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L5-S1 questions

I had ruptured my L5-S1 disc in January 2014 in which the ruptured part broke off and was in the spinal canal smashing the nerve. Dr went in and removed this but left remaining disc in there cause he said it looked healthy but would be weak.
Well just had my 2nd surgery 6/2/14 on same disc that herniated and so he just trimmed it off and still left the remaining disc in there. I have numbness in my right leg with leg pain and back pain as well and now he is saying that I'm going to need a fusion. My question is for anyone that has had the fusion of the L5-S1 and has it helped? Did they put spacer in? I'm just really scared and stressing over this and need someone's opinion that has had it done. Thanks for any and all opinions.


  • Thank you for all the information...now I know where to look and to ask questions.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 06/13/2014 - 5:57 AM
    Hi. Have you tried any conservative measures (Physical Therapy, injections etc.) to help with this? Fusion is a huge step. I'd at least get a second opinion before fusion surgery. Make sure you're fully prepared for rehab after surgery. Get as much information as you can. There are forums dedicated to surgery here. See you around ;-)
    Osteoarthritis & DDD.
  • I feel your pain and your fright. I also need a fusion, but I need a multi-level fusion, L4-L5, L5-S1. I have torn those two discs, with their nucleus pulposus leaking out. I'm in tremendous pain right now. I've torn those 2 discs over and over in the past 6 years. I'm miserable. The pain so bad, I'm screaming. I've lost 53lbs this year, now at a weight of 191, to try to ease my back pain, and then THIS happens again, all because I went to stand up from my chair!! My NeuroSurgeons have advised to NOT have the fusion surgery, to put it off as long as possible. I also have spinal cord compression in my thoracic from an arachnoidal cyst that is 3 inches long. They tell me as long as I can walk, to avoid the surgery at ALL costs because the outcomes are very very iffy and usually NOT good. Not trying to scare you, just telling you what I've learned.....
  • When the pain and risk of making the change outweighs the pain and risk you are currently experiencing, you'll know its time.
    There is no guarantee of any outcome with fusion. That said, there can be a certainty of permanent nerve damage if no action is taken. In my case they stalled the fusion and when I was finally exhibiting severe nerve problems in my butt, thigh, calf, and foot, it was time. ALIF L5/S1 and going into the surgery he had said L4-S1 changed his mind because the degeneration at L5/S1 was so severe as opposed to the ruptures and completely shredded L1-L5 discs, that he felt the nerve issues were most assuredly centered there at L5/S1. It may take up to two years for your nerve to "heal" inasmuch as it ever will improve. Mine was already too far gone so I have had a spinal cod stimulator now for 9 months. It helped more when I OTT than now but it still contributes some relief.
    If I had the choice I would've done the fusion sooner. Hindsight is a wonderful hing though. If I knew then what I know now......I wouldn't be in his spot because if I knew I was gong to live tis long I would've taken much better care of myself.
    I'm 55 but I don't feel a day over a hundred.
  • I ruptured mine August 2011 to cut a long story short I after many less evasive options I ended up having a fusion of my L5-S1 vertebrae July 19th, 2013. Today I am able to function at 85% to 90% of what I could do before my fusion, have never had the severe pain but still on Tramadol 3 times a day, I continue to improve at a very slow rate but at least I am improving. Don't expect a 100% recovery in three months like I was told its a long process so be prepared, I think three months is an exception to the rule rather than the rule. You should definitely explore or your options first and get more than one opinion this should be a last resort, also this surgery is primarily to stabilise your vertebrae not pain relief, reduction in pain is an added bonus.
  • sandisandi Posts: 6,342
    edited 06/17/2014 - 4:39 AM
    when you start to feel more able to get around post op, it is not the end of the recovery period, and surgeons really don't specify that clearly to someone.......the entire recovery period can be as long as two years, before you are mostly back to yourself and your activities, but generally, in fusion surgery, it is often said that the patient should plan on a year.....
  • timfnzttimfnz Posts: 10
    edited 07/02/2014 - 6:50 PM
    I tore my L5s1 disc when I was 22 in an accident, I used to surf, and kitesurf, mountain bike etc. Spent 6 years trying to make my back better with yoga, massage, chiropractors, then after many episodes of crippling pain, ie, no longer walking but crawling, I opted for surgery. By this point my back had worn out at that level and had very little stability. I was lucky not to have lost the use of my legs with the level of sport I had been attempting.
    My understanding is that a single level fusion at L5s1 has about a 85% success rate of reducing pain. You need to try everything else before a fusion as it brings stability to your back, but you may end up with a more constant pain.
    Trust me, having a fusion is like someone taking a sledge hammer to your back and mashing it. My surgeon took only 1 1/2 hours, and used a cage to space my disc space, and growth hormone to speed the bone growth. A x-ray at 3 months showed the bone already fusing. I was 28yo when I opted for surgery.
    I was able to walk or stand for 30mins per day after 3 months, and spent the rest lying down. I did reformer pilates at 6 weeks post op, and tried swimming 2 weeks after that. Because of the damage to your back muscles, and the change of biomechanics, after a fusion your back will never have the stamina it did before. Your hips will wear out faster, and you may still have annoying nerve pain. The next disc up your spine will also be more likely to wear out or herniate too.

