Spondylolisthesis: Spinal Fusion at L-4-L5

@kremer1 Thank you for posting your current medical situation. I have been told by one surgeon that I needed a OLIF fusion and a posterior fusion from L3-L5. I have spondyolethesis and severe spinal stenosis. I am in the process of getting a second opinion. The thought of two surgeries just day or two apart terrifies me. I have had back pain for years and the past year I have had tingling and numbness in my right leg which switched to my left leg after a epidural and now tingling in both my legs and feet. I also had a bout of sciatica on left side.
I will be 60 this year and like @upstatephil i was quite active. I was a runner, cycled, did triathlons. Now I just barely walk 2 miles every other day. I hope my next appt at Mayo will offer me some MI that won’t have me in the hospital for days on end and will help reduce pain as my stomach is not the best with pain meds. I go on the 14th and I am praying I feel better after this visit than I did with the first diagnosis.
I hope you get the answers you need to make a decision. Just know we are in the same boat! I look forward to hearing your outcome!

@ddister1 Yes! This is what I am going for. I want MI for spondylithesis and severe spinal stenosis. My appt is on the 14th and I am praying they give me better news than my local surgeon gave me. He wanted to do a two step surgery. One day going through my side and the second surgery a day later going through my back. I was simply terrified when I left his office.
Thank you for sharing your outcome!

I'm in the process of getting more information from the first neurosurgeon as well as a second opinion from another neurosurgeon. I'll have a better idea on the process that is being suggested and a better idea on an overall plan since I have DDD in cervical as well as upper and lower lumbar. Doing the L4L5 fusion isn't going to correct everything that is causing issues. That's a concern for me right now. It just takes time with the state of the health care industry with making appointments in a timely manner, another frustration.

Hi, and yes, a positive state of mind has been so important in my journey. Friends and family that see how difficult it is for me to stay active and not get depressed on what I can’t do anymore. Turning 70 and looking forward to working 0n “projects” I CAN DO, and living a useful existence. Death doesn’t scare me after 6 months of chemotherapy and 3 spine surgeries… has made me mentally stronger and thankful for my memories.
“ if you can visualize something in your life, you can have it in your life”

Thanks for your comments Wendyhobbie. Trying to keep a positive outlook, and I'm doing the best I can with continuing a PT routine and walk as much as I can. The tingling/numbness varies during the day, and is gone when I lay down. The lower lumbar back pain is the same way, varies quite a bit depending on my activities. I thought that PT and pain management would be enough, and am open to keep going with that as long as I can. But I need to get good information from the neurologists as to when to waive the red flag and say it's not working. I think upstatephil alluded to that in his comments in that I may be there right now, and to not risk nerve damage.
It sounds like you have gone through quite a bit, and are keeping positive about the way it's progressing.

@kramer1. My situation is very similar. Progressive leg pain came in episodic bursts over 3 years. The last one started in October of 2022, waned by December then returned in March with a vengeance. My radiculopathy was complicated by a muscle cramping that increased the pain. By May, 2023 I could walk only 20 feet and the right leg pain was intense and nearly constant. My physiatrist referred me for a surgical consult in June. They recommended a TLIF of L4-L5 using ground bone from the removed facet joint bone plus cadaver bone. Surgery in mid-July was successful with a neurosurgeon monitoring throughout while the orthopedic surgeon did most of the work. I woke up after the surgery with no pain and could walk the next morning with only a low backache. I’m so thankful to have gotten this surgery. Recovery has been hard mostly for the loss of energy (I am 77 year old female). I overcooked the rehab (SO nice to move without pain!) and now am grappling with hip tendinitis —a setback but fairly minor. My surgical team prepared us well and recovery lacked the unwelcome drama that others describe. I was more tired and more emotionally table than I expected but pain was less than pre-op and a lot easier to manage, too (ice or heat packs plus twice weekly massage) on quad muscles mostly that were objecting to 5 hours of lying prone after months of “shopping-cart” posture. PT now at 9 months is revealing deconditioning that I overlooked. I need to build muscle strength back with a bit more patience to allow more strenuous exercise. But I am optimistic and remain over-the-moon happy with that right leg pain gone. I wish you the best for the difficult decisions ahead. I hope my good news story will give some helpful dimension. In addition, this Mayo site has been a game changer for support and issues to bring up with medical support staff. Good luck!!

