One-level spinal fusion @ L4-L5

One-level spinal fusion @ L4-L5

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Anonymous (not verified)
Title: Member
One-level spinal fusion @ L4-L5

Worried

Diagnosis:
I have a small tear, smallish herniation around the degnerative disc along with some spinal stenosis.

History:
After several epidural steroid injections, 1 round of P/T, and several acupuncture treatments, I kind of had it when my back went out this last time. I was laid up for a week, unable to work or care for my 1 and 3 yr old kids.

Problem:
I got an epidural after my back went out in August and have been feeling great since, almost like nothing is even wrong. But this has happened before, and I know it's only a metter of time before it starts getting sore (before the shot I was icing my back every day all day and in ongoing pain)

Action:
I met with 3 different surgeons, 2 orthos and 1 neuro, and once I fell in love with the neuro went ahead and scheduled myself for a fusion on 12/9. The surgeon recommends 3-5 nights in the hospital followed by 6 weeks at home. He is not sold on physical therapy yet. He plans to go in through 2 small incisions on the sides of my spine, use a cage with protein powder and 4 screws - possibly titanium and possibly a newer kind that has a little more give (forgot the name if anyone knows it). He said the spine starts fusing between 3-6 months and at one year is as good as it will get. He said I will not need to wear a brace.

Dilemma:
Now I am reading all these posts from people who have had fusions and getting petrified into possibly canceling the surgery.

Advice:
I would love to hear from people who have gone through a similar surgery. I'd like the reality of what I'm looking at in terms of post-op pain and healing. What and when can I lift heavier objects? If there's no brace worn, how does the spine stay in place? How do you sleep? Do you need help dressing, showering, etc...? Please, any input would be appreciated.

Thanks in advance!

kinpain
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Joined: 06/20/2008 - 1:46pm
Jen, The surgery your

Jen,

The surgery your surgeon proposes is different in technique than what I had, as I had a posterior three-level fusion with two titanium rods and eight screws. So I can only tell you about my experience. Personally, I could not be happier that I went ahead, as all my pre-surgical symptoms (leg pain, stiffness, foot numbness) are gone. Don't let some of the posts scare you, there are many of us who had successful surgeries and are happy that we did as we are now so much better. Read as much as can about your surgery, ask your surgeon what kind of recovery you can expect, and take it from there. For me, surgery and recovery was easier than I expected, but then everybody id different. And yes, at first you have many restrictions, but you get used to them, just learn to do things differently than before. As you recover, the restrictions get lifted, e.g, at first I was allowed to lift 5 lbs, then 10, now almost 6 months after surgery my limit is 15 lbs.

If you have any questions, just post it on this site, many people are eager to help you.

Good luck,

Kin

Lo
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Last seen: 4 years 5 months ago
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Joined: 08/28/2008 - 10:10am
...

I had a fusion at L4-L5 on Sept 26, 2008. My surgeon went through the front and the back, using bone morphogenic protein and plastic cages, and in the back, metal rods and screws. I stayed 4 days in the hospital, and started feeling much better as soon as I got home. I have to wear a soft velcro brace every day except when sleeping. My surgeon does not believe in putting extra strain on the spine after a fusion, that it's not stable enough with out some form of brace, and then I will have physical therapy in a few months. I only have to wear my brace for 8 weeks, but I love it. I feel SO much better with it on. I needed help showering for about a week and a half. I'm almost one month post op, and I do everything myself now except lift anything heavy. I don't need help, unless I am like, looking to move furniture, Lol.

The spine stays in place with hardware... Screws and rods. It's much more stable with a brace, and there is a higher success rate, but it varies by doctor. Some think that the core muscles lose their strength while in a brace, but for me, I've experience that to be false. My stomach muscles and back muscles are not losing any strength at ALL. So it's personal opinion and experience, I suppose. Post op pain first couple days is ridiculous. But they generally give you a PCA Morphine pump. I was on Dilaudid pills every 4 hours and Valium 3 times a day for the first 10 days home. Now I'm back on my 8 to 9 Percocet a day and then just one Valium at bedtime. I sleep on my back. It hurts to sleep any other way. Sometimes I sleep with my heating pad, since my staples were removed almost 2 weeks ago. First week or so home I was waking up in the middle of the night to take pain meds, and after that I was fine sleeping through the night.

Oh, also, some surgeons say 12 months is the best it gets, and others say 24 months.

Personally, I can't imagine NOT doing physical therapy after a major back surgery. Can't really see the downside to it. I'm glad my surgeon will be sending me. I think once fixing the actual physical issue, building your strength even more and getting back into pre op shape is a great idea. I couldn't imagine doing it any other way.

Well, that's just my experience. There are sooo many people here with sooooo many different experiences and stories. Everyone has their own opinions on meds, braces, surgical approaches, types of doctors, pain, how long out of work, etc... Basically everything. There really aren't any definitive answers.

