L5-S1 Fusion at 36?

Posted by klov42 @klov42, 4 days ago

I first got diagnosed with a herniated disk at L5-S1 in 2015. I ended up getting 2 Microdiscectomys that did end up helping for about 10 years. (Also had an left side L4-L5 Microdiscectomy in 2023)
Earlier this year I began to have nerve pain again in my leg and since March have found myself riding a roller coaster of pain that has left me unable to fully function. I have tired a multitude of different treatments including ART, physical therapy, acupuncture, chiropractic, red light therapy, and steroid injections. I have visited with a new surgeon and my previous surgeon. The new surgeon suggested a 3rd discectomy while my previous surgeon is really pushing for a fusion. He states that by going to the fusion now we eliminate complications that could arise from another discectomy and that I could benefit from gaining the stability from the fusion.

Long story short, I’m scared to get a fusion at 36 years old. I want to get my life back and know that fusions can be successful but also don’t want to compromise my back for the rest of my life. I’ve heard a lot of people say they wish they hadn’t gotten the fusion and don’t want to do it unless I absolutely have to. What are some of your experiences? Should I be as wary of a fusion as I am?

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Jennifer, Volunteer Mentor | @jenniferhunter | 4 days ago

@klov42 Welcome to Connect. I do understand your concern. As you have experienced herniations tend to reoccur if they just keep trimming off an extruded portion. The L5/S1 level is bearing almost all your body weight and because of that, it is more difficult to fuse, but you need that stability to support your body. You could inquire about artificial discs. I don't have knowledge about what works for the L5/S1 level, but they do have lumbar artificial discs. I am a cervical spine fusion patient.

Any decision about spine surgery is a trade off. You will lose some motion, and a fused level forces the rest of the spine to need to move a bit more, so that stress may lead to adjacent segment disease. That does happen with artificial discs too, perhaps at a lower rate of incidence. Ask the surgeon what statistics apply to these situations. If you don't have surgery, that can lead to further problems as a disc collapses and the spine may start to fuse itself. The endplates can grow bone spurs and enlarge and begin to touch the other vertebrae leading to a spontaneous fusion. Spine surgery is a big surgery with a long recovery, but being young is probably an advantage in healing. Your experience may not be the same as someone else as there are many factors that affect health and healing.

There are a lot of discussions here about lumbar fusions where you can learn from others experiences. Here are a few I found by searching for those with L5 S1.
https://connect.mayoclinic.org/discussion/considering-l5-s1-fusion/
https://connect.mayoclinic.org/discussion/recent-l5-s1-fusion/
https://connect.mayoclinic.org/discussion/hi-all-anyone-who-had-an-l5-s1-fusion-what-were-some-of-your-symptoms/

jong | @jong | 3 days ago

I wouldn't touch anything artificial that low in your body, way too much weight to make it fail. You can check out my story, it hasn't been easy but way better than the alternative / pain and counter when I was in your stage. All in all you'll know when you have to do it because, it'll be the only option..

bobt8 | @bobt8 | 1 day ago

I had 3 surgeries between L4-S1 and finally was fused L4-S1 in 2000 when I was 40 years old. Surgeon said I was out of work for 6-9 months and all he wanted me to do was walk. I spent the next 3 months getting my kids on the bus and going for a walk. I went for my 3 months follow up and asked if I could go back to work. He asked if I was walking I said yes he asked how long was I walking for and I said I wasn’t sure but I was walking about 40 miles per week. He said he had patients that weren’t walking for 10 minutes at a time at 3 months. He signed off on my return to work. May of 2022 I had C3-C4 fused to complete my C3-T1 fusions, all done individually. I think I was 63 at the time. I know cervical fusions are not as bad as lumbar fusions but if you could get to walking prior to the lumbar fusion to get your core muscles to be more supportive of your lower back then I don’t think your age will be an issue. Walking is the best exercise overall. Good luck!

turtlebay | @turtlebay | 1 day ago

Reputable Doctors will say surgery is your last option. I would continue all other options such as PT, meditation and alternative treatments. You may be interested in a book that I found helpful-"Back in Control" by David Hansom, MD. In Appendix A, he states " For example, let's look at spinal fusion. There is clear research showing that only 25% of patients significantly benefit from a spine fusion for lower back pain (LBH) (1)." He sites a study in Spine (2006). My experience is two S1-L5 fusions done to stop pain from a bi-lateral Pars Fracture of the L5. One done in my 30's (failed to fuse) and a second done in my 50's (ALIF). Fusion was a success but pain was not eliminated and possibly made worse. Good luck and God's Speed.