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Am I too young for a fusion? Should I have surgery?


This is my first post! I am 22 and have been dealing with back pain for over 3 years now. I had a large herniated disk at L5-S1 and after trying conservative treatment for over a year I had a discectomy. About a year after surgery the pain came back and over the last 8 months has gotten progressively worse. I had an MRI recently and it is pretty clear that the disk space has shrunk a lot and the disc is herniated again (but not nearly as big as last time). My Dr. thinks the pain is due to the disc space, not the small herniation.

When I was seeing surgeons prior to my discectomy most of them said that I was too young for a fusion. Now I am a year older and talking to surgeons again (different ones than I talked to before the discectomy) who are suggesting that I have a fusion. Also, my PT said that she thinks I am too young to be having a fusion. So Im confused if I am too young or not. I cant imagine that one year makes that big of a difference.

Has anyone around my age had experience with having a fusion? Do you think having a fusion now will cause me problems in the future?

I'm kind of freaked out by the idea of a fusion and really dont want to do it. Does any one have any suggestions of other options?



  • SteveTSSteveT Posts: 178
    edited 08/24/2013 - 1:59 PM
    I'm in the same boat as you. I turned 24 today and am facing a double fusion at L4/L5 and L5/S1. I have annular tears at both levels and my pain has progressively got worse over the past few months. I've failed conservative treatment - epidurals and PT. PT made my leg pain much worse than it already was.

    My surgeon is also concerned with my age. I last saw him in early July and he said if I was 20 years older, he would have no hesitation. I see him again on Thursday and intend on scheduling the double fusion. It's absolutely possible a fusion now can cause issues in the future. When you fuse a level, you put more stress on other levels.

    Scary, but if it helps with my pain and is really my only option, I'll do it. I can't offer you any advice, but good luck and I'll be watching this thread!
    10/28/13 - ALIF, PSF, decompression at L4/L5 and L5/S1
  • I was 19 when I had a micro d. Suffered through 8 years of conservative treatment before having a transforaminal lumbar interbody fusion or TLIF at L3 -S1. Now have ruptured disc above fusion site giving me hell. Also permanent nerve damage, and arthritis. I do not regret having the fusion as I could hardly walk at that point. But things are not great. This is a big change from the natural anatomy. Only you can decide how much pain you can deal with and for how long. Fusion was not a cure all. That being said I am now scheduled for a two to three level cervical fusion on September 23. Prayers for both of you.

    One love, Stephanie
  • 32 years old now, going in for third back surgery.
  • as90, have you tried pain management? i have herniated l5,s1 and bulging l4,l5 as my last mri said over 2 years ago. they recommended the microdiscectomy for me also, but i have a physical job, must lift up 75lbs. as of right now i have been doing really well. i do stretches every morning, take 1 vitamin b comlex gummy, dont know if that helps, someone on here recommended it. also i take nucynta er 150mg every 12 hours, gabapentin and celebrex. right now like i said am doing well, so i am glad i did not get the surgery yet, plus all i read about is people reherniating, then needing more surgery. good luck to you.
  • SteveT and Downinmyheart good luck with your surgeries! I guess we area all (or were) in the same position and it is definitely a frustrating one to be in.

    catfishman, I have had PT several times (gone to 3 different PTs over the last 3 years), had 10 epidural steroid injections, have taken gabapentin and oral steroids. I feel like I have tried just about everything! Except I havent heard about the vitamin b, so I will try that. I also decided that I might as well try to move away from the traditional route, so I am getting acupuncture tomorrow and hoping that it will be helpful.

    I take vicoden everyday to be able to get through my daily activities, so Im pretty sure that that is a sign I need the surgery, but I really dont want to do it because it sounds so painful. I was so uncomfortable after my discectomy and I can only imagine this will be worse. So, I want to do anything I can to avoid it.