Good luck Smile

MarkR
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Joined: 08/29/2008 - 6:50am
L5/S! Fusion Experience

Jen,

I had my fusion at L5/S1 done on 8/18, so I'm still in the recovery phase. To answer some of your questions:

Post-op pain/healing: Everyone is different. I found myself being able to decrease from 8 percocets/day to 2 in a gradual process over the first 6 weeks. I've switched to Darvocet, but seem to have hit a plateau and still take 2 pills/day.

Lifting: You will need to consult with your doctor to make sure what he/she wants you to do. I was limited to no more than 3-5 pounds for the first 5 1/2 weeks. Now, my limit is 10 pounds. Lifting is to be done from waist height - no picking up from below the waist or above the shoulders.

Brace: My doctor had me in a hard brace for the first 5 1/2 weeks, now I am in a soft brace. You will get different opinions from different doctors about this. For the first few weeks when there is a lot of swelling, it would be difficult for you to bend anyway. If your doctor doesn't think a brace is necessary, I would trust them. My surgeon is not going to have me do PT, while most doctors seem to want patients to do it. He says I can do a home program and I trust his judgment.

I sleep on my back with a pillow under my knees. If I switch to my side, the pillow goes between my knees.

I did not need help dressing or showering, but did need help drying my legs and feet after a shower for the first 2 weeks.

As you read posts on this site, remember that most of them are from people who have experienced some difficulties from their surgery. Currently, 95% of fusions are successful in the US and most of those people don't take the time to post their stories on the internet. So, while you are reading horror stories about complications, they are from a minority of fusion cases.

I used posts on this and other sites for information, so I knew what I may possibly have to deal with. However, I took a positive approach to my surgery and recovery. I figured there was no reason to worry about things I could not control.

Good luck with your surgery. I hope it helps.

Angelback (not verified)
Title: Member
Hi Jen

and welcome to SH.
Now you said you saw 3 surgeons, so what did the other 2 recommend?
It just seems that a fusion is a big op for what you have (I'm not negating your pain at all as I know it is real) but is there any other surgery of a lesser kind that could help you.
Also you dont say if you have tried PT as yet or had other treatments like accupuncture, chiro etc.
Personaly I wouldn't head down the fusion track until I had exhausted all options and you will hear that from MANY of us here.

With a fusion, you will not lift anything heavy till you are completely fused! You will need help getting shoes and socks on but other dressing is fine. Sleeping is an issue for nearly all of us at some time of another, lots of pillows and your own bed. No kids crawling into it.
If you dont have a brace (I dont) your spine is supported firstly by the rods and screws then by your own muscles so it is really important to have PT to strengthen them as much as possible..

I hope this helps you a bit.

Blessings Sara Angel

bbcrazy (not verified)
Title: Member
Jen

HI!
I had a TLIF at L3-L4 on August 5th. However, mine was not minimally evasive likes your's will be. I had both autografting and allografting, so my situation is different from yours in those respects. I was in the hospital for two nights, and was released on the third morning. I was required to wear a brace, which I could take off when I slept and when I showered. I was told to wean off of the brace at 8 weeks, and was given 4 weeks to complete the weaning process. At first my upper back would ache, but I actually was weaned off of it in about two weeks. I did need help showering, as I was not able to bend or twist, so I could not get the shower turned on. However, I was able to start bending slightly at the knees at about 4 weeks, and gained a measure of freedom from help in that respect. As far as dressing myself is concerned, I have been able to dress myself with the help of my "grabber" and the "thing that you use to put on socks". I actually used a walker to help me get up and down, and I did purchase an elevated toilet seat. I have not taken any pain medication since the third week. However, I do have a high pain tolerance. Actually, it was my hips and groin area that had the most discomfort, but acetominophen and a moist heating pad helped me.
Since night one after the surgery, I have slept on my back with a pillow under my knees, and have had no discomfort from it. I guess I am lucky in that respect. A few weeks ago I wrote a post wondering if I was ready to return to my teaching job full-time next Monday. After starting physical therapy at 8 weeks, I feel much stronger, and have been teaching 5/8ths time. My superintendent has allowed me to keep my sub until Thanksgiving, however, and she does the bending and lifting for me :)))
Only once have I had a reoccurrence of my post-op pain, and that was because I twisted when getting into the car. I still have the no bending, twisting or lifting rule in place. I have felt so much better since my fusion. But, I have been very careful and have tried not to overdo it.
You are fortunate to have found this site. There are so many people here that can share their knowledge and experiences with you. I know that there have been many times that I have asked questions and received help. Just remember, however, that we are not doctors, and that everyone is an individual with their own unique experiences.
I am sorry that I have rambled on, but I was eager to share my story with you. Good luck!

