Spondylolisthesis: Spinal Fusion at L-4-L5

@ddister1, Thank you for your reassuring post! I've had spinal stenosis for decades, and also had epidurals when the pain became unbearable or too restricting. I'm much more cautious about that approach now, having read articles about the hazards of epidurals. Your post let me know there is an option for the future if the pain becomes intolerable.

Thank you. It's nice to hear that somebody had a successful surgery. I have to make a decision about surgery and I don't know where to turn for good information.

I have degenerative discs with stenosis in a few spots in my back. The spot that is causing the most issues is the L4 L5, and I have spondylolisthesis there too. I've had visits with two neurologist surgeons that evaluated my MRI's. One said nothing warranted surgery, the latest one now 5 months later is saying fusion of L4 and L5 is recommended since symptoms of pain in the back, and tingling of lower groin down thighs calves and feet has been progressing since the first Dr. The recent Dr. is saying my symptoms will likely progress to loss of mobility with foot drop if I do nothing. That Dr. is suggesting L4 L5 transforaminal lumbar interbody fusion with bone marrow, a cage placed where the disc was and I'm assuming some type of screw / pin support.
Has anyone else gone through this process? I've not scheduled surgery yet, I've a few more questions to have answered and stumbled into this forum while looking for answers.

@kremer1 - I understand your current dilemma and it can be challenging to make the right decision: surgery or deferral. Two things you mentioned got my attention: you described that symptoms seem to be progressing plus you were now experiencing groin tingling. Both comments suggest you may be approaching the point where the risks of surgery are outweighed by the risks of deferring surgery.

As the stenosis and spondy combine to increasingly pinch nerves in your lumbar spine - you want to avoid permanent nerve damage. A two-level “fix” can be pretty straight forward. I always suggest multiple opinions using the best diagnostic equipment available. The decision is framed as “personal risk”. Which risk are you most comfortable with?

Have you had a 2nd recent opinion? Are you comfortable that your films were made with the best equipment? I ended up with a great session with a physiatrist (like a pain doctor) which helped me frame the risk management decision. I had full work down on L2-5.

My best…

Thank you for your comments. You are correct in that the situation is progressing to the point that I think I need to go ahead with the surgery. I've another appointment with the neurologist/surgeon to review the procedure that she will use. What I was told from the first visit notes was L4-5 transforaminal lumbar interbody fusion with bone marrow aspirate. What I'm not sure about is whether it is done in a least invasive manner and whether the inner spinal ligament is removed. From looking at other information / video it sounds like it is best to avoid ligament removal for stability reasons. Newer technology allows to not remove it, I think. So the procedure is a TLIF, and I just need more questions answered, but am thinking that I have to go forward with the surgery.
How was the outcome of your surgery? Can you share your outcome, recovery time, any issues with it dealing with the problems you had prior to surgery? I may have more questions, and would like to maintain this open dialog if possible.

Upstatephil, you also asked about second opinion and imaging. I have had a second opinion last week, that is where the recommendation for the surgery came from. The Dr I saw in December said that there wasn't anything warranting surgery. The imaging that he was looking at was done in Nov, and the Dr I just got the second opinion from was looking at the same MRI. She went through it with me, showing the issue at L4-5. I have another apt with her this coming week to answer more questions, and I plan to ask whether the MRI should be done again to aid in the decision. I'll look into the physiatrist option, not sure there are any in my area.
Thanks again,

@kremer1 - First off, of course you can maintain a connection with me. My pleasure. Anything I can do to assist I’ll do.

Regarding my experiences, of course you appreciate that what happened in my case will not be exactly what happens in your case. Different degree of spinal problems to solve, different doctors, you and I are in different - physical\
condition, different hospitals, and so on. It can be instructive to hear of others’ journeys - but your case will be yours.

In May 2023 I had L2-5 discectomy followed a few days later by insertion of stabilizing plates, screws, and such. I was in the hospital 8 days because of some side effects that were not specifically related to the procedures. We had rented a VRBO close to Mayo JAX as we live a full seven hours away. We made the decision we’d stay close for four weeks just in the event any follow up was required. Turns out that decision to stay close was a good one.

