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Fusion Surgery for Spondylolisthesis & Pars Defect

BunnysnaxBBunnysnax Posts: 36
edited 06/11/2012 - 7:54 AM in Back Surgery and Neck Surgery
Hi folks!

I'm so glad I came across this site! So, hello!
Well, here's my story --> I've been dealing with back pain for years. Latest MRI shows Grade 2-3 Spondylolisthesis, Pars defects, ruptured disc, severe bilateral L5 nerve root compression.

I've done all the conservative stuff - Oral steroids, epidural floroscopies, physical therapy, massage, heat/ice, stretching, pain meds, etc. etc. etc.

A recent exray also showed that my L5 moves 3mm in flexion and 3mm in extension as well - which apparently is an instability.

I'm finally reaching the point where I can't stand this anymore. (which is what my many consults suggested waiting for before I decided on surgery). My current neurosurgeon said that ultimately, the surgical correction needs to be done, but I have to be the one to make that final decision. Needless to say, I'm scared shitless!

Spinal surgeries are totally like a Pandora's Box...and while the majority of posts I've read seem negative, I also understand that people who have had "successful" surgeries are generally not on support forums!

So I just wanted to see if anyone has a similar surgery that my Neuro is suggesting - Two level fusion of L4-S1 and removal of disc. I've heard the recovery is hard core, takes months, and really tests your will power.

Any and input is welcome. I'd love to hear you're thoughts. Like, I'd also enjoy hearing about your procedures as well - like how long you were actually in the OR (how long the actual surgery took), what the hospital stay was like, when you could go to the restroom by yourself, shower, how you handled personal hygiene, etc...how long before you could "safely" navigate a short flight of home stairs, etc.

Thanks in advance! I really appreciate any and all feedback/thoughts ya'll would like to share! :)
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Comments

  • to Spine Health. This is a great place to meet others who have / are experiencing similar problems to you and who can sympathise with spinal pain. There is also a wealth of information about spinal conditions.

    Well, in March last year I had a decompression and fusion on L4/L5 for Grade 2 spondylolisthesis. If I had to decide again whether or not to have surgery, I would definately go ahead. I had been in so much debilitating pain and was finding standing and walking slowly became very painful in minutes, causing me to need to find somewhere to sit down because of the stenosis, both on the central canal and the nerve roots.

    I am still having problems with my spine, but am almost certain that they were all there before my surgery and that I would have had them anyway.

    Before my surgery, I had been trying for over 2 years to do everything possible to avoid surgery. I was very scared and there was no way that I would even contemplate spinal surgery. I did anything anyone said might possibly help. All to no avail as eventually, as things progressed, I had to admit defeat. The deciding factor was when my orthopedic surgeon told me that I would end up in a wheelchair and eventually incontinent! Suddenly it seemed a clear decision.

    My surgery took 4 hours, which was longer than the surgeon had expected. I needed a blood transfusion and my incision didn't close properly (or opened again), which in turn meant that I got an infection. I also got over granulation tissue as it scarred, and had to have it cauterised with silver nitrate. The infection meant that I had to have dressings on my incision for 6 weeks.

    Despite all these problems, which were dealt with as they arose, I would say that my recovery was easier than I expected. Now I think that my recovery was much better than lots of others. The nurses, surgeon, doctors and physiotherapists were all amazed at how well I recovered.

    My surgery was on a Friday afternoon. During the night they took the morphine pump away because I was reacting to it, telling me that they would give it back later. They never did and I was then given Paracetamol and Diclofenac. That was it! Even so, my pain levels were much lower than before my surgery, so I coped well.

    I didn't have a catheter, and must admit if I had to chose again, I would ask for one. During the first night I had to lift up on the bed for a bedpan to be slid under me. Wow that was hard!

    The next day they had me up and walking. I was well motivated to get up because I really wanted to use the toilet. I managed without a toilet riser, much to the physio's amazement. I never had a cane or walker. They said it was because I had been doing so much exercise and walking to try to avoid surgery.

    The day after surgery, I had my meals by perching on the edge of the bed. Sitting is restricted, but perching on the bed (almost standing) is allowed. Slowly I built up my tolerance to sitting.

    On the Monday they had me climb a staircase and on the Tuesday they sent me home. They did try to send me home on the Monday but I asked to stay another day.

    I had a bed in the lounge at home to relax amongst the family during the day. I found that great because lying down was the most comfortable position to relax in. I could have climbed the stairs to relax, but being able to lie down with company was better. We put the tv up high so I could watch it easily. I took frequent walks, slowly building up the distance.