Ann

megb (not verified)
Title: Member
Fusion

You are obviously much younger than I so your recovery may well be much faster - however, I think some things are pretty standard. For example the restriction on bending, lifting and twisting lasts for several months - I am not sure how long but I do know that at 3 months post-op I am not yet allowed to lift anything above 10 pounds. The "no bending" is really the most difficult restriction for me - getting things out of low cupboards, the lower shelves of the refrigerator, the washer, dryer and dishwasher, if I drop something on the floor, etc. is a "no no" unless you are flexible enough to bend from the hips without bending the back. For some things you can use a "grabber" but it obviously won't work for things that will spill, etc.

I also believe that most people, regardless of age, need quite a lot of help at home for the first couple of weeks after being released from the hospital. My surgeon did not even allow showering for 14 days after surgery (that was AWFUL) and even then no bath because sitting in a bathtub is too hard on the spine at that point.

The pain of recovery seems to differ quite drastically depending on the person - I did not have much pain after the first 2 weeks. Some people do. But even without pain it is long and slow - partially because it is so important not to do anything that might prevent fusion from occurring.

I would advise anyone considering this surgery to talk to doctors about all the conservative options that can be explored before going ahead with surgery. If there are no good options then go into the surgery as prepared as you can be for the recovery period and all that it entails. For example - the list on this site of "Post Op Must Haves" is excellent and quite accurate.

Sparky123
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Joined: 09/24/2008 - 12:12am
Sounds familiar

I'm getting a 2 level Fusion (TLIF)on December 4th and I'm also scared to death, not about the actual surgery, but about the results. I personally think you need to go into this surgery with a positive attitude otherwise you will be a basket case by the time everything is done (hopefully for the best.) I have also noticed all the bad stories on here about bad results but you have to realize, everyone is different. Since this is your first surgery and they are doing minimally invasive, I think you have a good chance at a good recovery. My Doc told me just about the same things in regards to recovery, he also said the first two weeks after surgery will be the worst pain wise. Hopefully you have someone around that can help you the first few weeks, because he told me to pretty much do nothing during that time. He also said nothing about a brace (maybe that has to do with it being minimally invasive?) Good Luck!

Pika (not verified)
Title: Member
Advice

The reason you see all these horror stories is those who have great results are busy going about their life and not posting. I am scheduled for a 360 degree fusion L4-L5 11/10/2008.
I am not the least bit freaked out by the forum, I look for the experiences and advice and don't dwell on the individual results. Technology has improved as well as surgical procedures so please try and stay as positive as you can. Attitude is a great indicator of how well you will do. Remember, not all surgeons are equally skilled and educated. As far as post-op, getting someone to stay with you for a week or two would be great, you will need it. I will not need a brace and can walk some within the first two weeks. Showering shouldn't be an issue if your shampoo and stuff is at the proper height. Have lots of pillows for comfort since you will be resting a lot. Follow your doctors instructions and the nurses recommendations. I will let you know how I do after my surgery.
Best wishes

keecho (not verified)
Title: Member
jen...

I am just 4 weeks out today of a level 2 ALIF on L4/5 L5/S1 with cages and BMP with screws and caps.
Every day is a challenge, don't get me wrong. I got a hospital bed for home, as I had 2 levels. I was in the hosp for about a week cause of bowel issues, but other than that, I would have been home after 3 days.
I needed help dressing the first couple of days, but I really just stayed in my pj's as I slept most of the time. I had help showering the first couple of times, mostly for washing of the back and legs.
I squat instead of bending, and I do not have a back brace which I think is better because you are using your muscles and it will heal faster.
They went through my stomach for my surgery, so I kinda am assuming that your recovery might be easier if they are going through the side with 2 small incisions. I have a 9 inch incision on my stomach, so there is a huge difference. Either way though, it is major surgery so never take it lightly. Fusing also goes at different rates too.
Also, everyone heals at differnt rates and has their ups and downs. No one 2 people heal the same way at the same pace.
I am having issues right now that I am going to post, but don't ever get discouraged just because someone else is having problems.
Listen to YOUR body, and do what it is telling YOU and only YOU to do! Just because some have had issues, doesn't mean you will, and there are a lot of people out there who have had very successful fusions, but don't keep writing on the forums. I wished that they would for some of us who do get discouraged, but they don't.

Well, I hope I kinda helped you out.
Take care, and keep me informed! I'm here for ya!

Kim Hug

Joy
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Joined: 06/21/2008 - 5:11am
Jen

I didn't have the same surgery you're thinking about having, but I'm not sure I would put too much trust in the "6 weeks" thing. It is a long road to recovery. I'm at 4 months now and, if I had a job, believe I could think about returning now. That said, if you go to the "Good News" section here, you will hear a lot of success stories. Best wishes to you, and keep us posted, ok?

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