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L4/L5/S1 Fusion procedure questions - much appreciated

I have an L4-S1 fusion surgery coming up March 6th. I'm anxious and nervous at the same time. I'm nervous b/c of how invasive the surgical procedure is as well as being under for roughly 4 hours.

First, a bit of background... I'm now in my 40s and I've been dealing with low back pain for 3+ years. For the most part I just dealt w/ it as there wasn't much I wasn't able to do. I just lived through the pain. However, things progressively have gotten worse - I can't lift hardly anything off of the floor when bending over; I can't jump up and down; I can't run and play soccer w/ my daughter b/c the pain levels are too high and I sometimes get spasms. About two years ago I experienced 10 pain as I was on the floor and couldn't get up b/c of the pain. I was nearly screaming it hurt so bad.

For me, the only relief I get is when I'm in a seated position. This is the best of things as I have a desk job and I sit the vast majority of the day. It's when I want to "live" that I cannot. I love to exercise. My favorite thing I used to do every night was to pop in an Insanity DVD and do a workout in the garage. I haven't worked out in about 3 months b/c the pain just got to be too much.

I wake up every morning in a lot of pain. The best way to describe my sensation is that it feels like if I bent forward far enough, my back would snap in two. I have to get in a crouching position when I go to sneeze. I have to lay w/ pillows under my legs when sleeping at night. I can't remember the last time I got a good nights rest.

When I was in 10 pain I got an epidural b/c the pain was so bad. It was awesome for about 2 weeks, then went back to being bad. I've had 2 MRIs and I had one dr. tell me to go thru physical therapy and the other dr who told me surgery was my only option, other than living w/ the pain. I tried physical therapy b/c it wouldn't hurt but I did not get any relief. I left in more pain than when I arrived. I did the disc decompression machine and ultrasound.

So, I have decided to move forward w/ surgery. The surgical procedure is called an anterior-posterior surgery. I'm first cut open above the pubic bone, the intestines are moved so that the discs can be cut out, then rolled onto my stomach and cut in my back so that the rods and the rest of the fusion can be completed. An additional step of cutting me open in the hip area to take existing bone for the bone graft is also done. This is mixed with artificial bone to fill in where the discs were to create the fusion.

My initial thinking was that surely there would be a minimally invasive procedure I could benefit from. My dr swears by the anterior/posterior method. He calls it the gold standard and says it has the highest success rate. I told him Insanity was my gold standard and he felt very confident that he could alleviate nearly all of my pain.

I have degenerative disc disease. I'm curious to know/learn from others who have gone through this procedure. Did you have the same anxiety? Did you first try a minimally invasive method? What are the results 6+ months post operation? Do you feel like you're able to live? Is there anything that did not meet your expectation?

I greatly appreciate any insight offered? God Bless.