    After a year I felt good, with twice weekly massages. As long as I didn't have to sit down for any length of time I could return to work part-time. At one year, you can still feel discomfort at the sugery level, if you are walking and stumble, you'll feel some pain in the surgery. After 2 years I gained more strength and the fusion felt part of me.
    I have to do core exercises frequently, and stay really fit, lots of swimming to be virtually painfree, without medication. Slack off and do nothing and pain comes back (the constant type from fusion.). I rate my outcome as the best you could hope for.
    These days I am able to do short distance running, cycling (did a century ride (160km) last year, and returned to surfing after 3 years post fusion. Swimming 3 times a week, massages, and focusing on core strength are part of my weekly routine.
    To be honest, if you are overweight, lose it first, then I would focus on doing these things, for a year or two before committing to a fusion. Having great core strength will take the pressure of the nerves and discs, just like having a fusion would. See what the results are of having great core strength first, you can't go back from surgery.
  • morphia1957mmorphia1957 Posts: 84
    edited 07/04/2014 - 1:10 AM
    you are SO So right... I am grateful that I was in shape- great core strength before I did my fusion, and mine was L5-s1 and i am 56 now. (I soooo wished I could have told the woman in the bed next to me that pizza and soda wasn't a great option for post surgical snacking) Though, I still say to myself, WHY did I do this??? I did it because I might have lost the ability to walk at all ... (or so i was told... but... my back is actually as strong as it was prior to hurting myself.. I get very few pains in my back at all.. I had a high grade spondylothesis.. UNFORTUNATELY... a year + later (my surgery was 4-1-13) and my surgery was 5 hours. i have 13 screws and a cage. I have post surgical nerve damage, on my LEFT side - my left leg, and my left foot is hyper arched - almost the opposite of a drop foot. I can point my toes, but cannot stand on them. (thus, cannot walk right, I hitch..-I get crazy coxxyx, leg and nerve pain, I've been through hell this past year.. with pain management.. nerve blocks, etc., I can walk, but it's slow going. I can work out again but cannot run- i cannot do any kind of work where you push off from your ankle / calf muscle. I no longer have one. I was ecstatic when I could hold a plank again for more than 20 seconds. my balance is coming back, but it is HARD WORK and even harder in eating right and staying active when you feel like EDIT every day from chronic pain. i applaud what you've said as it's not said enough!! I've been told that my rsd and my post surgical issues will NOT change. this is what it is. My high heel days are over.. :-(

