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Recovery from 5 level Lumbar Fusion

I am a 78 year old caucasian male who was diagnosed with lumbar stenosis in 2015.  I had a lumbar laminectomy in October 2015 to relieve pain in my legs.  This surgery was successful in that the pain was relieved almost immediately and after a week in hospital rehab, I was able to come home and walk without assistance or pain.  However I was never able to regain complete mobility to the extent I had a year before the laminectomy.  I discussed this with my neurosurgeon, but did nothing further other than physical therapy.  Then in early May, 2018 I fell as a result of collapse of my left leg.  This resulted in a 5 level lumbar fusion on May 4, 2018.  I spent a week in the hospital and about 4 weeks in a hospital rehab unit doing physical therapy.  When I went home I could walk short distances, but only with a walker.  After about 4 months I was essentially pain-free, but still required the walker to walk.  When walking I was not totally erect, but tended to lean forward supporting myself on the walker.  

At this point, about 10 months since the fusion surgery I am still in essentially the same condition.  About a month ago, I contacted a different neurosurgeon to assess my situation.  I told him I was pain free, but was concerned by my lack of progress in mobility.  He told me that he thought I had recovered ~ 75% of what I would eventually attain and that if I wanted to walk without the walker again I would need further surgery.  

We did new  Xrays which showed that my spine above the lumbar region was significantly curved forward.  His proposed solution was to straighten the upper spine by insertion of 15 - 20 screws and rods.  He discussed all of the risks and downsides of this surgery: significant pain in the first month, reduced freedom of movement, potential of failure of one or more of the surgical procedures requiring further surgery to repair, and general surgical risks associated with a surgery requiring 8 - 10 hours of sedation.  He estimated a week in the hospital followed by possibly a month in hospital rehab unit before being able to come home.  He thought I would be essentially pain free after about 2 months and regain most of the mobility I could expect after about 3 months, with full recovery in 6 - 12 months. He said that he does 3 - 4 similar surgeries a month so he has experience.  He emphasized that if I could be satisfied with my current situation I should not do this surgery.  Currently I will see him in about a week after I get some tests completed. 

I would appreciate any thoughts or comments from members of this group, particularly from anyone who has experienced similar situation.  Thank you very much.

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Comments

  • WLLadyWLLady Ontario CanadaPosts: 1,486

    hi bobp

    welcome to spine-health

    please read new member guidelines and checklist 

    learn how to use spine-health - take the system tutorial

    which levels were you fused?  i'm curious if the leaning forward is because of the level above your fusion getting pjk (proximal junctional kyphosis).  if the sagittal balance is off from the first surgery it can affect the spine above it. did the surgeon give you any reason for why your spine is bent forward? 

    in my experience-i had stenosis and ended up having laminectomies, facet joint removals, 10 levels fused and my surgery was 12 hours plus another 12 in recovery.  i didn't end up in rehab but they sent me home on the friday, my surgery was monday....so after 5 days....i still walk slowly, but i'm upright and no cane or walker.  not bad given i had an 80% chance of being in a wheelchair coming out due to the damage (i had a 110 degree scoliosis/kink in my spine at surgery) to nerves and my spinal cord.  it took me a long time in physio to learn how to walk again...and hours and hours on the treadmill and walking around the house. it's been 2 years since my surgery (dec 2016) i still cannot go far outside, but i'm up to about a km outside now....i do have issues with being able to stand upright, like totally straight-especially if i'm tired or after a day....because of the muscles and length of the bars in my back.  i think in your case i would be wondering why things are leaning so far forward and if it can be corrected would concentrated physio help you get back some of that mobility.  the longer fusions are a long long recovery, and if they extend (like mine) from thoracic to pelvis then twisting and bending at the waist won't happen any more. 

    i do know a couple people here that have had pjk and gone through revision surgeries, but i haven't seen them back on the forum (one just had surgery a couple weeks ago). i haven't had the problem to the extent that my surgeon wanted to fix it, and i found that physio helps me enough to keep myself ambulatory without aids.....so i'm not sure i'm being any help here at all....but i did want to welcome you to the forum!

    Kathy
    Veritas-Health Moderator
    ---------------------------------------------------------------
    Dec '16 T10-S2 fusion with pelvic fixation. Laminectomies L2, L3, L4, L5, facet removal, cages L4-5, L5-S1, severe scoliosis, arthritis and stenosis repair. 

