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Advice on L5/S1 fusion at young age

Hello everyone, I
wanna share my story with you in order to hear some of your thoughts and own
experiences and any advices you may have.

 I’m a 6’5, 200 lbs,
23 year old male. I played volleyball competitively from age 12 to 20. At age 16
I had severe low back pain and was diagnosed with a L5/S1 herniated disc. Treatment
was standard: physical therapy and pilates. The result was very good, I was pain
free in 3 months and managed to play volleyball all the way through my third
year of college, at which point I decided I wanted to focus more on school and
my future rather than keep going with the sport…Going from a 6 day a week
practice routine to sitting a lot and not doing much exercising made me remember I had
a herniated disc, that was a particularly hard semester as I had just come back
home from the USA to finish school at home (I’m from Brazil). So at this point
I started to have sciatica pain down my left leg. A new MRI in March 2017 revealed
my herniation was now bigger and I was starting to have degenerative disc disease
in the same disc. Conventional treatment was prescribed once again, only this
time the improvements were little, I was able to live a somewhat normal life but
still with everyday pain, I decided I was not going to do the same mistake
again and began exercising regularly. Fast forward a year and a half later, the
sciatica pain is getting worse, still able to function somewhat normally though.
On a stupid attempt to get rid of this pain I made the worst decision of my life,
4 visits to a chiropractor was it took to make my pain go from annoying to debilitating.
I could no longer do any form of exercise other than pilates and no more than
30 minutes of walking without having pain. 
I returned to the doctor and had a new MRI, it all looked pretty much
the same, except the herniation was again a little bigger, back again to conservative
treatment (which was something I really never stopped doing since the sciatica
started). It’s been 6 months now and with no improvements at all I returned to
doctor this week and yet another MRI confirmed that the degeneration of my disc
is severe and I was recommended a fusion of L5/S1. The doctor said he would not do a microdiscectomy on me because the severe DDD requires a fusion.

I am absolutely terrified. At the same time
that I trust the doctor’s recommendation, since he performed a L4/L5/S1 fusion
in my 65 year old mother and she has never been better, everybody else that has
helped me before (Pilates instructor, physical therapist) tell me to hold on
and try more conservative treatment, even though they are the ones helping me
in my conservative treatment for almost 2 years without great signs of
improvement. My doctor denies that a L5 S1 fusion will put more pressure on my
other discs making them start to degenerate and herniate, saying that this a myth
and if it is true how come do I have DDD without never having a fusion? He
claims that doing this now will actually prevent my other discs from becoming “sick”,
which goes in direct controversy to everything I read here on Spinal Health but
it is what happened to my mother, she waited to long to have surgery on her L5/S1 that she developed the same problem on L4/L5.

 I don’t know how to
make a decision, I’m so young and have my entire life ahead of me. Do I wanna spend
my youth in pain and maybe have this surgery further down the line when I just
can’t take it anymore? Or do I wanna get it over with now and endure a 6 months
to a year recovery and possibly be pain free for a long time but have the
possibility of developing even more problems? What sucks the most is that
nobody seems to guarantee I’ll be good other than the doctor.

Hope you guys can help
me decide. Sorry for the long post, good luck to us all.

 

 

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1

Comments

  • I’d be taking my MRI to 2-3 different neurosurgeons and maybe 1-2 orthopedic spine surgeons and see if there’s any agreement on how to proceed. Good luck. Please keep us posted.

  • Update: had an appointment with a neurosurgeon yesterday. We talked for an entire hour and he passed me a lot of confidence, he said I could benefit from a video assited discectomy, which is basically an entire disc removal without fusion. I failed to understand how one can remove the entire disc and not perform the fusion. Still some research to do for me...if anybody has any info on this it would be greatly appreciated. Thank you

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  • Update 2: Saw another orthopedic surgeon last Friday. This one wants to perform a classic microdiscectomy (not by video) removing only the part of the disc that's herniated. My concerns right now are many: microdiscectomy is usually a band-aid type of thing it seems, fix the issue now but be bothered by it again from a new herniation in the near future; fusion surgery is more guaranteed for the problem right now as it stands, but the massive recovery and the possibility of never being the same person again scares me so much.

  • Hello! Speaking as another young person who spent most of my 20s dealing with insane pain, I would say that sometimes you have to weigh the pros and the cons. A fusion surgery is an invasive surgery, but I honestly wish I didn't wait 6 years to have mine. I had the same fears as you, with the long laundry list of what-ifs, but I have my fusion in September and have honestly had a very smooth recovery. Since you are young and an athlete I think you have that on your side, physical therapy has had a huge impact on my positive progress. But, most importantly find a surgeon you trust who you feel comfortable with - I went through 13 before settling on mine.

  • I cannot imagine a doctor saying that the vertebrae around a fusion site wont pick up additional strain.  I'm not a doctor, but I would think common sense would suggest the other levels are going to compensate for those not working.  I agree with L4-5, get several opinions.  My 21 yr old son has been told he needs a fusion, but at 22 yrs old, I told him to try everything else first and cut last.  It's a tough decision to make.  At the end of the day, it all comes down to what you can tolerate.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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  • Update 3: First of all, thank you for all of your inputs. I saw a fourth and for me final doctor, another neurosurgeon. All of this search for what to do has been causing me some serious mental issues and I decided to draw the line at four. Going in for an epidural tomorrow. Hoping that the epidural + the conservative treatment I already do can reduce my pain to some degree that I can avoid surgery for a couple of years. I know that that is a long shot and maybe too high expectations but I'm trying to stay positive.

    So to summarize my quest so far:

    Orthopedic surgeon 1: fusion

    Orthopedic surgeon 2: microdiscectomy

    Neurosurgeon 1: discectomy

    Neurosurgeon 2; epidural then microdiscectomy if necessary.

    I'm afraid of the fusion because of the grandiosity of it. But I'm skeptical about the microdiscectomy because of the reherniation possibility.

  • If I were in your shoes I’d like that 3/4 surgeons say microdisectomy vs fusion.

  • I went through this also, but from a car accident. I did the discectomy and laminectomy.... 6-8 months later I was on the table again having a fusion. It’s so difficult to make the decision because you spend years doing conservative treatment and you are just getting worse and frustrated and you want it fixed and then you have the surgery and do well and then bam, it’s all back. I’m 23 and it’s truly been an awful experience I wouldn’t wish on anyone, I did end up having a fusion and I am a year out from that now. 

  • @reagannicolexo thanks for sharing a little bit of your story. How are you doing from your fusion? It's hard to find positive stories around here. Hope you're doing well!

  • Also, to update this thread for anybody following it: I did have a nerve root block injection on January 10th. It worked quite well for my left leg sciatica. I'm not pain free, I'd say I had 7/10 pain most of the time and now it's usually a 3 or a 4. It allowed me to go a little harder in my recovery exercises but it's been tricky, a simple 2 hour car ride or a day where I walk too much or sit a little bit more than normally (albeit still less than the average person) gets the pain back to that 7. One particular day, putting socks on, I must have done a weird movement and got my pain to a level I never felt before, thought I had screwed everything. Had to lie down for the rest of that day and with a couple of painkillers it was gone the next morning like it had never happened (weird).

    I feel like I've stagnated in my improvements. As much as I'm glad to not be in so much pain everyday I feel like the restrictions are all still here. One thing that became very evident with the decrease of pain is the numbness in my toes and the lack of strength I have in my left leg.

    Thinking about joining a gym and getting back to some light weightlifting being super careful with form. I've been living under the motto of only doing what doesn't cause any pain or discomfort but that has me not going forward anymore.

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