    Post edited to remove inappropriate language...Liz spine-health moderator.. Please read the Forum rules
  • back01bback01 Posts: 14
    edited 07/03/2014 - 3:53 PM
    Hi Firechick I'm so sorry you're going through this and I know it's scary. That's the great thing about this site I know that everyone can actually have true empathy regardless of where on the spine our issue is. When I initially injured my spine my I was referred immediately to a neurosurgeon whom I met with the next day. He said 100% i needed a fusion. I decided to get a second opinion as I was an extremely active 41 year old and loved my job. I was super concerned that a fusion would mean I would have to change jobs - I'm currently a Emergency ALS Paramedic and it's a very manual job requiring loads of lifting, CPR etc. So, cutting a long story short I opted for a different surgeon and we went conservatively with epidural steroids (no help) and eventually lamenectomy/disectomy jan 2013. However, as was probably always going to be the case (although I refused to admit it) my vertebrae was just too unstable and I ended up having a fusion anyway (April 2014). If I could turn back time and go the fusion initially, I would. I have wasted a year and been through a great deal of pain emotionally and physically. Anyway, that's just my story briefly. My fusion was inevitable and I put it off causing far further damage to my nerves especially L5. Good luck with your decision making. I am 3 months post surgery and I'm starting to feel fantastic! I can sit down which is a massive change and I'm in 2/10 pain compared with 10/10. My future looks great!
  • backache99backache99 Posts: 1,338
    edited 07/04/2014 - 2:55 AM
    its a purely mechanical fix a bit like a scaffolding around a building a good orthopaedic consultant will do this either by ALIF/PLIF or both there are others but A/P LIF are the most used ALIF is the worst to recover from as its the most invasive .ALIF stands for A anterior surgical reference to forward approach L is lumbar lower back .I interbody F fusion [to bond} P posterior from the rear
    or you can have both sometimes called a 360 or global
    any mechanical fix is classed a major surgery and not to be done without trying all other things first
    please be aware that a fusion wont stop pain if the pain was there in the first place if there was nerve damage that's permanent .sometimes a patient may get some pain relief if there pain was just mechanical but sometime nerve damage can occur during surgery so make sure you chose a competent surgeon
    if a fusion was your first surgery then you stand a good chance of a good recovery but if you have had previous surgery and you need multi levels doing then your chances are decreased and your recovery time will be longer anywhere up
    to 3 years .fusions can be life changing so make sure you know that before you decide to have one ,also make sure your not a suitable candidate for artificial disk because if you are you will get better movement in your spine you will need a discography and MRI scan to determine if you are suitable for ADR a discography is VERY painful but necessary for a fusion .if you were a man you need to know that ALIF can affect your ability to have sex { its had that effect on me ] and even if it had not the last thing I want is to be touched or bear weight in that area ! .please read as much as you can about fusions and beware of very optimistic posts and very optimistic consultants saying things like you will be back to normal in 6 weeks ...you wont !! if you are in the uk I can recommend someone but I can't say on here it would be a PM or email many of us on here have had fusions so please read what they have to say ,good luck and if I can help please ask
    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
  • donsteinerddonsteiner Posts: 1
    edited 07/07/2014 - 6:22 PM
    Hello, I had an L5/S1 fusion performed by Dr. EDITED) on May 28. I am doing great. The first 5 days were hard but after that each day was markedly improved. By the second week I was walking 1 mile per day. By week 4 I was up to 3 miles per day. The parts he used in me were a cage (I guess you could call it a spacer also), 4 screws and 2 rods. If you Google EDITEDyou can see the parts used. Like I said I'm 5 weeks post surgery and feeling great.

    Post edited by Sandi- Please see the forum rules at the link below for more information.
    You agree not to post specific physician names or health care facilities , devices or product names on Spine-Health.com.


    Don Steiner
  • Hi fire chic I had my fusion in April of this year on my l5/s1. Because I fell at work in January and broke my l5 vertebrae . I had 2 rods & 4 screws put in. After surgery I fell no pain. As the days turn to weeks and weeks to almost 3 months now. I have hurt so bad since my surgery. Pain going down my back to my legs and feet. It burns tingling sharp pains . When I lay down I am in so much pain trying to get up I am in so much pain that I become paralyzed with pain. I am on muscle relaxers and pain meds all they do is dull the pain. The pain gets so bad I want to cut my 2 pinky toes and heel off. Dr tells me it takes three months to fuse. I got hurt on my job so I have workers comp nurse and she says I shouldn't be hurting so bad I start crying. I am sorry you are going through this. I had two surgeries prior to this one for a herniated disc. They cut it off twice? And everything was fine so pain until I fell and broke my back. Since my surgery my pain has gotten worse. Before you decided on fusion surgery be aware it is a hard I mean hard recovery. I to a point I am starting feel like I have a failure fusion. Which will require another surgery. I hope it helps and hope you feel better soon
    Doris Driver
  • You are only now, just getting out of the acute phase of post op recovery. A flare up of nerve pain is expected post op and can take some months to resolve itself, especially if there was nerve compromise prior to surgery. Then to add insult to injury, the nerves, muscles, tendons and ligaments, are moved, cut and stitched back together to gain access to the area of the spine the doctor needs to fuse. The nerve pain will get better, as time goes on......there are medications that can ease nerve pain, until the nerves recover. Gabapentin, lyrica, cymbalta, amitryptaline and there are others.
    It is far too early to decide that your surgery is failure. The normal recovery period is anywhere from 1-2 years, depending on the type of fusion and the extent of the damage.
    You still have a lot more healing to do, before anyone calls your surgery a failed fusion.

  • maybe it is just semantics but seems like a lot of opinions on here.....are what people posting as responses from personal experiences?.....i know a lot of people suffer the same as me.....just curious because i read the forum rules and yet seems to not always be the case....

