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Need advice on Lumbar Fusion from first hand experience

bbvanbbbbvanb Posts: 2
edited 11/05/2015 - 3:52 AM in Back Surgery and Neck Surgery
I'm Bailey, a 26 year old female. I currently work as a Veterinary Assistant in the lovely state of North Carolina. I'm also a certified horseback rider and trainer, but I currently do not practice the sport at this time.

My problem is primarily wrapped around grade II spondylolisthesis at L5-S1.

My spondylolisthesis was more than likely brought on by trauma as a (younger) child. I was very active, participating in many extra curricular actives: Track & Field, Soccer, Basketball, Dance, and horseback riding. I was also a very competitive gymnast starting before grade school all the way throughout early high school. I was around 13 when I did have to quit the sport of gymnastics due to lower back pain (2000-2001). At that time my parents took me to see a chiropractor who said I had a "stress fracture" and that I shouldn't continue with the sport. So that is as early back as my back pain goes.

Years later (2010), while I was attending an equestrian trade school, I was thrown from an unruly horse. I landed on my right side and I'm fairly certain I broke 2 or 3 ribs. I did not go to the doctor and I continued to ride even after. However, after this incident my back was never 100%. Since then I've had to quit working my initial trade and move to working with smaller animals. I've been working with small animals for the past 3 years while seeing a chiropractor regularly.

More recently (starting a month ago or in early October of this year 2015) I started to get one of my typical lower back flare ups and chiropractic care didn't seem to help much. I just popped over the counter NSAIDS and continued working. My pain started to get worse and I started to develop a pain in my back with every step I took and I started to limp. I kept working anyway and developed numbness in my right foot. I still kept working up until my entire right side of my body from my lower back down to my foot went into spasm and ended up at Urgent Care. I didn't know it at the time, but I lost all feeling along part of my L4 and all of my L5 nerve root as a consequence. NO medication other than narcotics touched the pain I was in at this time. Even then they only helped me sleep more than got rid of the pain. Needless to say I had to take time off work.

I saw my chiropractor for 3 weeks straight (every other day) before he suggested I see an orthopaedic to get an MRI. Then I went to see a DO who told me I needed flexion/extension radiographs and a MRI. I got both done. I also started Physical Therapy while waiting to get my MRI scheduled. My results are as follows:.

RADIOGRAPHIC:
Findings/impression: Bilateral L5 spondylolysis with associated
approximately 10 mm of L5-S1 anterolisthesis, unchanged with flexion or
extension. There is multilevel degenerative disc disease, including at L4-5
and L5-S1.

MRI LUMBAR SPINE WITHOUT CONTRAST:
FINDINGS: Conventional lumbar numbering. Loss of normal intervertebral T2
disc signal and disc height loss is noted at the L4-L5 and L5-S1 levels.
There is mild retrolisthesis of L4 on L5 and mild anterolisthesis of L5 on
S1. Bilateral L5 pars defects are present. Conus terminates at L1-L2. The
visualized spinal cord morphology and signal, and the cauda equina appear
normal. The vertebral bodies demonstrate no evidence for fracture with
normal alignment and marrow signal. Negative for epidural hematoma. The
sacroiliac joints and surrounding paraspinal and retroperitoneal soft
tissues are normal.

--T12-L1: Sagittal imaging only. There is no evidence of spinal stenosis,
disc bulge or neural foraminal narrowing. No facet degenerative disease.
--L1-L2: Sagittal imaging only. There is no evidence of spinal stenosis,
disc bulge or neural foraminal narrowing. No facet degenerative disease.
--L2-L3: There is no evidence of spinal stenosis, disc bulge or neural
foraminal narrowing. No facet degenerative disease.
--L3-L4: There is no evidence of spinal stenosis, disc bulge or neural
foraminal narrowing. No facet degenerative disease.
--L4-L5: Mild retrolisthesis of L4 on L5. Mild diffuse disc bulging with
superimposed large right subarticular disc extrusion with caudal migration
with associated moderate right lateral recess narrowing. This impinges upon
the descending right L5 nerve root. No significant canal or neural
foraminal stenosis. Mild facet degenerative disease.
--L5-S1: Mild anterolisthesis of L5 on S1. Diffuse mild disc height loss
with associated degenerative endplate changes. There is unroofing of the
disc with mild superimposed diffuse disc bulge. This combines with mild
facet degeneration cause moderate right neural foraminal stenosis. No canal
stenosis.