    I found sleeping difficult. I would wake up every couple of hours and need to reposition myself to try to get comfortable, often needing to get up and take a walk first before trying a new position. Cusions were my best friend. :-)

    I had a shower chair which I used and for the first week or so, I needed my husband to help me shower. He had 2 weeks off work to stay and look after me, and I think that the fact that I wasn't trying to do too much myself probably saved me from hurting myself by over doing it.

    I had bought a toilet wiper device but never needed it. (That was something that I had worried about.)

    Constipation is a problem after surgery. The anaesthetic and the pain killers cause it. Once they had sorted me out while I was still in the hospital, I was ready to go (literally!). I didn't have a problem again, but then I was not taking much in the way of pain meds.

    Even though my recovery was pretty good, I had 5 months off work (Teaching Assistant, so involves bending and sitting), and then, after returning, in less than a week, I was signed off again and put on a phased return to work over a month. After that I coped quite well, but did have to be careful.

    I had expected my recovery to be absolutely awful and I think because I had expected the worst, I was pleasantly surprised.

    There is no doubt that this is a difficult surgery to recover from. My pain before surgery had been very high, having me in tears regularly, so perhaps that is why my recovery seemed not so bad. The surgeon said that the stenosis was worse than he expected and that it was very severe, so he had to remove a lot of bone to free up the nerves and cord. He said that was the most invasive part of the surgery. The disc was completely removed and a cage put in, using my removed bone that had been ground up. Then I had 4 screws and 2 rods put in. He did manage to pull my slipped vertebra back into a better alignment.

    When it comes to bending now, I don't notice any difference from before surgery. Mind you they said my back wasn't bending properly before, and I only had a one level fusion.

    I had had my problem for very many years. I had had limited standing since I was a teenager and also suffered with bilateral sciatica and low back pain. I managed to get into my 50s before having surgery. If you are young, then the chances of a good recovery seem to be better.

    Have you decided to go ahead with surgery, or are you still on the fence?

    I wish you well. Do let us know what you decide and how you get on. During recovery, the support here is a wonderful help.

    :-)




  • Hi there! I am almost 4 months post op from my L5/S1 fusion for grade 1 spondy that was unstable. I also had a spine deformity. A normal disc space at L5/S1 is supposed to be almost horizontal but mine was almost verticle which was the surgeons big concern. With the extreme angle, he was afraid of the damage that may happen if I were in an accident or something. I did have 2 severe flare ups before the surgery which is when I found out I had such a problem with my back.

    I went into surgery with slight left leg pain. I had issues with standing for any amount of time also.

    I had PLIF with 2 cages and 4 screws and 2 rods. I had a single scar which is about 5 inches long. My surgery lasted 5 hours and I was in the OR for 6 hours. The surgeon said there was a lot of clean up to do as a result of my bones rubbing against each other all these years. I was in recovery about 2 hours. I stayed in the hospital for 2 days.

    I was surprised at how long the recovery process has been. In previous surgeries I have had, I noted differences in how I help every couple of days. With this surgery, I would notice the differences about once a week.

    I did have to take neurontin because I did have severe nerve pain after the surgery. This lasted for about 5 or 6 weeks and then I was able to wean myself off the neurontin. I only get slight nerve pain now if I have overdid myself with activities or something.

    I noticed a huge difference at the 3 month mark. I noticed my back or bone pain significantly reduce. I have quite a few other people say they noticed a big difference at 3 months.

    I am almost 4 months post op. I have in physical therapy for a month now and working on my core muscles. All in all, things are going well. My back is still really stiff in the mornings or if I am in the same position for to long. I can't lay on my back for long. My back definitely feels different now but I guess it is something I will get used to. I still take 2 tramadol 2 to 3 times a day for muscle soreness, achiness, or for other reasons not related to my back.

    I am very pleased with the results. I am very glad I had the surgery. For me, it was a positive experience.
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  • Welcome to our forum. :)))

    I had a fusion nearly 2 years ago on L4/5 for spondylolisthesis. My surgeon didn't correct the slippage but put in a large cage to jack open the space Ias well as screws and a plate). Mine was done from the front and all went well with recovery - good days and bad days and frustration, but that's normal !!

    I was in hospital for 5 days and the nursing was excellent. My pain was well controlled. I think it was Fentanyl in the pump, and then onto oral meds. I had to stay in bed for 2 days and a catheter was in for 3 days. I was also on a liquid diet for 2 days and light diet for the rest of the time. The day before surgery, I had to do a bowel cleanse. I had those inflatable things on my legs for 3 days, as well as compression stockings. I was hooked up to a cell salvage machine but was told I didn't lose any blood. My wrists were black and blue and there appeared to be lots of needle marks. Not sure what that was.

