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Long Term Success for Level 1 L5-S1 Lumbar fusion

L5S1SpondyLL5S1Spondy Posts: 5
edited 06/11/2012 - 7:49 AM in Back Surgery and Neck Surgery
This question is for those folks who have had a level 1 fusion at L5-S1 five or more years ago.

Did you experience adjacent disc degeneration or adjacent spondylosis due to the stresses placed on those vertebrae adjacent to the fused ones? Especially if you had no problems with those adjacent vertebrae prior to the fusion.

If you did have problems, what were/are they and how are you treating them? Did they require another fusion? Or disc surgery?

Att the time of the first fusion did your NS or OS mention anything about adjacent vertebrae problems 5 or 10 years down the road?



  • ....but in all likelihood you are not going to get a good consensus for the answer. Most people who have success and no further issues are not going to be here 5+ years later. You'll be lucky if they are here 1 year later.

    Barring the ones who just like it here. Most that are here 1 year or more post-op are most likely still having issues. The majority leave and go back to their life.

    Even getting most to report post-op how well they are doing is difficult. If it went that well, most disappear. Kinda answers the question in a round about face way though.
  • No answers here. But I'm curious about the same thing!
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  • Wish I had some answers for you, but I'm only a month in. I would love to know some long term results (hopefully successful) as well.

  • although I only had my 2-level fusion in July 2010.

    This is obviously from my own experience you understand. This is my history (as brief as I can make it to explain what I mean).....

    Although I had experienced back pain 15 years ago, it settled down without too many problems. However, 5 years ago I had a herniated disc at L5-S1 and with it, sciatica. At that time I had a discectomy in June 2005, but because that failed, I had a repeat discectomy a month later. After the second operation my surgeon said that it would have been quicker to have done a fusion! Anyway, I had experienced back pain/sciatica since then, and tried every conservative treatment option. I was on strong pain medication, but nothing seemed to help.

    After numerous MRIs over the 5 years, and being referred to about 4 different consultants for 'second' opinions, I eventually decided to have the fusion with a surgeon that I had 100 per cent faith in.

    This, eventually, is the point I wish to make....

    After 5 years, the last MRI indicated that the level above (i.e. L4-L5) was also damaged and therefore I ended up having a 2-level fusion.

    If, for instance, I had had a one level fusion 5 years ago - and then had to have another level fused 6 months ago, I would have definitely thought my first one caused the problems in the adjacent level. And obviously I know this to be untrue.

    As it happens, through degenerative changes that would have occurred naturally anyway, that's why I ended up with a 2-level fusion.

    I'm probably not making my point clear - but natural changes in your spine could occur whether you have a fusion or not. I don't think having a second fusion can be blamed on any previous surgery. Though I do understand that perhaps having a fusion in the first place might put an extra burden on adjacent levels (and this was explained to me by my surgeon before my last surgery), I think the way we use our bodies might have more to do with it (i.e. when being told not to bend, lift or twist - after a period of time, we might go back to old habits and therefore put extra strain on our spines by ourselves). Do you know what I mean? I hope so.

    As a previous post mentioned, those people who have had successful outcomes probably don't visit this website anymore, so it's going to be difficult to get a cross section of people contributing to your post.

    2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!
  • I think Sue makes some very good points. If we have a degenerative situation to begin with, who knows whether further problems would have occurred anyway?

    It seems that many people get into additional problems because after they recover from surgery they go right back to all their bad habits -- putting weight back on, gradually giving up the walking,slouching, gradually forgetting about good posture, being less diligent about using good body mechanics, etc.
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  • Yeah I agree that most move on. But sometimes people check back. And sometimes people on the forum now with a problem were on the forum 5 years agao with an "adjacent" problem. Thanks to all who answered. I tend to agree with the resumption of bad habits theory. Vigilance, vigilance!
  • Well, I'm almost halfway to the 5 year mark ;)

    I had a double fusion though.

    I consider myself a wonderful success story. That said, it's not been without its ups and downs.

    The success part:
    - only occasional back pain.
    - NO more CES symptoms AT ALL!! YEAH!!
    - I have resumed a mostly normal life again
    - I am a strong advocate of exercise, weight loss and minimal to zero medication use.

    The bad part:
    - There are some things I will never do again, got to protect the back!
    - My next level up is not an 'if' but a 'when' It was injured in the accident as well, NS just didn't want to do a 3 level all at one go.
    - I do depend on Tylenol a bit, several times a week at least.
    - I will forever have to stay physically strong (not gain weight, exercise, eat right) in order to keep the success I've worked so hard for and gained so far.

    There is light at the end of the tunnel - just make sure you aren't on a train track.
  • Everyone makes good points. You did not mention your exact problem or if you had the surgery.

    For what it is worth, I am 8 months out and excellent. The question is how bad are you now. I was horrible and looking at possible wheelchair if things got worse. So, what might happen in 5 to 10 years was of no concern to me.

    My problem is in my signature. I will say my doctor did not move the L5 all the way back into position. Maybe only halfway and did some bone removal to give the nerve room. Good decision as far as I am concerned.

