouldn't that make your operation PLIF?? have you got a scar on you back or abdomen? /i can't believe your out and about after such a short time ..i was in hospital for 7 days and in so much pain post op i was on diamorphine and ketamine and other drugs ..then spent all night in recovery as i was so ill .then spent the next 6 weeks at home zombied on my recliner ..12 MONTHS on i am hardly any better still taking 3x 80 mg of oxycontin and 6 x20mg oxynorm and 4x 5mg diazepam a day .still can't walk far still unable to sleep for more than 2 hours always in pain very debilitating pain often has me crying .so you have done so well .just be careful and don't over do things .
    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
  • horselady21hhorselady21 Posts: 174
    edited 12/17/2012 - 8:56 AM
    Welcome, NurseTippy- this forum gave me so much info and helped me thru some real rough spots!
    backache99- Are you on any nerve pain meds? It sounds like you need to see your Dr....no way you should have to live in that much pain for that long) I just realized aboout 3am this morning after a night of excruciating pain again, as bad as it was in the hospital, that I forgot to put my Neurontin pills in my pill minder; I put the morning ones in but forgot the evening ones. So as soon as I realized it, I grabbed the bottle and swallowed 3 pills, slept for 2 hrs., got up and took 2 more, slept and woke up with virtually NO PAIN! I had thought the Percocets were helping the most..boy, was I wrong! And they weren't giving them to me while I was in the hospital so that explains why I was in so much pain.

    All the research I did on the ALIF/PLIF (I have a scar on front and one in the rear) said average hospital stay is 3-5 days. And I knew the meds they were giving me weren't going to help me so I just wanted to go home! As soon as I got back on my regular meds (Neurontin included), I started getting better. I just didn't realize how much etter until this morning.

    NurseTippy- that is how my pain usually went...but I didn't realize until this morning that the Neurontin was doing more for my pain than the Perceocets. Are you on any nerve meds? They sure help me and from what I have seen on other posts, they help a lot of people. Some are on Lyrica also.
  • Hey there horselady21! Thank you for the warm welcome and sharing : ) I was on Neurontin pre-op when I was having hip/leg pain and the feet were numb/tingly. I was only on 100mg 3 times a day and didn't really notice much difference. They didn't have me on the neurontin in the hospital and it didn't get renewed upon discharge. I had read up on the neurontin and noticed it is most effective for nerve pain in higher doses (like 900mg per day), so maybe I should see about going back on it and upping the dose? I am not able to take Aleve, Advil, or any other NSAID other than Tylenol because I have a stomach ulcer, so I wonder if this would be more reason to try the Neurontin?
  • I would definitely check into getting the Neurontin prescribed at higher dose (you start low, like you were on- 1-300 mg pill 3 x daily) and eventually work up to 3-300mg pills 3 x daily. I couldn't do that much in the morning when I was still working, because it makes me drowsy and I driove an hour to work, and found myself dozing off behind the wheel! So I dropped it to 1 pill at reakfast, 1 at lunch, and 3 before bed. That pretty much controlled most of my nerve pain but not all. Now that I'm off work, I went back to the 3 pills 3 x daily and it is amazing the difference. If you look up Neurontin on drugs.com and look at the dosages, it says most effective between 1800 and 2700mg daily, with max at 3600mg.
    Like I said previously, it has saved my sanity, and I have read other posts where taking it has dropped the use of narcotic pain meds in half! I've heard good and bad with Lyrica too. But the Neurontin is available generic too (gabapentin). Let me know how it works for you!
  • Great info! Thank you! I think I'll go back on it (I've got some left from before). I will definitely keep you posted! If I don't post before, then I hope you have a very Merry Christmas!
  • Good luck to you and I hope it works for you! And Happy Holidays to you and your family as well!
  • I took Cymbalt lte in 2011, and it worked great for my back pai..until I broke out in giant hives on New YearsEve! That was horrid! sso I had to drop that. Then my pain mgmy Dr. put me on the Neurontin, and when he told me the dosage (2700mg/day), I said, are you crazy?? Well, I tried to follow it at first but was falling asleep at the wheel (I drive an hour to work) so dropped to 1 pill morning, 1 at lunch, ad 3 at bed time, and that seemed to work pretty good for me. Now that my surgery is done and I am not working, I can take the full dose, and am happy for it! Yeah, it makes me loopy, and a little groggy but it is worth it to me. I see where some people prefer Lyrica

