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How much flexibility is lost from single level L5S1 fusion?

nreidnnreid Posts: 8
edited 05/10/2015 - 9:03 AM in Back Surgery and Neck Surgery
Hi everyone,

I had an L5S1 discetomy in February 2014 which is 15 months ago now and made a fantastic recovery from it returning to full function and returned to my job also. I had 9 months of feeling 100% better until December 2014 when due to the nature of my work, I suffered an additional tear to the outer annulus of the same L5S1 disc I previously had surgery on. I have been out of work to date.

Since December I have made a very decant recovery twice and also re-injured myself twice, each time setting myself back about 6-8 weeks in my rehabilitation. The problem is no matter how many times I recovery and no matter how well I recover I always seem to be just on the cusp of re-injury made susceptible by one slight wrong turn, or wrong bending motion or one slight lifting motion. In a sense I'm walking on eggshells so to speak and my surgeon has said that each of these bouts of back pain I experience are additional small tears in the outer annuls of the disc that are occurring.

Just this week I have experienced a bout of back pain that was reasonably bad but was by far not the worst I have experienced and it only really lasted a few days which is not bad at all but it really has me thinking.....It appears to me I have two options in front of me:

1. To accept this as my lifestyle and continue being reasonably well and accept that I will continue to have flare up's in pain from time to time and manage this through pain medication and physical therapy.


2. Do something about it. Get a spinal fusion as recommended by my surgeon and set myself back at least four months in my rehabilitation but hope it will be successful and fix the problem of this degenerative disc disease and give myself a lifetime free of pain going forward.

I have the same trepidations as anyone considering this surgery and am not afraid of the physical operation itself or even how horrible the recovery and pain is in the short term but am far more concerned with the longer effects such as reduced flexibility and permanent nerve damage.

As I am a keen sports person I would really be most intrigued to know as to how much flexibility would be lost from a single level fusion? I have always had hyper flexion to some degree and have been able to bend over and touch beyond the point of my toes to my ankles. I was told by my family doctor once before that this hyper flexion was part of my spinal issues and partly to blame as it was causing excess movement of the vertebrae causing wear on the disc. I've never know whether to fully believe this or not. I wonder how far I will be able to go after the fusion?

As per permanent nerve damage? What more can I ask about this other than has it happened to you and if so..to what degree of feeling did you loose?

Thanks for reading and responding...


  • Every one is different but He said 3 degrees flex / twist is lost by fusing one joint.

    He's a good physio and experienced.

    Hope that helps.
    L5-S1 herniation. Both knee meniscus tear. L4-5 herniation - 2 x nerve block injections. L4-5 discectomy. L1-2 nerve block injection. L4-5 reherniation - TLIF fusion. 2016: L1-2 and L5-S1 retrolistheses and multiple facet joint degeneration.
  • The fusion site that you are questioning is the most non movable part of your spine because it involves the sacral area according to my dr, so people tend to do well with those levels fused. I know a couple people that had fusions of that level that can still bend and touch their toes. On the other hand, there is a massive bundle of nerves there, so if anything I would think there could be an increase in nerve damage if anything. I'm not a dr by any means, and myself have been fused at L2 L3 and am 7 wks out, but even though I'm still needing to fuse, I can bend quite a bit. I've always been hyper flexible as well. I would talk to your surgeon and see what they think regarding outcomes in your particular situation. Everyone and their recovery is unique. Some have complete recovery, some have partial, and others are made worse. Best of luck to you.
  • I just had ALIF on L5-S1 on April 20th. I was back at work part time after 2 weeks, and full time at 3 weeks. I have an office job. I had back pain for 7 years and now it's about 90% gone.
    Like EMTNELLY said - I was told there is little flexing from that section of the spine so I would notice no difference in motion after.
    Good luck!!!

    Edit to add - I'm in a brace for three months - no bending, twisting and lifting. But thats it.

  • I had the ALIF procedure in June 2011, so almost four years ago now. I HAVE noticed less flexibility in my spine. Probably I notice it most when I (sorry for the graphic nature) have to wipe after going to the rest room. I can still do it but sometimes I feel like an acrobat trying to twist. But the stiffness would probably lessen if I did more physical therapy I think. I did ALL the PT the doctor wanted me to do after surgery but have not done much daily to try to keep up the flexibility. So what I suggest is you keep up daily with flexibility exercises and you might avoid this problem. Also, I have been noticing - only over the last 6-12 months, some numbness and tingling in my toes and I have NOT had verification hat this is because of the surgery. I could be a number of things I guess, but I think the number one idea in my head is that it is from the surgery. BUT, that all being said, I am in SO MUCH LESS PAIN. I am glad I had the surgery. I had a great surgeon, so my mother actually told me that I should do it if I felt confidence in my surgeon, but if I thought he was IFFY, to keep looking for one I could be confident in treating me because it is a BIG surgery with a LOT of recovery time needed. I went back to work after about six weeks after the surgery - I have a desk job. It was uncomfortable to sit there all day and it took time, but I am fully recovered and only have the problems I mentioned. I do not have a lot of pain anymore, but I wouldn't say I was 100% pain free...
  • I also was lucky and my fusion actually FUSED fairly quickly. Please follow all your doctor's instructions for the best possible recovery.
  • Thanks so much everyone for the responses. Like any user on this website, it is an extremely difficult decision to have to choose to go with the fusion after having already gone through a discotemy but one thing I have no concern of is my ability to commit myself long term to my rehab mentioned already, I am an avid sportsperson and throughly enjoy exercising on a daily basis wether that's in the form of active competitive sports or rehabilitation.

    In the past six months, i have missed less than seven days of working on my rehabilitation for a minimum of an hour a day and sometimes longer. I'm at a loss at the moment as I've had another bad week of pain flare up and its easy for me to think on weeks like this that the fusion is a no brainer ...that is until I come out the other end of this pain cycle and feel good again and start questioning wether the fusion is actually necessary. It is an evil repeating cycle and is difficult to separate my own emotional investment in this situation from the practicality of it. I wish the decision could be made for me.

    I am back to my surgeon next week again and will discuss all the revelant question and concerns when I see him and hopeful my mind will be a little more at ease and I can make a decision a little easier.

    I think one thing I know for sure is Iif i continue my daily thearpy routine I will most likely be able to keep my pain at bay but would not ever return to a position of being able to actively partake in proper exercise which really is the main bottom line goal for me long term considering I do have a passion for sports, exercise and health.

    Thanks again for reading and any comments.
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