Recovery is ongoing even at 12 months (almost) post surgery. The spine (lower spine especially) is the structure holding up your body. Surgeries can be complex and it can take awhile for the body to readjust to a “new” spinal reality. Also, some of the recovery includes the need to grow new bone which is a slow process that can’t be speeded up by much of anything you do. I was told to expect 9-12 months for bone growth to be completed. I am a week away from 12 months and I think I’m still not 100% there?

I am glad I had the surgery. 100% of the spine difficulties related to stenosis and spondy are resolved. I feel great. I still struggle to regain my former physical condition (I’m a pretty healthy and active 71+). I still see a physio-therapist (different than a physical therapist). I work at regaining strength and stamina every day. I remain optimistic. But no question - this has been a trying and challenging trip…

I’m happy to share anything else. What other questions do you have? Side note: I’ve compiled a very lengthy outline of questions, answers, and things I’ve learned along the way with the idea of producing a patient “help” guide. I’m no where near done with that work.

Oh - one other very helpful suggestion I received and want to pass along: maintain a diary of your journey. I’m not a journal person but I’m so glad I have my journal…

What else can I do to assist? Know you have many folks willing and able to support you along the way.

Yes, I agreed to a minimally evasive fusion procedure over a year ago. Four small surgical sites. Very good surgeon and was ready to go home in 24 hours. I am no stranger to Pain… and was told that because my arthritis and fibromyalgia, this could only take care of one half of my pain. I had gone through chemo and my lymphoma is gone, but I was left it some bone and nerve damage.
I have fallen 3 times last year but the glue at the fusion site heldL4 & L5 in place 🙏

upstatephil and wendyhobbie,
Thank you for your feedback. I think it makes sense to add more of my situation. I live in OR, and just found the Mayo site while looking for answers. I've had some back issues for many years. I have family history of arthritis, my father, and have done fairly physical work in the past 35 years. Looking back probably too much and not careful enough. I had xray's and MRI's done 7 years ago, showing degenerative discs and arthritis, and started doing PT and more exercises. But I've been pretty fit and active prior to that with jogging, hiking, biking, etc. not overweight and eat healthy. The PT has helped some, and about three years ago started pain management with injections both facet and epidural. I had full back MRI in March 2022, and repeated last fall. Prostate surgery, TURP, Aug 2019, bilateral hernia June 2021, GB June 2023. Tried to stay active and resume activities post surgery each time as directed, but have slowed some. The post GB slowed me more than the others, and starting last fall, 2023, it was more apparent that more was going on lower back. I had MRI's done again, appointment with neurosurgeon who said there wasn't anything warranting surgery. So I continued PT and pain management as before. Late last year things kept getting worse, abdominal discomfort along with lower back. I had imaging to see if there was any abdominal reason, and all was fine, which my PC Dr says points to the back. My PT suggested another neurosurgeon that she would trust for surgery if she needed that. I saw that Dr last week, she reviewed MRI's and is suggesting the L4L5 TLIF fusion. I have a follow up apt on Wed this week to get more details on the procedure.
My concern is about degenerative issues throughout my back, not just L4L5. There is retrolisthesis L2 to L5. Also stenosis in cervical and at T12. If the L4L5 gets fused, what will happen to the rest of the lumbar? I have symptoms; slight tingling in feet, calves, thighs, lower groin, that the Dr says will likely progress over time to decreased mobility. I've not had any issues with bladder or bowel. But have abdominal discomfort that might be coming from the T12 to L2 situation. Am I looking at more fusion in the future for those areas? So, I have a few things to discuss with the Dr. on Wed apt. I'm sort of realizing that the surgery is needed due to the symptoms, but want to make sure this is the best course to follow given my full back picture.
I appreciate those who have made comments, and welcome any others that want to comment. It is difficult finding reliable information on-line. There are quite a few You-tube video's and I'm not sure how reliable they all are. As upstatephil said, everyone's situation is unique in various ways. But we can give each other moral support. It helps to hear what others have gone through and know that surgery can help but may not cure.
Thanks,

BTY, upstatephil, I too am 71+ and have been active and want to remain that way. Trying to maintain a positive outlook and focus is difficult at times.