    Thanks for the input everyone!
  • I am three weeks out of a 360 fusion at L5-S1 and I am a month from being 24. A fusion was my last option after conservative care and it did take some time to find a surgeon comfortable with my age. When I did find him he explained everything really well and I decided I would rather have a fusion and get back to serious athletic activity instead of live with the pain. My slippage of vertebra was also getting more unstable and I had a lot of nerve compression so it wouldn't have taken much longer to get to this point anyway. At this point I am one hundred percent sure I made the correct decision. Although I'm sore I'm not in pain and my nerve issues are ninety percent better and continues to get better. The doctor was serious when he said there is a greater possibility of the level above having issues as times goes on but only time will tell and I will cross that bridge when I get there. Choose your surgeon wisely, I met with four before I found one I could connect with and one I could trust to tell me everything. So yes you are young but not alone, take care!
  • I do not understand why your young age is a factor? If a disc is herniated, it is herniated. If you had been in a car accident would they say the same thing? I just had a open fusion on L4/L5 13 weeks ago. I am 43. I suffered for 3 years prior. I still have pain so I think it is coming from S1 but it is less pain. Somedays I have no pain. I say go for it. I know a lot of people who have had sucessful fusions and are back to work. Try and get it done minimally invasive so you can recover quicker. Mine was open and I think that is why I still have pain.

    Grade 4 tear in l4/l5 was missed in first MRI so did injections for a year
    SI joints "messed up" not sure if I will get them fused at a later time
    Had Open PLIF L4/L5 5/28/13
    Woke up to permanent nerve damage in legs and feet.
  • Age is a factor because if you get a fusion when you are younger, it increases your chances of causing damage to other levels. Figure if I get a fusion now when I am 24, I could be around for another 60 or 70 years, and would likely end up with additional fusions because that's a long time to be putting stress on other levels.
    10/28/13 - ALIF, PSF, decompression at L4/L5 and L5/S1
  • EMS GuyEEMS Guy Posts: 916
    edited 08/26/2013 - 3:18 AM
    Just from my perspective, minimally invasive 360 ALIF has caused more problems than if the surgeon would have just opened me up. Each of the holes they put in your back have the potential of filling with scar tissue. Scar tissue surrounded by healthy muscle can lead to irritation and spasms. My latest MRI clearly shows where all the scar tissue is at and why it's a contributing factor with my ongoing pain.

    Also - JP, be very careful getting back to serous athletics. Take it slow so you don't mess up what the surgeon did. Three months after surgery I felt better than I had in a long time. I was put into work conditioning (strenuous PT) for several weeks and that's when the pain returned (and hasn't gone away). It's great that your are feeling better and I hope you continue to improve for the long haul!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Jumping PenguinJJumping Penguin Posts: 7
    edited 08/26/2013 - 6:11 AM
    EMS- thanks for the advice! I know that although I feel pretty good I still have to go slow. I don't expect to get back to my previous competitive state but I want to be able to participate at least. Still i know that will take at least a year or more.

    As far as minimally invasive or not, mine was all open and seems to be doing great. I think research with your surgeon is key because as you can tell from these forums everyone has individual needs and differences and I don't think any two people have the same experience with surgery or recovery.
  • Hi AS90

    I agree with what some of the other posters have said- I'm not sure what age has to do with it if you have these clear issues. it sucks that you have to deal with this now, but on the plus side, you might have a better recovery since you are so young.

    I want to comment on what your PT told you- that you didn't need surgery.
    I have gone through PT two times: two years ago and again am going through it now. Both times the PTs have told me that I did not need surgery. I personally think that PTs have a very healthy non-surgical approach to managing pain and spinal issues, BUT, they are not doctors nor do they have to live in your body. I know it makes it very confusing to have so many experts give you conflicting news. I am going through it now. All I can add is what a lot of people on these boards say all the time- take the time to do your research, find a doctor you trust, and make sure you are the one who is making the decision.

    Has the PT worked at all? Also, ask your PT directly why s/he thinks you are too young. What is the age requirement they recommend? My PT has provided a great deal of information about the spine, mostly for the simple reason that I am with him one-on-one for an entire hour.

    Anyway, good luck with your decision.

    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
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