    He said the partial moving back into place of L5 would actually put less strain on the above vertebrae and reduce the risk of future surgery. That is of course me and how bad they are above L5 will dictate future issues.

    But, for me no choice. Pain to high and risk of further injury too great.

    Good Luck,

  • L5S1 Spondy:

    I am a candidate for fusion of L5/S1 and L4/L3. Continuing to evaluate the "quality of life" issues. My situation also includes a spondylolistheses at L5/S1.

    When I was last evaluated by a surgeon in Jan 09, he said my surgical option was a double fusion, but that within 10 years I would most likely require another fusion one level above due to the transfer of stress to the higher level. I am 59. Don't believe that the activity level of my 60's will be anywhere close to my 30's, 40's and 50's that brought about my current condition.

    This "surgical" decision making process is difficult. Lately, I have been listening intently to the comments that my family and friends make about their observation of my mobility, moods, capabilities, etc. Evaluating one's quality of life can be somewhat mesmerizing. Standing back a distance enables us to differentiate the forest from the trees.

    Lots of variables = a very difficult decision. Good luck.

  • Hi there - I had L5/S1 fusion surgery in October 2009, and I consider myself a success story, especially considering that I had C5-6-7 cervical fusion surgery just 6 mos. before my L5/S1 procedure. I do not have a degenerative condition. I was injured by a bad guy. He severely herniated two discs in my neck, one of which was so bad that the cervical surgery was considered emergent, as a bad fall could result in the severing of my spinal cord. He blew out my L5/S1 disc completely - an empty tire.

    My neck surgery has been a huge success (though there are definitely ways that I can't move anymore after 2 level fusion in my neck); my back surgery is a good success, all things considered. According to the x-rays, I'm 100% fused. It took at good 9 months for me to feel "good" again. By that, I mean to a condition in which I didn't feel like I had had surgery 80% of the time. Now, I'm virtually pain free. I say "virtually" because I still have flare ups, which my doctor warned me would occur and are okay so long as they go away. In fact, part of the reason that I am revisiting this site is because I've felt a pain running down the back of the leg that was not my symptomatic leg pre-op. I suspect that it is just a muscle issue or a flare up that will go away in time, but as many people reading this forum know well, after you've been through the pain of spine injuries and the surgeries to regain your life from them, it doesn't take much to make you freak out that there might be something else wrong, especially given the increased likelihood of fusion at adjacent levels after fusion surgery.

    I know that 1 year, 3 months isn't the long term scope that you were looking for, but I think I've done pretty well to reach this point after two surgeries bookending my spine in titanium in six months. If I have any tips, they would be these:

    1 - Don't be afraid to call your surgeon and ask questions if something hurts. For one thing, if something doesn't feel right, you want to jump on it right away to avoid further damage.

    Also, one of the hardest things to deal with post-op (to me, anyway) when you start to feel better is anxiety. When you're living in the pain of the spine injuries or the surgeries, all you can think about is how you are physically going to get through a day. When the pain starts to reduce, and your mind isn't befuddled by painkillers, you start thinking more about the realities of what you're living with and the future. When something flares up and hurts, it's easy for the mind to go wild thinking about what else might be wrong, and that can really impact your recovery. Do yourself the favor of reducing that anxiety somewhat by calling your doctor, discussing the pain, getting an opinion, and even going in for x-rays to make sure that the hardware is where it is supposed to be and the other levels (in terms of vertebrae alignment) look okay.

    2 - Work out, particularly abdominal work. Strong abs are the best way to protect your back. Crunches hurt for me b/c of scar tissue, so I do pilates type moves and electronic stimulation. The latter isn't sufficient to build the muscle you need, but it feels like it helps. I also do the PT that my physical therapist gave me to do at home every day. It took me a while to learn that I had to prioritize my PT (vs. work), but each time I had a flare up because I was working too much and not taking care of myself enough, I realized it wasn't doing me or my work any good to not put my PT first.

    I am nowhere near where I need to be in terms of condition. I was pretty much immobile and living on a diet of narcotics for 1-1.5 years leading into my surgeries, and then off my feet for the recoveries. My surgeon has taken squats and lunges off the table as conditioning options. As a result, the "getting back into shape" process is longer than it would normally be if I could really do resistance training, and I have a longer road to go than I would have had I been in shape going into the surgeries. But, I noticed a significant reduction in post-op pain when I did start to lose a few pounds, even 3-5lbs. So, staying motivated to do your conditioning work is probably a good tool for long-term success.

    3 - Be realistic. My surgeon told me that I could resume a pretty much normal, unrestricted life, "within reason." I asked him what that meant, and he said to use common sense about the things I choose to do to continue my progress and avoid future injury. Can I ride a horse? Yes. Run? No, too hard on the skeleton. Can I cross-country ski? Yes. Downhill? No. That kind of stuff.

    Just my thoughts. Keeping my fingers crossed for continued progress and hoping the same for everyone else.
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