  • pennie92pennie92 KentuckyPosts: 16
    edited 02/26/2014 - 10:30 AM
    Hello, I read your post and could relate very much…I had an anterior/posterior spinal fusion with 2 rods, 6 screws, 2 cages that were filled with bone that was grafted from my hip and these cages were inserted between vertebras where disks were removed…But the reason for my surgery was I have Spondylolisthesis L5-S1 Grade 5..which means a vertebra slipped over the top of another and fell off the track of my spine…having this type of surgery is a major surgery and for me it was an 8 hour surgery…I had an orthopedic surgeon and a neurosurgeon ….your surgery is getting very near..We don't' have the same issues but are having a similar surgery to correct things so to say…It is very normal to feel anxiety Trust me!! I was 32 at the time of my surgery and now I am 43 years old. It will take a full year before your fusion is totally healed and for you to possibly feel back to your old self..well a Better Self!! That is great that your surgeon is confident in relieving most of your pain, ..Alot of doctors don't do the approach of going through the front and the back to fuse…at least for Spondylolisthesis…but I was happy and still am happy with having this type of surgery done…it makes sure that nothing ever moves forward..which is the case sometimes with just having an anterior spinal fusion…I am an Administrator on a Spondylolisthesis support group…so I have gotten to talk to a lot of people that have had spinal fusions done…I know there are support groups as well for degenerative disc disease…do you have Facebook? there might be a group there for you to join …I find it easier to chat with people in those types of groups and not have to wait for a response and can chat with someone at that very moment you are looking for answers…anyways…You ask if I feel like I am able to live after this type of surgery…Yes…I think you have to look at the quality of life you are having now..are you in constant pain every day even after you get up in the mornings ? Is the pain constant? I can tell by what you write it is interfering with you life…do you have any other problems? From the waist down? Such as numbness, tingling, shooting pain, in your legs, feet, buttocks? Also this might seem personal and Im not asking you to answer..but some woman and men as well don't realize that this could also be affected..but if you are having any bladder or bowel issues, or issues with your manhood? Sometimes when Nerves are pinched, or damaged this can affect us in different ways and we don't realize that it has something to do with our lower back problems…For me…I had no idea I had any problems until it was severe and one day when I lifted a very heavy box i felt a popping in my lower back and pain immediate that wouldn't go away and was getting worse by the day…got an X-ray a month later to find out what was wrong and was told I needed immediate surgery….or I would wind up in a wheel chair and have no feeling of having to go to the bathroom…this was because my nerves were sooo stretch and intwined with each other and since my vertebra was holding on only by these nerves…it wouldn't take much for them to snap and leave me having severe problems…so 3 months later i had the surgery, at the time I had a 3 and 5 year old…I had to wear a brace for 4 months and not bend….I also had to rent a hospital bed for my home which I used for 3 months..this was the best thing ever!!! And insurance paid for most of it..I know one thing for sure ….you will need someone to help care for you when you come home from the hospital! Unless you are sent to a rehab….That was never a choice for me..but many people have had that choice and it has helped them a great deal! Please don't hesitate to send me a PM….I will get that much faster then checking on here…I don't visit here often ..usually if Im online I am chatting on the group I told you about…I know you have a million questions, thoughts running through your mind…I would love to help you with some of your anxiety and if you PM me I will send you some links we have in the Spondy group..about preparing for surgery…etc..what you might need when you come home..things like that…Not sure of your location…are you in the USA?? I live in Kentucky USA. Well Robert I hope to hear from you before your survey day :)Take care!!! Hope to hear from you soon:)
  • SarahLindeauSarahLindeau Posts: 767
    edited 02/26/2014 - 10:54 AM
    Hi Robert,

    I also had the same procedure - a 360 fusion (meaning both approaches, front and back) at L4-L5 and L5-S1 with decompression, instrumentation and iliac crest bone graft. Same exact thing - anterior vertical incision, having a vascular surgeon push aside my aorta *eeek* and then my neurosurgeon removed the discs. FLIPPED me over (would have LOVED to see how they did that!) at about 3 hours into the procedure so the hardware could be installed from the posterior approach. I have 6 screws and 2 rods. I'm 1.5 inches taller now! Original estimate for op time was just shy of 6 hours. But as I was pretty slender, they finished in 4. Now I am just about 9 weeks post op and with the exception of a lot of stiffness and bone graft pain, I'm doing really well. Started back to work last week and things are going ok.

    I will admit I was VERY nervous in the minutes leading up to the procedure, but they gave me a little versed and the nurses were all very lovely. Once I got into the OR, I was unconscious in 30 seconds.

    The thing I will tell you to be prepared for is the INTENSE pain you'll have in the first 3-4 days after the op. Make sure you have some family or close friends to be in your room with you in those moments. They are VERY tough. I never was able to get on top of my pain until they put me on oral meds. It was very difficult. I also had a lot of trouble keeping my blood pressure up enough. My BP alarm went off ALL night the first night and they were afraid I was going to lose consciousness or worse. I also was only breathing 6 times in a minute and it was kind of scary. Mind you, I personally don't remember much of it, except the pain, but my family were there to help me get comfortable, put a compress on my head (severe headache) and offer me the support that only a close friend or family member can offer.