IMPRESSION:
1. Large right subarticular disc extrusion at L4-5 with caudal migration
which results in right lateral recess narrowing, impinging upon the
descending right L5 nerve root.
2. Bilateral L5 pars defects with associated grade I anterolisthesis of L5
on S1 and minimal compensatory retrolisthesis of L4 on L5. As a result of
the listhesis, there is moderate right neuroforaminal stenosis at L5-S1.

After my MRI my DO recommended a spinal epidural steroid injection (to reduce inflammation around my nerve root that was being compressed by a disc herniation). I did that as well. I don't think the injection did anything at all, but with lots of rest and NSAIDS I haven't been in pain (I wasn't in much pain at all prior to my injection either---just lingering leg weakness and numbess at that time were my biggest complaints) However, I continue to have numbness and weakness in my right leg. My DO wants to try another injection but has openly said that she is not optimistic about the injections and that I should consider surgery.

I am wondering if surgery is something I should even consider? I understand that my lower spine is unstable which predisposes me to disc herniations, nerve compression and furthering of degenerative disc disease..... Is it worth it just to get rid of some numbness??
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Comments

  • Hi Bailey. I too was diagnosed with spondylolisthesis and spinal stenosis in the L4-L5 . I tried everything including PT and injections. Nothing worked, As the pain worsened, including searing pain down the legs and numbness, I finally decided to go ahead with spinal fusion (this was 3 years after the initial diagnosis). After the surgery, my doctor told me that in his 25 years of practice he had never seen a spine as unstable as mine. Recovery for the back went well and was back to work in about 6 weeks. I have other issues as well as a hip replacement was done 6 months after the fusion. That was a year ago. I am now am going to have more back surgery as the stenosis has advanced significantly in my middle back region and has nothing to do with the fusion. Arthritis sucks. All this being said I am at the gym everyday hitting weights. riding bike, doing some crossfit stuff. Have had to modify where I don't do anything to compress the spine. I have no regrets with the surgery and feel that it gave me some of my life back. Hope this helps
  • hvillshhvills Suzhou, ChinaPosts: 798
    I've had 2 lower lumbar fusion surgeries in the L4-L5-S1 region and I can tell you that in both cases the nerve pain and numbness was reduced/eliminated quite well but the recovery is a LONGGGG and emotional road... and my lifestyle has been changed forever. In my first surgery it took a full 12 months before I felt 100% again... but then I over did it and had have a second surgery only 18 after the first surgery because I broke one of the pedicle screws and badly herniated the adjacent L3-L4 disc. I'm now at 10 months out on my second surgery and progressing ok but certainly not 100% yet. I've also (had to) accepted that going forward I will likely not be able to do a lot of the heavy lifting and other back stressing/jarring activities that I did before... as it potentially will put me back on the surgeons table. You are young so that helps a lot in your recovery... and with a positive and accepting attitude toward the physical/emotional recovery road and lifestyle changes you can have a good and lasting result.
    Harry - 63 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
  • SavageSavage United StatesPosts: 5,940
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  • hvills - this actually makes me feel much better (i have a L5-S1 scheduled for this friday, 20th).

    bbvanb - based on your story (thanks for sharing!), i'm thinking it might be something to consider. in my case the sciatic numbness, pins and needles, etc were mild after my first surgery in 2013 (discectomy) but over the last couple years progressively turned for the worse and eventually escalated in excruciating pain, ankle weakness,etc. are you in any physical therapy programs, etc? also, has your doctor put you on something other than pain killers, like lyrica, etc?
  • RunnerHKTRRunnerHKT Posts: 230
    edited 11/15/2015 - 11:11 AM
    My personal experience- your results may vary- I herniated a disc last october (2014) and had a discectomy. A day before the surgery they discovered a pars defect and the MD suggested fusion and no running ever again. He also suggested that the Pars defect was pretty stable, so I might be able to avoid fusion. SO... in February I had the diseconomy which was somewhat successful. unfortunately I am very active and I pretty much reherniated about 6 weeks after surgery. I read a lot and found several other surgeons who do allow return to sport 1 year after fusion.... went to one of them, and he explained that if I did not have the repair I would continue to have worsening symptoms. I thought he meant over like, 2-3 more years... about 4 week later, I could not walk without a huge limp, etc.... I recommend always getting a second opinion, but I'm learning that in the case of the unstable fracture, there isn't a whole lot PT can do to make the area stable. I wish I had never had all of this happen, but I am very happy so far with the results of the fusion. My numbness and weakness are slowly resolving and i can walk very steady... I just get to be patient while waiting for fusion (fingers crossed)...
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