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L4/L5 Fusion-To do or not to do?

After about 10 years of off & on pain in my lumbar spine, a spinal specialist has diagnosed me with degenerative disc disease and recommended fusion of L4/L5.
I'd like to avoid surgery and have done loads of things over the years to improve the health of my spine (physio therapy, cortisone injections, maintain a healthy weight, I practice and teach yoga, use an inversion table when the pain requires it). To give you a better picture of my situation: I can walk but I can't run (due to pain), sitting for more than 10 or 15 minutes in the same position is impossible, I can work in the garden & do household stuff (mopping, vacuuming, etc) but then have to lie down for an hour and take anti-inflammatories until the pain subsides. Most postures in yoga are okay but I avoid extreme backbends and positions that aggravate the pain. There is not one day that goes by when I am not reminded of my back and the pain.
I'm just starting my research into this and was wondering if there are folks out there who have had this done and what results you have experienced? Thanks in advance for the feedback!


  • Nick_MurphyNNick_Murphy Posts: 171
    edited 04/06/2013 - 1:32 AM
    In 1997 I had an experimental fusion alternative, a Graff Stabilization, for L4 / 5 / S1 as well as a double discectomy. This lasted around 14 years, but in 2011 I began having problems again and it was noted one of my pedicel screws had snapped and likely some if not all the ligaments (part of the Stabilization hardware) were broken. Throughout 2011 / 2012 my surgeon attempted various conservative treatments, but ultimately agreed in December 2012 that a 2 level fusion was the only way forward, and I had this carried out 7 weeks ago. Still early days in my recovery, and probably some time away from being able to confirm success or otherwise. I saw my surgeon yesterday and was extremely pleased with my progress and remains confident I will recover well, however from what I have seen elsewhere its most likely that over time there will be increased pressure on the levels above (in your case could also be below ie L5/S1) and possible surgical intention required.

    I think it's tough to decide when surgical intervention is required, particularly a fusion, however I am a firm believer that when you reach a point that your life is being negatively impeded by your condition to the extent that you no longer can experience a normal lifestyle after having tried more conservative measures, then it's time to let the surgeons do their thing! From what you have described above, personally I'd feel I was already at the point where a normal existence was no longer viable, and move forward to the fusion option - but that's just my personal opinion.

    Of course, I may have a very different opinion should my progress not continue as planned, and it will be interesting to see what response you receive from others that have gone through fusion. However, as I have seen others point out, often those that have successful fusions tend to leave forums such as these and it's mainly those with continued issues that remain on the forums, so try not to let this cloud your judgement when weighing up the responses.
  • I clean houses for a living and 4 yrs ago I started getting back pain.I started wearing a brace while I worked.It got real bad so I had pt for 6 mths no change.Started getting siatic pain down right leg.Working was a struggle every day but I don't believe in calling in as its my business. I then went to chiropractor, no change. Tried steroid shots. I went to work and was vacuuming the stairs and got a siatic pain so bad ,I dropped the vacume and collapsed.I new then that I was done.That was dec24th. I called my surgeon and said im ready.On march 13 I had ALIF L4L5S1 Surgery. I spent 5 days in hospital.Im home now and getting better every day.Im still on morphine and Gabapentin for nerve pain. I see improvement every day.I saw my surgeon postop and he said everything looks great.He said ill have a full recovery , but it will take time because I have a hard job so he wants me strong before I go back.The only one who can know when surgery is an option is you. You will know when its time, when you cant take it any more. Good luck and if you want to pm me im here. kathy
    Kathy B
  • Did the surgeon talk about other surgical options with you or just fusion? I'm curious as to why he only discussed fusion if that was the case. I can tell you in my situation personally I wish my surgeon four years ago had talked fusion instead of discectomy that has led me down a road with five surgeries in 4 years at the same level and now I'm at the point to where he says that a fusion is my last option. I was a highly competitive triathlete at 35, running 25-35 miles a week, cycling @ 125 miles a week and swimming 5 miles a week. Now the only hobby I can still enjoy is woodworking and fishing, and I live in Alaska. I think most times when we are contemplating surgery then it's the right time or we wouldn't be thinking about it, if we are at a point to where we can not comfortably do the things that we love to do then we might as well gamble on that the surgeon can do something to get us back to that point. The upside is that you'll be able to do what you want again, the downside is that you won't, which is where most of us are when we are considering surgery anyway. The choice is obviously yours, but with the chance that they can make you somewhat better than you are now in my case was worth the chance, you gotta ask yourself if you can be happy with your life the way it is right now.
    Microdiscectomy/Laminectomy/Foraminalectoy L4/L5/S1 Oct 2009, Mar 2012
    Laminectomy L4/L5/S1 Dec 2009, Oct 2012, Dec 2012
    Microdiscectomy and Synovial Cyst removal Feb 2013
    St Jude Spinal Cord Stimulator implanted January 2014

