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Spondylolisthesis and pars defect: Considering L5-S1 fusion
I am 46 year old - athletic and active. Was diagnosed with Spondylolisthesis and pars defect 2 years ago after sudden onset back pain. I have seen 3 spine surgeons and tried physical therapy, steroid injections, nerve blocks, therapeutic massage, fascia massage, and most recently stem cell/PRP injections. Nothing has relieved the pain and unfortunately surgical fusion of L5-S1 is the only option left that I haven't tried. I have heard differing things from each surgeon. From get the surgery now and enjoy the rest of your life pain free - to put off the surgery until the pain is completely unbearable and incapacitating. I also heard differing opinions on what a fusion will mean as far as increasing my chances for needing additional fusions in the future b/c of the stress fusions put on the vertebrae above. It is very difficult to make decisions when I don't feel like there is a consensus with the information. My biggest fear is regret. Either regret that I do the surgery and open up pandora's box that I will suffer from for the rest of my life OR regret that I don't do the surgery and unnecessarily live additional years in pain.
Has anyone had L5-S1 fusion? If so, are you glad you did? Were you able to participate in the activities you previously enjoyed afterwards? Did you have to have future back surgeries as a result?
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There is new minimally invasive bandaid surgery.....am going to see about it
Hi all, I have been in severe pain for over 8 years, 4 failed surgeries, one of those was a revision which was incredibly difficult. L4/5 is fused, L5/S1 was fused in 2019 when doctor found the disc torn in half. This fusion also failed with no bone growth and the hardware now loosening. I have degenerative disc disease and have no plans to have more surgeries. What I know now is avoid surgery at all cost. Success in resolving pain via surgery is a coin toss even if you have a successful osseous union. All surgeries done at high end hospitals with top tier surgeons. Fusion surgery is still in the dark ages. Electro-ceutical implants, stem cells, are probably the future but cost always comes into play for me, so I understand. I had to retire in Nov. 2020 because of all this mess. I have tried every treatment known to man except an implanted stimulator with zero positive results. Stim was ruled out for me by every doctor I have had. Pain is crippling...we can split an atom but we cannot find a non invasive solution to chronic back pain. Although expensive, stem cell still may be cheaper than the copays over time on other treatment. I Have over a $million dollars of insurance money into this....keep that in mind when making decision. Be well and take your time. Desperation has driven most of my decisions...which were wrong
2959 days of crippling pain and counting.
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1 Reaction@sober395 I'm so sorry your still in pain . I have seen to many failed back surgeries I try to avoid this path by going to chiropractor, acupuncture and plane old ice,heat therapy for me this eliminates the pain then I can do gentle stretching now I'm up to chair exercises but the stretching of the muscles and bones has helped me a lot 😀 I've had 2 back fractures and impinged nerves Pool aerobics works for me and is easier on the joints I hope you get some relief.
Good grief, I am so sorry. That sounds miserable. I appreciate your comparison about splitting atoms but not being able to fix back pain problems.
This is my story:
I suffered a bi-lateral pars fracture of the L5 vertebrae in my teens. I my late twenties I had an S1-L5 fusion with no instrumentation (plates & screws). Fusion did not take. In my late 50's I had a ALIF (anterior lateral inter body fusion). They go in through the front. The fusion was successful but unfortunately my symptoms of lack of stability and soreness and ability to play golf/tennis etc remain. I realize every case is unique and it is difficult to draw general conclusions. If I could turn back the clock, I would have decided against the surgeries. If possible get as many opinions as possible both orthopedic and neuro surgeons. I manage my pain by religiously swimming, fitness center doing exercise bike/EFX 6 days a week but of course I'm disappointed I didn't get the result I wanted. Remember I've heard but never read any studies confirming that 1/3 of back surgeries are a success, 1/3 cause no harm but are not effective, and 1/3 result in being worse off. Best of luck and I wish you the best.
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2 ReactionsSo sorry you're having to deal with this at such a young age. But you seem to have a clear headed view of the decisions you face - which is a good starting place. I'm 71 and had a similar L2-5 decompression and fusion 6+ months ago. I'm glad I did it though I am still in the recovery mode even six months post.
Here are some of my learnings which might help you with perspective: (1) Select a top notch institution to do your diagnostic work - the best docs and the newest equipment. (2) This is your spine. Protect your nerves as much as possible and, as such, I'd recommend a neurosurgeon as primary doc. (3) No other person's experiences will directly inform what you might experience. Helpful but not definitive.
Despite my comment #3 - the surgery you contemplate is major. Recovery can be long and difficult even if everything is successful. Depending on how well you are managing the pain you feel today - Surgery deferral until the pain is intolerable - is a reasonable strategy.
Good luck! Wishing you the best...
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7 ReactionsI, like you, was diagnosed with spondylethesis. This diagnosis was done by an orthopedic surgeon who, apparently, saw something in a new MRI that previous interpretations had not revealed. The fusion of mu L5-S1 was recommended. Of course, still being relatively new to all this, I went along with it. Surgery went fine. No complications. Four months later, I had healed, but had no pain relief. If I could go back I would never have had the surgery. I have read that spinal fusions are a big cash cow for hospitals. Still trying to get my pain under control 6 years later.
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2 ReactionsI had an ALIF on L5 S1 in 2002. I am now 69. The procedure was a breeze and I was walking down the street the same day with no pain. I had an excellent surgeon. I feel you are a great candidate if that is your best option. You are very active and will do well strengthening those back muscles which is essential. In my case I find my lower back is not strong and aches terribly if I sit too long or bend over to garden or push a vacuum. A fusion does put pressure on the other vertebrae. I have had to get steroid injections and physical therapy over the years so it was not a cure all for me however I am not a very active person and maybe walk a couple miles three times a week and do water aerobics four times a week for exercise. I know more routine strengthening exercises helps and my problem is that I don’t do them until it starts to hurt. I feel if you build those muscles to support the L5S1 area after the fusion, get a really good physical therapist, and stay active you will be fine. Praying for you!
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3 ReactionsThank you so much for your response. So sorry you did not have the outcome you were seeking. I appreciate your insight.
Slowgo. Thank you for asking this question. I have the same question for the same problem. The surgeon I talked to didn't quite explain why the surgery would relieve pain. He told me about a long horrible recovery. Then, said it might not work. Meanwhile, I am doing the best I can with medication and corresponding side effects.
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