    My hospital had a roll out BED (not just that chair-thingy) and I had someone stay will me the first 3 nights, in my room. It was very helpful. Having their support when I was moved into my sitting chair, and when they had me on the walker on day two, was invaluable.

    You will do fine. There is just a LOT of pain and healing (and TIME) in between your current state and your success just now. Take it day at a time.

    2015: Thoracic protrusions C7-T1, T3-4, T6-8
    Dec'13: 360FusionL4-S1 w/bone graft
    2013: 3x2-level disc injections: 12mo surgery postponement
    Dec'12: DiscogramL4-S1
    Sep/Oct'12: Bi-lateral Rhizo AblationsL4- S1
  • backache99backache99 Posts: 1,338
    edited 03/04/2014 - 10:18 PM
    I want to tell you what to expect from MY OWN EXPERIENCE .first its a massive operation with a long recovery .the operation is technically difficult and when you wake expect pain ...lots of pain ..if this is your first operation you may not be as bad as I was as I have already had 2 previous spinal operations .expect weak legs expect pain like you have never had before {don't be shy about asking for pain relief ] you will be hooked up to a PCA that's a patient control analgesia devices.you may be in hospital up to or even over 2 weeks .I was in 7 days .but the next 6 weeks back at home were horrible I was just zombie on my recliner unable to do anything for myself and the slightest thing would set my crying ..this is normal /it can take upto 3 years for a fusion to completely heal .you will be bruised and if you a man you may experience ED .you could do with a grabber and a decent rise and recline recliner .it will be invaluable for you recovery ..I know many that have bought one and now don't know how they lived without it ..mind doubles as a bed as I can only sleep for 2 hours then pain will wake me .for me its been two years and I am no better of and I now have leg problems where I had none..i am a particularly bad example and you hopefully will do better .for me it looks like I may need more surgery ..I too have surgery this march but its on my bladder also as a direct cause from the ALIF .I have also had bowel issues due to the ALIF.good luck with the operation you will need lots of support following your surgery ,again good luck
    tony{UK} ps I have written many posts on this subject if you wish to read them ..beware of posts saying that they recovered in two weeks !! its not right I have an excellent consultant and he told me that my spine had been butchered and he did not have much to work with ..have you had your discography yet? again good luck
    your in for a long haul
    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
  • Sorry I didn't get back sooner. Thank you so much for your responses. First, I feel terrible for you Tony and wish you the best with getting back on the right track. I can't imagine having to go through this multiple times. Getting psychologically prepared has taken a lot!

    I've prayed a lot about this and I feel really good about my doctor so I'm at peace w/ my decision.

    Pennie: my pain is not constant as I have a desk job. Well, I could say that I do have some pain while seated but it's very manageable. I would not be getting a surgery if my pain level was where it is when I'm sitting. In fact, I wouldn't even see a dr. for it. It's just a minor annoyance. The pain is very bad when I wake up. I have to take my left hand and place it on my left knee to do any type of bending b/c I need the support. This would be for doing things like lifting the toilet seat. Simple stuff that is incredibly painful to do.

    Sarah: Thanks so much for the heads-up. What I'm finding very difficult to reconcile in my head is the post-surgery pain I can expect. I think I have a pretty high tolerance for pain. I refuse to take medication for the pain I have as I think it just masks the problem, or it actually gives me a massive headache, like vicodin. It's like pick your pain, you want back pain or a migraine headache?? I really appreciate the tip also re: having support in the room. I actually have instructed that I don't really want people around. I don't want people to see me like this... I think I need to re-think this.

    It must have been pretty scary for you re: breathing and your conciousness. Praise God you're here and on the mend.
  • i hope all went well for you and thank you for you kind words on my post .we will speak when you feel up to it
    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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