  • Oh How I wish I hadn't had the surgery, so I had
    drop foot and spinal stenosis, the pain was manageable
    with Ibuprofin, and it was getting harder to lift my
    foot off the ground and so after a second
    opinion I had the spinal fusion L4 and L5 done
    on November 20, 2012, and it was fine at first, was
    able to discard the turtle shell brace and then
    the walker, but in January, started having pain
    in my pelvis and right hip to the extent I wanted
    to scream when I turned over in bed or pulled
    myself up the stairs, now I am finding my balance
    has gone, so far I have managed to catch hold
    of something and have not fallen to the ground,
    even my stabilized cane doesn't help.
    My quality of life has so deteriorated since the
    Surgery that its hard to get out of bed anymore,
    I don't go out in public now, terrified someone
    will brush past me and I will fall, it happens
    all the time without warning........ would I recommend
    this surgery........ Dear God NO!!
  • Every persons experience is different. Every body is different. What is good for one person might not be good for another. You need to make decisions with yourself and your dr. I had a 2 level fusion in 2007. Although my recovery was awful the fusion was perfect and took all my pain away for 5 years until the level under it blew. I am scheduled for another fusion on Thursday. Make decisions with your dr and always get a 2nd DRS opinion. Best of luck!

    DDD 2 level ALIF L3-L5 in 2007. 4/11/13 posterior fusion w/decompression on L5-S1.
  • essmoe29eessmoe29 Posts: 317
    edited 04/06/2013 - 6:10 PM
    I've had DDD and a 57-degree scoliotic curvature for the past 14 years,with progressive degeneration to the point of having to use a rollator walker for distance walking and a heating pad with an automatic shutoff feature at night whenever my pain is worse. Last November I went to one of the best orthopedic spine surgeons in the Tampa Bay area to find out if he would be willing to perform a less invasive procedure than fusion, which I'd been advised by another OSS to undergo. When I walked into the surgeon's office for my most recent appointment, I was very apprehensive due to fear of being told I would need a fusion. My fear turned out to be groundless, for Dr. S told me he was "on the same page," that he's reluctant to operate unless the patient is in excruciating pain. I was soooo relieved! Granted, my pain has progressively worsened over the years, but I am so afraid of fusion, I will let a surgeon operate on my dead body. Put me in a wheelchair, but I will never undergo spinal surgery!
  • mrscahillmmrscahill Posts: 43
    edited 04/16/2013 - 3:01 AM
    I say never say never and everyone responds to surgery differently. I read SO many negative horror stories before my surgery. I too had DDD of L4-L5 and I'm only 30. I was miserable and quality of life severely diminished and I'm a medic my patients rely on me. On February 18,2013 I had the ALIF and yesterday was 8 weeks and I go for my second checkup today. My first on the were absolutely tickled with how extremely well I'm doing today will be no exception. I've been out of the brace for two weeks I'm bending slightly (listening to my body) and my only pains are rolling over when lying down and if I stay upright too long and overdue it but that pain is upper back not the surgery area. The first two weeks were hardest especially the incision site but I don't regret it one bit. I know I have a way to go but it gave me my life back and I'm so thankful. Good luck to you.
  • I'm 27 years old and have DDD as well as had 2 blown discs. Three car accidents and a pregnancy did a huge number on my spine, especially for someone my age. I had a 2 level ALIF done on January 4th. (L4-S1) I'm still healing, but I can say there has been a vast improvement in my nerve pain! The surgery we pretty rough, and I have a good 8 inch abdominal incision/scar, but once I got through the first couple of weeks, things started getting better. I'm still on MS Contin & percoset for breakthrough pain, as well as flexeril and neurontin. I hope to be weaned from everything except the neurontin by 6 months post-op.

    Only you can really decide if the surgery would be worth it. I know I couldn't even vacuum or sweep, let alone do yoga! If you can put off surgery until absolutely necessary, I would suggest it. I exhausted every other option there was, including a failed discectomy in 2011. Since my ALIF I have been able to slowly 'graduate' to lifting 20 pounds, take out the garbage, walk for a good amount of time, and sit comfortably.

    I hope you can find a treatment that makes you more comfortable. Never hesitate to ask us questions! :)
    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
  • Had my checkup today. Drs are beyond impressed with me. I've got a 15lb weight limit but I'm doing great. I walk several miles a day about to add the elliptical and machine weights and only meds I take are lowest dose of Percocet and robaxin nothing else and I only do it at night. I'm eight weeks out. Anything is possible.
  • Thanks for the update. I am facing the same surgery, but trying to hold off until next summer.
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