  • My fusion was L1 - L5 and no rods or screws were inserted at that time.  I have been doing Physical Therapy, but not directed at the curved spine because it wasnt curved at the time of the fusion surgery so Physical Therapy was focused on strengthening the lower back.  I am thinking of trying to do a few weeks of Physical Therapy focused on strenghening and straightening my upper back before doing this extensive insertion of rods and screws.  I am encouraged to hear that therapy seems to have helped you in the past and continues to help.

    I have a family contact who is a neurosurgeon specializing in back and spinal issues, so I am seeking some technical comment from him, but as several have told me it is ultimately up to me to make the decision to accept the risk of this additional surgery in hopes that I won't have to spend the rest of my life in my present condition. 

    I was attracted to his Forum in hopes of hearing from people like you that have already experienced some of what I may be facing.  Thank you very much for your reponse and I would welcome anything else you might think of at any time.


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  • Hi Bob. I am 64 and had surgery 11 months ago for scoliosis. I am fused from T5-L5 with screws and rods. I am still undecided as to whether or not this was a good idea. I was in terrible pain prior to the surgery and was unable to do much. I still have many difficult days and have some limitations but things are improving. I spent 8 days in the hospital and 2 weeks in rehab. I very much underestimated how long the recovery process would be. I was on opioid medications for about 6 months and then had to go back on for a month. I'm fortunate to live in a state where pain meds are prescribed when necessary.  We're all different,  but this is a big surgery. I think your doctor may be a little optimistic about the recovery timeline,  but like I said, we're all different.  Just be prepared for a longer than expected recuperation period if you decide to move forward. I wish you all the best. 


  • Hi lollypeg, Thanks for your respoonse.  Your fusion sounds pretty much the same as my surgeon had proposed for me, so I certainly appreciate you sharing your experience.  When you were on the opiods for 6 months did they alleviate the pain?  Do you still have pain at 11 months?  I am not in much if any pain at this point, but I am very restricted in what I can do, which means I can do pretty much anything including drive my car as long as I am sitting.  I just can't stand for very long and can't do much while I am standing. I haven't been able to travel or get out of the house for dining, the theater, etc etc.

    Knowing what you know now, would you have had this surgery?  I hope you are going ot be much better soon.  I am sure you have paid the price!

  • Hi Bob. I was on oxycodone and it helped a lot, but didn't completely alleviate the pain. My neurosurgeon would only prescribe for 3 months so my pain mgmt doc took over after that. I still have pain but it's tolerable. I also have fibromyalgia and I think that is partly what is causing the pain. I recently started taking cymbalta for that and it seems to be helping the nerve pain. A couple of months ago I probably would have said I'm not sure it was worth it,  but things seem to be improving at a faster pace now. It's been almost a year and that's a long time. Many people say it could take 2 years or more to completely heal. I used a cane if I had to stand or walk any distance up until very recently. I am able to do more than I could before the surgery and am in much less pain so right now it's starting to feel like it was worth it. I just wasn't prepared for how long it takes to recover even though I was told. My neurosurgeon also said I would never be completely pain free. Long car rides are still difficult and it usually takes me a few days to bounce back, but I am able to travel. Hope this is helpful. 

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  • lollypeg, I am sure there are many differences in detail between your issues and mine, however the one which stands out to me is that before your major fusion surgery you were in significant pain.  I am essentially pain free at this point.  I just have considerably limited mobility.  Given that and your and other comments I have received, I am planning to spend at least another 3 months in focused Physical Therapy to try to strengthen and straighten my upper spine without the surgery.  I can always do the surgery later if that doesn't work.  I have been doing Physical Therapy for several months already, but that was focused on my lumbar spine and given that I am pain free I would have to say it has worked.  Maybe I can improve my situation by shifting the PT focus to the upper spine.  I am going to give it a try.  My family is supportive of that approach!  Thanks again for your comments and please do not hesitate to add to them when or if you are inclined.

  • Bob, I think you're making a wise decision at least for now. If you're not having significant pain I'm not sure it would be worth it. Some people do have a quicker recovery and less pain than I did. This could possibly be because of Fibromyalgia but it could also be because I'm older. Good luck with therapy - I hope it improves your mobility. 

  • Visited the neurosurgeon yesterday.  My situation, as described above, is diagnosed as Adult Kyphosis.  This is not uncommon following the lumbar fusion surgery that I had about a year ago.  If anyone identifies with this diagnosis, please respond with what you have done and how you have recovered.

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