What are people's experiences with spinal fusion surgery?

Thank you. That was my guess but I don't like to guess.

Surgery from both front and back, through the stomach and the back to get to both sides of the spine

The surgical procedures and techniques have come a long way since I had my L4-S1 fusion in 1990 with stainless steel plates. They’re still holding firm and I’m still going strong albeit with the help of pain meds, and cannabis. Current procedures usually use titanium hardware which leads to much better surgical outcomes. My outcome wasn’t bad but many weren’t as lucky and needed to have old extracted and new implanted. Ouch!

Sorry its so long. I am from Pennsylvania. I will share my first and only back surgery thus far, nay feedback would be appreciated. I had L5 leaning on sciatica and caused me excruciating pain 24 x 7. I could not even walk to Men's room. After MRI etc. I was told that L4 L5 Fusion is the answer. I did lots of research and tapped into a college friend who had same surgery. So I went with it. The sciatica went away immediately however the pain level never went below 8 - 13 for past 7 months. I was referred to Neuro Surgeon for " another pair of eyes". S0, its a compression fracture of L5 from metal spacer. The Neuro was very empathetic and proceeded to inform me he performed same surgery from same doctor who performed my first surgery. Neuro states he needs to cut front and back....remove old hardware and install stronger hardware. What? TY for whoever reads this. I am in pain.

@jraffuel Hello and welcome! I can understand your disappointment with a setback during your recovery. Of course, it's hard not to be upset by that. I would feel the same way.

Have your doctors investigated why the compression fracture happened beyond saying the hardware caused it? Is there a cage that would be a better choice for this?

Compression fractures are somewhat common in older patients with osteoporosis who have less bone density. It happened to my mom at age 92 and because of severe osteoporosis, she was not a candidate for the procedure that glues the bone back together with bone cement. She had a brace to wear instead, and it healed with a 43 degree curve adding some deformity to her spine.

The lumbar end of the spine is bearing most of your body weight, and pedicle screws must be placed at precise angles so they do not pull out and be the right size for the patient. If the surgeon places rods into the spine, this is how they anchor the hardware.

I am a spine surgery patient with a cervical fusion that was done with only a bone disc spacer (no hardware or metal plate). My surgeon told me that it heals best with bone spacers because it is natural. I don't know if they use those at the lower end of the spine because of the body weight pressure. The spacer is the mineral matrix left after all bone cells are cleaned out of it from the donor. During healing new bone building cells move in and colonize the matrix, and some of it is reabsorbed and the news cells build more bone.

The concern now would be to prevent a spine deformity that would affect your spine alignment from here on as you recover from the surgery. If your bone mineral density is less than it should be, an endocrinologist would be a good consult. It is common for lumbar surgeries to have a front and back approach. It all depends where they need to stabilize the spine. Have they discussed what new hardware should be used now, and why this is better? What will prevent another hardware failure? Certainly a discussion about how experienced the surgeon is with this more complex surgery would be helpful. I have watched a lot of spine presentations by surgeons online and they say that L5 S1 is the most difficult level to fuse because of the pressure. I don't know if your surgery would extend toward also fusing to S1, but it raises questions in my mind.

Do you have revision surgery scheduled or are you seeking another opinion beyond what you have now?

Thank you for sharing your story. I'm sorry about the pain you are having.

A neurosurgeon wants to fuse my L4-5 too. My personal feeling about doing the lumbar fusion isn't "enthusiastic." I don't know what to do so surgery hangs over me while the problems don't go away. However, the problems don't seem to be getting any worse.

I had a repeat MRI recently which was good news from my perspective. My lumbar spine doesn't appear to being getting "progressively worse" as the neurosurgeon used to say.

My neurosurgeon hasn't called me yet about my recent MRI results but I can read the MRI report. The MRI report from a year ago detailed everything that was wrong with my lumbar spine. My neurosurgeon showed me the images and pointed out all the problems. The neurosurgeon emphasized synovial cyst formation, severe spinal stenosis and atrophy of paraspinal muscles just to name a few of the problems.

My recent MRI doesn't report much of anything:

FINDINGS/IMPRESSION:
1. The synovial cyst at L4-L5 is decreased in size since March 2022 and is now barely measurable. Regardless, there is still severe canal narrowing at this level.
2. Remainder of the examination is unchanged. Paraspinous tissues demonstrate no mass lesion.

My neurosurgeon seems agreeable to postpone surgery:

"Given his improvement, absence of debilitating pain, in his stable if not improving lumbar paresthesias, I would not rush to do an operation and we will not try and talk him into it since he is not particularly eager about it.

We have mutually agreed to update his MRI and x-rays as well as get a DEXA scan to look at his bone density. We will hold off on any operation this month (we had saved him a date) and see him back in 4 months."

I'm willing to wait but I wish the problems would go away!

@jenniferhunter

I had a pre-op bone scan recently to assess for osteoporosis due to long term prednisone use. I have been off prednisone for a few years so I thought things might have improved by now.

My current neurosurgeon wanted to recheck a bone scan again because another surgeon was reluctant to do surgery. The surgeon in the past wasn't sure that I had enough "good bone" meaning normal dense bone.

My recent bone scan was called "normal" with a T-score +4.2 but the report says the following:

1. Normal bone density on the bilateral hips.

2. Due to extensive degenerative changes in the lumbar spine, the spine is
invalid for assessment for osteopenia. On the follow-up DEXA
scan, consider including the forearm.

A bone scan done 6 years ago had a similar finding. That scan stated my T-score was abnormally high and advised "clinical correlation" of the result. The surgeon in the past said there was a lot of bone that needed to be removed. He didn't think there would be enough "good bone" left to hold all the hardware that would be needed to fuse my lumbar spine.

That put a damper on the whole idea of doing the fusion 6 years ago!

@jraffuel, I'm sorry you have gone through all this. I'm new on this board, are you allowed to name the doctor that did your first surgery? I have severe spinal stenosis l4-l5. I've been hem hawing around because I know how important it is to choose the right doctor. I've been to two different surgeons but want a third neurosurgeon to take a look. Are you allowed to name the doctors? What part of PA are you in? I'm in the "Philadelphia region".

@nannynana I wanted to let you know that it is OK to share names of doctors on this forum as long as it is not a negative criticism of a person. Often we share names of specialists who have helped a lot to help other patients find care. If @jraffuel wishes to share names of their providers on a public post here, that is fine or you both may use private messaging.

Jennifer

Just my own opinion but always get a 2nd opinion from a qualified spinal surgeon. Unfortunately most of us don’t ( like me ) and we end up in worse shape than before. Once done, it can not be changed. Just a FYI, only 1 out of 8 patients resume normal employment after spinal surgery. ( I was one of the other 7 lol ) . Also after any spinal surgery, you face adjacent disk disease where the stress is put on other vertebrae. …..David