    The levels either side of my fusion aren't too good but the surgeon didn't want to fuse them - perhaps better to wait and see how I coped was the right thing for me. There's no spondy at these levels. As long as I exercise every day (walking and tai chi), then I cope with the residual pain in my back. I don't have any major leg and buttock pain any more - only a little if I overdo things occasionally.

    Prior to fusion, I had a laminectomy/discectomy which made me worse and my surgeon indicated that it was the wrong surgery for spondylolisthesis.

    I'm very happy with my fusion because I can walk and do the activities that we take for normal. Prior to that I used to watch from the sidelines and even felt a little jealous seeing people enjoying themselves.

    Recovery in the early stage is not easy and you'll need to rest and walk, rest and walk ...... Healing takes a lot of energy and you'll be surprised at how tired you'll feel. Pain meds need to be taken as prescribed and on time. I had oxycontin, oxycodone and gabapentin (neurontin) for about 6 weeks after surgery. I was fused within 6 months, but it's taken another 6-9 months for the fusion to feel strong.

    Good preparation is essential - getting the things you'll need from the Post Op Must-Haves list, especially meal preparation and freezing, as well as stocking up on essentials at home.

    Bending-lifting-twisting restrictions will be in place for a few months or until your surgeon says it's ok to do more. I had a domestic service come in once a week to vacuum and wash my clothes for about 4 months. Friends also helped me and cheered me up. For the most part I was on my own and looked after two Labradors. They knew things were different and were very gentle. I was driving short distances at 7-8 weeks (can't remember exactly). I got myself into the best physical shape I could prior to surgery by eating a nutritious diet and doing the chores I knew I wouldn't be able to do during the first few months after surgery. Keeping busy and giving myself lots of little treats helped with the nerves.

    I still can't sit still in a normal chair for too long and I'm more comfortable in my recliner. However, in the early days of recovery, my recliner with a couple of pillows didn't give me enough support and I was better off lying on the big lounge propped up by pillows.

    My surgeon aims for 80% - 90% reduction in pain, and that's what he's achieved with me.

    Hope all goes well for you next January or whenever you decide to go ahead with surgery.

    Trish














    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Well you guys have made me feel a bit better about things. I'm sure you guys were all scared shitless before the surgery too!

    It's so good to hear that ultimately - after all the stress and pain of the surgery - that you are all mostly satisfied with your outcomes.

    The "quality of life" issue is certainly bearing on all this too. I can't take my dog for a walk, without feeling pain within the first 5 minutes anymore...stuff that you, Trish, mentioned in your post - the stuff "normal" people take for granted.

    I'm so glad I found this forum. There is so much information here - both good and bad - that is realistic, helpful and as they say, "Straight from the horse's mouth" which is usually better than the doc's descriptions of things.

    Thank you again for sharing your personal experiences, it's such a big help for those of us that are still standing on the cliff and looking over the edge!
    :OO
  • Do you have any advice about choosing an orthopedic surgeon vs a neurosurgeon for spondylolisthesis surgery? A friend recently had a fusion for spinal stenosis and the surgeon was a DO neurosurgeon newly out of residency. She had a computer assisted, minimally invasive fusion using an artificial disc. Comments?
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  • jellyhalljjellyhall Posts: 4,372
    edited 02/13/2014 - 1:45 AM
    This is a very old post (July 2011) so not all the posters may be still here to answer you.

    Here is a link about finding a surgeon:

    http://www.spine-health.com/blog/finding-a-good-spine-surgeon

    I was advised to have an orthopedic surgeon for my lumbar surgery for spondylolisthesis as the problem was due to the positioning of my bones.
    A couple of years later, I was advised to have a neurosurgeon for my neck fusion surgery because my spinal cord was being compressed and needed a very delicate surgery around it.

    Probably either type of surgeon could do it but having training and plenty of experience in spinal surgery is the main thing. You want to find the best surgeon that you can.

    Just to inform you, members are not allowed to name or recommend specific surgeons on the forum. Here is a link to the rules of the forum :

    http://www.spine-health.com/forum/forum-rules

    There is a very helpful section of this site that has links to all sorts of questions you may have. Here is the link to it :

    http://www.spine-health.com/forum/forum-faq

    I suggest that if you have more questions that you post your own thread and introduce yourself. That way more members will be likely to read it.