  • 5.12 You agree that any information, opinions or other content provided by doctors or patients on Spine-health.com forums is for educational purposes only and is not intended for medical diagnoses or treatment. Always consult with a physician for any health problem or medical condition.
  • Hi fire chic sorry to hear about your back. I have had three surgeries of my l5s1 like you first one was a herniated disc and dr went in took out the bad part left the rest year later it happened again so there was my second surgery after that I was great for 4 years not having any problems but in jan of this year I fell on some ice at work and hurt my back. Had test ran cause the pain was so bad down my right leg. Turned out I broke the l5 vertebra and it was pushing forward in my spinal cord. Ended up having it fused in April. I can't say that the surgery helped me, because I hurt worse now than I did before surgery, but everyone is different you have to remember that, what's good for me doesn't mean it will work for someone else. I am three and half months out of surgery and wish I can say I am better because I am not , it hurts when I try to get up from a sitter potition and when I lay down oh I really catch it them the pain is so bad I go to the floor in pain. My dr is running ct to see what's going on. You have to weight your pain level and see what's right for you and your quality of life. I was in so much pain and still am that I wasn't still am not living I am merely existing not living. I wish you we'll in your recovery remember you aren't gonna have the same out come good or bad as some one else. We all are different and heal differently . Good luck
    Doris Driver
  • timfnzttimfnz Posts: 10
    edited 08/27/2014 - 3:10 PM
    I would add that specifically for L5 S1 fusion, afterwards, you'll notice your flexibility is reduced by a small margin, but you may notice your tailbone doesn't 'tuck under' so much, and becomes a pressure point when sitting.
    I agree that a fusion is just for stability reasons, and there are so many nerves going through the region of L5-s1, compared to L4, that your chances of reducing nerve pain are not great. I actually put up with my bad back for 6 years, and remained very active, ie mountain biking, surfing, before finally ending up with a permanent back condition. In that time I managed to wear out my vertebrae 'wings', resulting in an abnormal range of motion or movement, along with tearing my ligmentum flavum multiple times (the ligament running parallel to my spinal cord) resulting in a lot of scar tissue. Hence I was never a candidate for an artifical disk. My problem was the disc was no longer able to restrain the movement of my spine at that level, ie no stability, so my back would 'go out' unpredictably. I found a chiropractor that could adjust my vertbrae back into alignment, and that worked for 3 years, but eventually didn't help. That was when I decided more extreme measures were necessary.
    In the end, with a fusion you must realise that for most people, you must do more exercise and conditioning for the REST of your life if you choose surgery, than you may have done pre-surgery to feel that your life quality has been improved. In a lot of cases you ended up on this forum, with a back problem because of poor fitness and core strength, unless you had an accident.

    In my case, my level of physical conditioning was insufficient for the level of sport I was doing, and then had an accident, with the results playing out over a number of years.
  • hi could anyone please help i have a L5 S1 disc bulging and they say the disc has torn this was done through trauma and happened early 2013 i am still in severe pain and due and epidual on tuesday has anyone had this done and does it really help, any information would be appreciated
  • Ice as soon as you can! It really helps with the procedure pain. It takes a while to know if its going to work so don't get discouraged in the first week. Sometimes it works & sometimes it doesn't even for the same patient. It's worth trying. :-)
    Osteoarthritis & DDD.
  • thankyou for your advice much appreciated i am an AE nurse and only have the following day off is this enough do you think my job is quite hectic, sorry for picking your brains.
  • The injections can cause the pain to flare up for several days until the steroids kick in. Ice is going to be your best friend, and sitting /resting as you are able. Muscle stretches may help too but do them slowly and don't push too hard. Once the steroids kick in , you should get some relief from the pain.


  • Ice is my best friend and it took around 48 hours for my injections to kick in. Major relief - now I just ache, but it's manageable.
    2013-4 Level ACDF C4-C7 herniation with severe spinal stenosis at C4-C5. .Bulging disk at L3-L4, and L4-L5. Herniation at L5-S1. As of 8/29/14 Bulging disc at L2-L5-S1 and disc protrusion at L3-L4.
  • I have little kids & we use those ice block things you put in their lunch boxes to keep things fresh. I take a couple with me & ice on the way home. I've managed to avoid the worst of the post procedure tenderness by doing that. I can function for the next few days but I'm not a nurse! Good luck! ;-)
    Osteoarthritis & DDD.
  • Im off to get ice packs today thanks for letting me know il take it easy for a couple of days fingers crossed il be up and running in a few days, not literaly thou lol x
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