Question for upstatephil. I'm curious about your symptoms and imaging for the decision to have L2-L5 fusion. Do you have degenerative discs, retrolisthesis, spondylolisthesis, any other spine instability issues? Did you have any abdominal discomfort, bowel/bladder involvement, tingling in groin/legs/feet? If you had any of that, has the surgery helped? How is your range of motion now compared to before surgery? Bending, twisting, etc.? I think you said you are about a year out from the surgery, what was it like 3 months, 6 months?
I'm trying to deal with abdominal issues, determining what's causing it, and not sure I want to do fusion until I get that resolved. I've got Dr. appointments soon that may give me answers, I hope. But my lumbar has retrolisthesis L2 to S1, with L4/5 level 1 spondy. One neurosurgeon says to fuse L4/5, another says it wouldn't help. Trying to get a third opinion, but it's going to be August at the earliest and maybe Dec!

@upstatephil
Question for upstatephil. I'm curious about your symptoms and imaging for the decision to have L2-L5 fusion. Do you have degenerative discs, retrolisthesis, spondylolisthesis, any other spine instability issues? Did you have any abdominal discomfort, bowel/bladder involvement, tingling in groin/legs/feet? If you had any of that, has the surgery helped? How is your range of motion now compared to before surgery? Bending, twisting, etc.? I think you said you are about a year out from the surgery, what was it like 3 months, 6 months?
I'm trying to deal with abdominal issues, determining what's causing it, and not sure I want to do fusion until I get that resolved. I've got Dr. appointments soon that may give me answers, I hope. But my lumbar has retrolisthesis L2 to S1, with L4/5 level 1 spondy. One neurosurgeon says to fuse L4/5, another says it wouldn't help. Trying to get a third opinion, but it's going to be August at the earliest and maybe Dec!
I'm not sure how to post so that it prompts your Mayo Connect site, so I'm posting a reply another way just in case. Also adding that my abdominal discomfort is cramping/maybe some distention not entirely sure if it gastric related, abdominal adhesions from GB surgery, or what? I have apt with gastroenterologist this coming week to hopefully provide answers/direction. Also trying to get apt with neurologist with PT background ASAP. I'm hanging in there doing what I can to maintain while the medical appointments play out.

@kremer1 - Lots of great questions! Let me give it a go...

I had every symptom you mentioned and more. Tingling, numbness, bladder and bowel issues, and on and on. What finally moved me to seek a surgical solution was when I suddenly began experiencing nearly instant on-set full leg numbness. When it hit, I literally had to sit down immediately or I'd fall down. I kept picturing that happening while I was standing at the top of a long flight of stairs! At that point - it was clear I had to do something different or risk personal in jury or permanent nerve damage.

For me - I had/have degenerative arthritis along my entire spine. When I developed spondy in the lumbar area - that triggered the numbness. Now - 95% of all that is gone. I still have some residual right thigh numbness but it is slowly lessening as the damaged nerves heal themselves.

I just passed my one-year anniversary and my activity level has really ramped up. I wasn't always so sure I would get back to normal - and I may never recover 100% - but today I am WAY better than before surgery!

There will always be some reduction in range of motion - bending forward and twisting. I have these titanium plates now permanently installed and they don't bend! The results justify the reduced motion.

How else can I help? Make sure to take a written list of questions for your dr appointments and I found it helpful to have someone else with me (my wife in my case) to also listen.

@upstatephil,
Thank you for your reply. Just to clarify, post surgery your bladder/bowel issues, and most of tingling sensations are repaired/corrected? What about other abdominal discomfort, did you experience that too?
Your surgeon opted for plate vs fusion with grafts? Did you have spondy through the lumbar spine that had surgery?
As I indicated, I have retrolisthesis L1 through S1 other than the MRI readout says spondy L4/5 which the surgeon says is level 1. She wasn't concerned about the retrolisthesis in the lumbar only the spondy at L4/5 being unstable. But I'm not convinced about that. And the other surgeon said fusion at L4/5 wouldn't help and could make the other areas unstable, at least above and below the fused area.
My wife has gone with me to the visits, and we ask all of the questions we can, but still go away with uncertainty and sometimes more questions. Then the other difficulty is getting in to a follow up visit or to see another Dr. for another opinion in a timely manner.
I have some tingling, but not the extent you talk about. But the area at L4/5, I'm assuming, is getting more painful. I'm doing the exercises suggested for spondy in the lower lumbar and it's not helping much. Ice, heat, Tylenol only do so much. I go for short walks and eliptical machine, and can tolerate that. Seems like my symptoms are progressing, and I'll be making a surgical decision in the future, but what extent to do is my most difficult decision and I need the Dr. input for that, and repeat imaging.
Thanks again.