    Everybody reacts different, and it takes a while to find the right "cocktail" of meds for each of us!
  • that's a MASSIVE operation .i was scheduled for one but my consultant was happy with the ALIF .i was glad as the ALIF almost wiped me out .i have already had 2 previous operation on my spine done via the conventional route .as for medication i can not take any of the gaba type drugs {lyrica/gabapentin/pregabalin /amitriptyline etc] when i was on them they made me extremely ill with fluid retention and massive weight gain.serious weight gain and serious water retention ..i had to came of them immediately .funny thing was i had no withdrawal from them .i spent the weekend peeing !! and felt so much better .and they never did anything for the pain ..as for pain clinics i have been discharged after ten years they have tried every things i have had loads of various injection and loads of different medication ..we have settled on oxycontin ad oxynorm and diazepam and temazepam .i can tolerate them .my problem is original poor surgery initial followed by another poor attend to repair me .then i eventually saw one of the uk's best consultants .but he told me that this are so bad he doubts that any pain relief would come from any surgery .but surgery was needed as my spine was in a dangerous state from a stability point of view.i have horrendous mechanical lower back ache and permanent nerve damage .i will have to live with it .
    i see the consultant next jan
    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
  • Hi Frank. I had a double level fusion four months ago. Pain was pretty bad post surgery for about two weeks. Specifically the first two days were very rough, but they will have you on some good meds. After that it gradually got better. I took 4 weeks off of work which is the minimum that my surgeon recommended. Good luck with your surgery, I know how nervous it is just waiting for the day
    L4-L5 / L5-S1 fusion surgery on August 20, 2012
    Four months after surgery and pain level is worse than pre surgery levels
    Doctor says fusion looks good. Is recommending SI joint shot to help with pain. PT makes me feel worse.
  • I spent 3 nights/4 days in the hospital. My bill was roughly $100k, but luckily I met most of my deductible and had an out of pocket max that wasn't too bad
    L4-L5 / L5-S1 fusion surgery on August 20, 2012
    Four months after surgery and pain level is worse than pre surgery levels
    Doctor says fusion looks good. Is recommending SI joint shot to help with pain. PT makes me feel worse.
  • Its a rough surgery but you can do this. Pain is crazy but they keep you good and medicated. Most important thing I can stress is make sure you have a plan for meds when they release you. In the hospital, they keep you on high doses, of course you are okay. For me, they released me with medication that I was on before the surgery. Not enough and I ended up back in for 3 days for proper pain management. Meaning, they weaned me down from IV meds to oral....took me to what they would send me home with. Seems like common sense, but they are not always good at the common sense part of things. My best advice is do not rush your recovery. This is a big deal and while you might feel better and ready to go in a few weeks...you are not! Take it slow, it is not a rush to the finish. Slow and steady wins the race here. I didnt do that and5 months out I am really suffering. If you ever want to talk to another 3 level, I am here. I am 44, was in good shape prior....thank goodness becasue boy would it be a different story. I have 2 little kids, which is what has been the hardest to deal with. I have a 3 year old and found myself lifting him when I though I was better...I am better...but I should never again lift my 35 pound son! I am a little down right now, not my usual positive self, but I will be as honest about my experience I can with you. It is totally possible to come out on top with this surgery. You MUST take it slow and stay positive and follow directions to the T! Let me know if you have any questions, Frank...I would be happy to answer! Peace, Ellen
    3 level fusion L3-S1 July 23, 2012
  • Hi Ellen good to know that you are still around. Haven't seen you on the radar for quite some time.
    How are you going with pain at the moment?
  • Roz5382RRoz5382 Posts: 46
    edited 12/21/2012 - 3:49 PM
    I notice that after the surgery, the long awaiting period of recovery. There are many challenges. Pain is still there for some people. Over doing it will make things worst, not better.
    Many questions and really hope that the NS is a phone call away and can answer all questions.
    I am 4 months post op PLIF L5/S1. I can walk longer now. Last month before I started PT and OT, I can sit 35 minutes without pain. But now after PT and OT it's an entirely different story. It drives me into an entirely different world and I just simply don't understand it. So I am going to stop PT and OT for a while and see how it goes.
    I go to spa every day and it helps with the pain. Hydro and walking in the water also helps. I am also swimming a little bit.

    Let us all be strong and stay positive, although its easier said than done.
  • I am glad to read all of your stories, esp. the 3 level ones.

    Days are not too bad, unless I over do it, which, like ellencali said, is easy to do once you are feeling better! But boy, I dread the sun setting and bed time getting nearer. Sleeping is the absolute worst! Even with the Valium he gave me, I still wake up and although my lower back no longer hurts (which is a blessing in itself), my hips, thighs and calf muscles are killing me! I tried taking the muscle relaxer too (Flexiril?) but no differece. So I am up and down all night, thne sleep til 7am, go b ack to sleep and wake at 1pm, then try to stay up the rest of th day.

    I want to try to start doind more exercising esides walking but afraid that it will be too much and myh mmuscles will hurt more at night!

    Merry Christmas/Happy Holidays to all if I don't post til after Tuesday
  • edited 12/22/2012 - 3:31 PM
    So happy to hear you are recovering well. I'm having a 2 level ALIF done in 13 days, and I've been soaking up any and all information I can. Thanks for sharing your progress with us!
    DDD L4-5 & L5-S1 w/ herniation
    Failed discectomy, 8-15-11
    Discogram, 11-14-12
    L4-S1 ALIF (2 plastic cages, 2 plates and 8 screws), 1-4-13
    FBSS & SI joint dysfunction, 12-30-13
    1 year post-op CT hardware scan & left SI joint injection, 1-17-14
  • horselady21hhorselady21 Posts: 174
    edited 12/25/2012 - 2:59 AM
    I think I got the sleeping problem somewhat solved.

