Spondylolisthesis and pars defect: Considering L5-S1 fusion

I am a 68 year old woman. I have had type 1 diabetes for over 50 years and also have osteoporosis. I was dxed with spondylolisthesis several years ago. At first I responded well to PT--but over the next two years became increasingly incapacitated. I was in a great deal of pain-mostly with standing-and at the end needed a walker to go even several feet. I tried gabapentin, steroid injections, nerve blocks etc. Nothing worked. Finally, I had an L5-S1 fusion. Like rng1954 I recovered well. I walked out of the hospital after 2 days and (unlike a close friend whose surgery was successful, but who had a long painful recovery) I needed no pain meds. Its been over a year now and I only feel occasional mild back discomfort which is addressed by yoga and other activity. I try to walk at least 5000 steps a day and keep resolving to do more core exercises. My osteoporosis was addressed by Forteo injections 4 months before and 10 months after surgery. It may be that I will have future problems--but my surgeon tells me that I have healed very well and he doesn't foresee them. I believe that factors in my favor were: 1. very good luck. 2. a very good, meticulous surgeon with a very good track record (I had worked in the hospital and talked to his nurses). 3. I was considered-based on spine imaging-and despite my diabetes and osteoporosis-a good candidate for the procedure. Its a gamble---and I know of far less successful outcomes--but it was definitely worth it for me.

I was diagnosed with degenerative spondylolisthesis last year. I am older (75 yo) but was very active: daily gym workout, mountain bike, ski, travel, etc.. My neurosurgeon recommended an L4-L5 fusion. After doing a fair amount of research, I agreed. October, 2022 had the fusion. Long story short, turns out my surgeon damaged my nerve when he inserted the right L5 pedicle screw into the nerve. Yes, take your time; do the research. Turns out there are several techniques used for pedicle screw placement; my sugeon used the free-hand method, and didn't work out that well for me. Since my surgery, I have not been able to walk without walking sticks or a cane. Good luck to you, my friend.

@dennymt I feel your pain. I also was very active pre-fusion and post I have been in very great pain from fusion with no end in sight. I was told originally I would be recovered in 4 weeks; and while I have no nerve damage, it is now over 5 months and no relief from the impact of the fusion surgery itself. It feels like I have a lump of cement in my spine, with rods sticking in it, pain everywhere around it in upper back, numb painful muscles around it, inability to lie on my back, and mobility and flexibility loss. Good luck is right.

I'm so sorry to hear you are not getting relief from pain after your surgery. Thank you for sharing your experience and advice.

Thank you @slowgo. I hope your decision is successful for you. Unfortunately it seems nothing is clearcut in this area of medicine, it is very personal and luck of the draw on impact to one's body and how well the surgeon actually performs.

I had L5-S1 fusion a little over 6 years ago. I had injured my back after a ski fall. The pain increased over the next year. I was finally directed to a marvelous neurologist who put me on a cocktail of drugs (tramadol, gabapentin, diclofenac potassioum, and diazepam. It took me a few days to acclimate to the side effects of the drugs, but after that, I felt 100%
better, I was back to cycling 30 to 40 miles a week, hiking, and working around the house. I did have an occasional bad day when the pain returned (not as bad as the original pain). I wasn't satisified with what I had gained, so I was directed to an orthopedic surgeon who ordered another MRI (my third one in less than two years), Interestingly, he said that the scan showed spondylothesis at L5-S1 (even though previous scans revealed nothing of the sort). That was early in my pain journey, so what did I know? He recommended fusion. So, I said "go ahead". Surgery went fine. Four months later, I had more pain on my "good days" and worse pain on my bad days. If I knew then what I know now, I would have gotten second, even third opinions, and other radiologists to interpret the MRI images. No way I would have that fusion again. I am still much better off than many that I see on this site, so, I feel blessed for that.

Hi I don't know if my situation is very similar but I have severe lumbar stenosis and after I walk and stand my calf muscles throb all night making sleeping difficult. The surgeons say I need laminotomy and then fusion or a spinal cord stimulator if I can't do the surgery.
I have an acquaintance who is in training for acupuncture and Chinese medicine who says I should try that for a few months. Any advice ?

Get more opinions about that spinal fusion stuff. I had one at L5-S1. Did nothing to help my lower back pain. Go ahead and try the alternative medicine. As long as it doesn't drain your bank account, what have you got to lose? I had a spinal cord stimulator that worked fairly well in reducing the pain for about 3 years. Suddenly, it just stopped working. The trial for the stimulator is fairly simple and will give you a good idea if it will help your pain.

Thank you for this info. I am struggling with this decision and sorry for your experience. I can relate because I skied for 30 years, but I don't blame that for my back pain. Maybe I should. I think a surfing lesson at age 70 did me in. Or maybe gardening- this heavy flower pots are a challenge.

I am taking meds and getting injections. My meds are or have been gabapentin, prednisone, tramadol, tizanidine, naproxen, and Tylenol. Prednisone gave me Cushing Syndrome. Naproxen was discontinued when I ended up in the hospital with diverticulitis. I didn't like the tramadol and I started getting hooked on it, so I stopped it. I am still on prednisone because you have to wean off of it. Surprisingly, a max dose of Tylenol per day is effective. I use tizanidine in the evening when I know I won't be going out again. Gabapentin seems good, but I don't actually feel it working; its effect is subtle. Pain management is my main activity every day.

I have only talked to one surgeon so far who told me the recovery would be brutal and the surgery might not work. This message board has been helpful.

Thanks for the info about the SCS. Which one did you have and did it help with throbbing calf muscles ? Or leg pain