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How much is too much?

I am 3 weeks post op from an L4-S1 PLIF without instrumentation. I have suffered lower back pain for almost 20 years from a spondylolisthesis at L5, herniated L4 disc, ruptured L5 disc, spinal stenosis, SI joint pain, and arthritis. I managed fairly well with conservative treatment (nsaids, occasional narcotics, PT, injections, nerve blocks, etc.) until a couple of years ago. I was finally authorized to have a fusion with instrumentation at l5/s1 only (insurance didn't agree that a fusion was necessary at l4/l5). During surgery on 4/27, the doc found synovial cysts at both levels and removed them. He also found that most of my symptoms originated at l4/l5 and determined that a single level fusion w/ rods & screws wouldn't help and may be detrimental. Instead he did bone grafts at both levels workout the instrumentation. I stayed 2 days in hospital before coming home. Fortunately, because my mother had some serious medical problems a few years ago, my dad gave me a hospital bed for the main floor of my multi level home (5 total). I spent the first two weeks getting out of bed only to walk and use the bathroom and shower.

Over the last week, boredom and frustration have driven me to be more active. I have gone to a school play, out to dinner, done a little grocery shopping, and pulled off a little housework, been up and down all of our stairs, and can drive sport distances. The problem is I find myself reaching, bending, twisting a little and trying to lift small things. My pain level, which was easily manageable is now through the roof. I can walk a block with my cane and not feel to bad, but the stairs are killing me. I'm worried that I am pushing took hard, but on the other hand isn't activity good for me if I am more careful and avoid the bending and twisting? Doctors orders are so vague - "Take it easy. No bending, lifting or twisting. Just rest and walk."

Any advice/instructions? I don't think I can stay in bed for 3 more weeks, but I need this to heal properly.


  • Are you wearing a back brace? If you're going to be that active, you may want to consider getting one, as it will be a constant reminder to not bend or twist too much.
    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
  • Not a doctor but how do you do a fusion without instrumentation posteriorly for spondylolisthesis?
    96-Right disc frag L4-L5 disco-On/off back pain,no leg pain/2007-Right herniation L5-S1 unbearable leg pain/08 L5-S1 discectomy /leg pain relieved/14-chronic LBP,rhizo relieves facet pain on right side/15-L4-S1 collapsed,facets shot,PLIF scheduled 4/13/15
  • "Without instrumentation" is misleading. I do have the titanium cages filled with bone graft material in the disc spaces. I do not have additional screws or rods holding the vertebrae together.
  • I had disc replacement surgery (L5) last August. The whole "how much is too much" conundrum is something I know intimately. I know we have different back situations, but for me, the first 5 months was 1 step forward 2 steps back, or 3. This period of time was a bit awful. Every time I thought I could take my daily activity (which was pretty much staying in bed, walking to the loo when needed, trying the stairs in my house) to the next "level" I'd land right back in bed for days. This is the stuff that makes you lose the fruit from the fruitloops and the potential to go crazy stares you down in the mirror. So, with that in mind, what helped me sometimes was watching YouTube. I'm sure some one will laugh but you get to a point where the pain takes over everything. You can't read, you can't write, you can't even think. I'm telling you this because it sounds like you may still be there some days.

    How to know when it's too much? I usually couldn't until too late. So, I waited, and waited, and waited some more. I think part of the battle with mending is the wait, it's a psychological nightmare but you have to bring out some coping tools and get to work that way. I'd be in the shower (on days I could) thinking this is going to be the rest of my life, the pain I mean.

    Today, 10 months after the surgery, I'm feeling pretty good. I can do my physical therapy exercises with minimal pain, I can walk my dog around our hilly neighborhood, I can drive for about an hour before my right leg goes out in a blaze of glory (neuropathic pain - nerve damage, can take another year to go away), I'm going to South East Asia for the month of July (ok, this scares the you know what out of me, that's a hell of a long plane ride). I'm at the point where movement feels good so I think that that is my body telling me that I'm doing what I can and should.
    BUT, be patient, be kind to yourself, and maybe you should rest more and bring out YouTube or whatever works for you.
    Listen to your body and when you feel up for it, I suggest you move on to physical therapy ASAP. It was a while before I could do it but it has helped me gain my strength back immensely.

    I hope you don't take me as a know it all because I'm only telling you how I got through the horrible parts of the wait and the pain.

    P.S. I don't know where you live but if medical marijuana is legal, you might want to do some research. I got off all pain meds and muscle relaxers taking an edible CBD medical marijuana candy that helps with pain. And it definitely helped me earlier in the game with the "losing your marbles" part. CBD isn't psychoactive, it's analgesic and it helped me TREMENDOUSLY.

    I wish you well!
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