    Looking forward to getting to know you better. :-)





  • Hey There!

    On May 1, 2013 I underwent an L5/S1 TLIF to remove/replace the disc with a synthetic bone graft and to remove the pars defect as well as stabilize the spine with 2 rods and 4 screws. After a 3 day hospital stay (I was walking the night after surgery) I was home to recover for 8 weeks. Around 4 weeks into recovery I started physical therapy. I can honestly say, at 26 (was 25 when surgery happened) I am very happy with the outcome. The pain and instability of my spine that I had is so much less than what it was before the surgery. I had some continued nerve pain after the surgery but the ability to straighten my left leg has returned and the pain is only on and off! :)

    If you have any specific questions, feel free to ask! :)
    Olivia Douglass
    MIS TLIF L5/S1 on 5/1/13
  • I thought I would add to this thread to help anyone who is currently facing the decision to have spinal fusion surgery due to spondylolisthesis due to a pars defect. I had this surgery 3 months ago (Sept 2016) and when I was researching about the surgery I found so many negative comments and not very many recent comments as well. I would love to help anyone who is working through this decision!

    I had spodylolisthesis due to a pars defect that was at about a 6-7mm slip at my L5-S1. I had some sciatica pain initially, but fortunately the pain went away (something my PT did helped), but I was left with numbness along the top of my foot and into my toes. It was fortunately more just an annoyance and eventually got to a point where I wasn't always aware of it. My lower back was what was causing me the most issues. I was able to modify my life in different ways to avoid constant pain, but I had put myself into a very small bubble. I was sleeping in a recliner because if I slept in a bed I would have bad back pain and have a hard time getting out of bed. I even got to a point where I had to carry a reclining camping chair with me on vacations! I was a very active person before my back started hurting (I hadn't had any back pain until July 2015 when it came on suddenly). I had been training for triathlons, skiing, boot camp style workouts, etc, but once my back pain started I could only walk a mile before my back started hurting too much. It was very life changing and not in a good way. I tried chiropractic care, acupuncture, physical therapy (with two different PTs and two different approaches) and a cortisone shot. Nothing helped except learning to avoid certain movements. I had been trying to avoid surgery and was going to a spine doctor who was not a surgeon. Eventually I realized that what I had been trying was not working and decided to seek a surgical opinion. Spine surgery is a BIG deal, so I interviewed four surgeons and all four said that surgery was what they suggested, but that it was elective and I had to get to a point where I was mentally ready. I had dealt with back pain for over a year at that point so I was already at that point and it was mostly just about figuring out when the best time to have it was.

    I am fortunate to live in Seattle where I have many surgeons to choose from. I didn't realize that I wasn't just choosing a doctor, but I was also choosing an approach. The approaches range from more traditional to minimally invasive. I spent a lot of time reading up on all the different approaches to see which was the best for me. I ended up choosing an approach that is kind of in the middle. It was a traditional open surgery, but instead of taking a bone graft from the hip I had a laminectomy where they used the bone to mix with InFuse. I chose this approach because I had heard bone grafts can cause hip pain later and I didn't want to deal with that. As mentioned, I am very active and so I was looking at what surgery can give me the best long term outcome. The doctor I chose is the only one who said his approach doesn't lead to any long term limitations.

    I was in the hospital from Monday morning to Thursday afternoon. Those first couple of days were the worst part of my experience. I was pretty nauseous the first day and the second day the pain was higher. Then the third and fourth days I just felt generally bad, but in reflection I think a lot of it was because of one medication they were giving me. Once I got home I felt much better and I spent the first couple of weeks at home sleeping.

    I am VERY happy that I decided to have this surgery and it has made the quality of my life much better. I could have lived without this surgery if I had to, but I chose to have the surgery because I realized I didn't want my life to be "good enough" anymore. After a year of not being able to be active I still missed it and I realized that physical activity is something that I really enjoy. I was fortunate that I was able to line up help for the first 4-6 weeks and was able to take the time off to properly heal. I don't think back surgery is the answer for every back issue, but for this one specific problem (spondylolisthesis due to a pars defect) it was the answer for me. At 6-8 weeks post op I was already feeling better than I was before surgery and knew I made a good decision. I'm at 3 months now and daily life is pretty normal and I am working on getting back to a higher physical activity level. I am back in the pool, walking 2-3 miles, and doing my physical therapy exercises (which are a lot like a workout). Finding a good physical therapist has also been a huge help and very important in my opinion. 
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