    Right before I am ready to go to sleeo, I take 2 Percocets, 2 Neurontin, 1 valium and 1 Tylenol PM. The past 2 nights that I've done that, I have slept from about 10pm to 5 am! That is definitely an improvement!

    Happy Holidays to my soiney friends, and here's hoping all a pain-free day.
  • Today is XLIF L4-5 day + 14 for me. Obviously, the night of surgery was the worst. Either I wasn't breathing deeply enough, or I rolled over on the PCA button a few times, but the apnea monitor went off several times, which I am sure aged my poor nurse about ten years during the course of the shift. About 4 AM when he came running in saying, "OMG, OMG," and I made some sort of verbal response, thus reassuring him that I was in fact breathing, we talked briefly and I slurred out to him, "well, why not just call the doc and get an order to turn off the basal?" I figured I'd rather be breathing and in pain than in respiratory depression, and figured that if I was in that much pain, I could always just hit the button if it woke me up enough. Obviously, I survived the night, it wasn't much fun, however.

    On discharge I was prescribed Lortab 7.5 every 4 hours PRN, max 6 doses a day, and Valium 5 mgm TID prn, max 3 doses a day. The surgeon encouraged me to take the full dosing for a few weeks and "stay ahead of the pain," in order to start home PT more comfortably. He assured me he would be willing to renew said prescriptions should I say I need them. He says my priority for the next several weeks should be walking and doing mild home PT exercises. I'm down to five Lortab a day, and reasonably comfortable enough to walk around the house at least a dozen times a day. Right now, the worst of this is the left psoas "charlie horses," which sometimes feel like the Kentucky Derby, and the incisional itching. Once the staples came out on the 21st I felt considerably better. The other issue is the back brace. I have what the orthotic fitter calls a "high hip to waist ratio," which I suppose either means hourglass figure or "fat ----," depending on how you look at it (I'm actually pretty slender,) but my body type is definitely not the cylinder that the DonJoyLSO seems to like. Having the "chairback" feature dig into my armpits at Olive Garden the other night wasn't fun. Additionally, I'm very short-waisted, and yesterday spent half an hour having the brace readjusted. Reasonably comfortable chairs are an additional annoyance for me.

    The big trick I learned with the DonJoy is to prepare to adjust tension when one changes position to avoid the brace shifting upwards or downwards.

    Everyone's pain experience is different, and the one thing I'm learning from this experience is to NOT try to be some kind of hero, and describe my discomforts as accurately as possible.

    Oh, by the way: Changing mattresses to what the doctor said: "an extra firm high coil count high twist innerspring mattress" turned out to be excellent. It has a viscofoam pillowtop to avoid pressure points, but the support I get is great. I sleep like a log on that thing!

    Hope everyone's holiday is reasonably comfortable.
    I'm not a spinal diagnosis. I'm a human being with a spinal diagnosis.
  • Well.....spoke with my neurosurgeon's nurse last week and she said I must have done something to irritate the surgical site and/or muscles in my lower back. I told her it feels like a Charlie horse across my entire lower back when I wake up in the mornings. She ordered me to be on bed rest the last few days and to take my muscle relaxer and pain med around the clock again. I have done as she said and it's still happening :(. She said I could possibly have a seroma. I'm gonna call her again tomorrow and see what she says. I have noticed that I don't have the spasms if I sleep on the couch, but when I sleep in the bed I always wake up early in the morning with unbearable spasms......maybe it's my mattress? I don't understand why it just started happening the last week and a half or so.......I'm 7 weeks post-op, so I don't get it?!
  • odile53- I am glad you wrote out your experience (I ca imagine your first night- wha a scare that must havebeen!) Anyway, you say you were prescribed Lortab7.5...do you know how that comparesto my percocet 10/325? The were giving me 2 every 3 hours in the hospital, then when I got home and had the script filled, it said 1-3 every 4-6 hrs.., which didn't even begin to touch the pain I was in! I called in and nurse said it was om to take what I was taking in hospital, then had my 2 week check up and got same script. But my pain doesn''t seem to be getting any better. And gosh, my legs hurt, esp. mythighs and behind my knees. Is that what you mean by Charlie horses? Dr. gave me Valium but nothing I take lasts very long. It seems like I am constantly fighting pain, so much more than before surgery. I had asked him about MSContin, which my PCP had prescribed for me when I was in bad shape before surgery and he said he dosn't prescribe any of the Contin drugs at all. So is Percocet my only option??
    NurseTippy- At 7 weeks out, I thought you woule be better nd running laps! I am sleeping on a relatively new mattress ut it is hard to get comfy...I just shove a pillow or 2 between my legs, lay on m right side (can't lay on left- way too much pain there) and hope for the best. Hoe are you doing otherwise?
  • Glad you are doing better.
  • midatlantic545midatlantic545 Posts: 24
    edited 10/03/2014 - 2:02 PM
    Hello all, My date is closing in fast Jan 28th.
  • Hello all, just finished the Pre op stuff
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