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Considering L5-S1 fusion

Posted by slowgo @slowgo, Nov 27, 2023

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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heisenberg34 | @heisenberg34 | Dec 5, 2023
In reply to @annie1 "thanks for your reply. I did have acupuncture many years ago when my stenosis first started,..." + (show)
@annie1

thanks for your reply. I did have acupuncture many years ago when my stenosis first started, with a Chinese recommended practitioner and actually it didn't help then. I just happened to meet someone who's in training at a Chinese medicine School that's has a good reputation and she kept telling me I should try it for about three months in order to see some change. But I don't know if I want to wait three more months since I've been dealing with this for six years now. Anyway thank you for your response.

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"Try it, you'll like it", goes an old commercial. Of course they want you to try it for three months. More dough in their pockets.

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Phil | @dover1036 | Dec 6, 2023
In reply to @maryanne7 "Keep us posted. My sister keeps telling me to get acupuncture. People I talk to about..." + (show)
@maryanne7

Keep us posted. My sister keeps telling me to get acupuncture. People I talk to about it, tell me it helped but they did not sing its praises. I read a long time ago that the Mayo Clinic says that there is no evidence that it works. Maybe somebody here has some info on that.

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I have tried it off and on for years out of desperation.
No luck.

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dougies | @dougies | Dec 15, 2023
In reply to @dennymt "I was diagnosed with degenerative spondylolisthesis last year. I am older (75 yo) but was very..." + (show)
@dennymt

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.

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Thanks for your response, my question is what were/are your symptoms from the nerve that was damaged? I had a L5-S1 fusion with disc replacement 6 weeks with ago. I’m recovering slowly but making good progress. Since I started walking a mile a day the last 2 weeks, I have started having nerve symptoms in my legs and hips. Surgeon thinks it’s from the nerves that were being compressed are now being stretched by the increased activity, that this will resolve over time.

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heisenberg34 | @heisenberg34 | Dec 16, 2023

There you have it. Cynical me. I have been down your road. Even the dos aren't sure as what to do. I had L5-
S-1 fusion for supposed spondylethesis. If I could go back in time time, I would not have the surgery. Four months of recovery and no better. What'sinteresting is that two previous MRIs showed nothing of the sort. Suddenly, it appeared out of nowhere and I needed surgery? A little too convenient. Has anyone discussed a spinal cord stimulator. I had the Medtronics unit implanted, and it helped quite a bit. Unlike fusion, you can hav a trial that will give you an idea if it will give you pain relief. A relatively simple procedure done in the pain specialist's office. Worth a shot before you go ahead with a non-reversible procedure.

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1 reply
maddiemae | @maddiemae | Dec 16, 2023

Hi all. I'm sorry for the suffering you're experiencing. I had S1L4 spinal fusion 2 and a half months ago. I had horrendous pain on my left thigh but the worst at the time was on my inner thigh. It felt like my thigh was being ripped up and down with a searing knife. I saw my neurosurgeon and after an MRI spondylolisthesis was diagnosed. I was shown the mri and saw the slipped disk. I chose surgery because I could not stand that pain any longer. It was every second of every day. It seems better but in the process of the mri and x-ray it was discovered that I have osteoarthritis in the hip which is causing a world of of pain. I will see the ortho surgeon and am anxious to hear what he has to say. I have to wait 6 months before I can have hip replacement. I am looking forward to it because as you all know constant pain ruins our quality of life.

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slowgo | @slowgo | Dec 16, 2023
In reply to @heisenberg34 "There you have it. Cynical me. I have been down your road. Even the dos aren't..." + (show)
@heisenberg34

There you have it. Cynical me. I have been down your road. Even the dos aren't sure as what to do. I had L5-
S-1 fusion for supposed spondylethesis. If I could go back in time time, I would not have the surgery. Four months of recovery and no better. What'sinteresting is that two previous MRIs showed nothing of the sort. Suddenly, it appeared out of nowhere and I needed surgery? A little too convenient. Has anyone discussed a spinal cord stimulator. I had the Medtronics unit implanted, and it helped quite a bit. Unlike fusion, you can hav a trial that will give you an idea if it will give you pain relief. A relatively simple procedure done in the pain specialist's office. Worth a shot before you go ahead with a non-reversible procedure.

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I have not tried the stimulator, but a friend of mine had one for a different back problem and it was a life saver for her. That's my next question when I go back to the dr.

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slowgo | @slowgo | Dec 16, 2023
In reply to @maryanne7 "Slowgo. Thank you for asking this question. I have the same question for the same problem...." + (show)
@maryanne7

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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So sorry - it really is a confusing predicament. Good luck to you as you try to decide which route to take.

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1 reply
slowgo | @slowgo | Dec 16, 2023
In reply to @mcsnail "I am a 68 year old woman. I have had type 1 diabetes for over 50..." + (show)
@mcsnail

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.

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That is so wonderful - I am happy to hear that there are success stories out there. That gives me hope 🙂

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maryanne7 | @maryanne7 | Dec 16, 2023
In reply to @slowgo "So sorry - it really is a confusing predicament. Good luck to you as you try..." + (show)
@slowgo

So sorry - it really is a confusing predicament. Good luck to you as you try to decide which route to take.

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My primary says I should get a second opinion on surgery. I think that's a good idea.

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ga29 | @ga29 | Jan 9 1:01pm

I had a revision to a previous fusion, L4-L5, NS removed the hardware, then continued fusion down L5 – S1. That was the end of July, 2023. It is a long recovery and I am still dealing with pain in my left hip, Traveling down my left leg. I feel it is somewhat better, my spine does feel stronger. I have degenerative conditions in my hips and SI joints as well as osteoporosis, it’s hard to figure out what’s causing this pain. My lower back hurts when I bend for tasks, like kitchen duties or standing. I think I’ll have a better idea if it worked or not in another year!
I agree with the other commenters, wait as long as you can. I would definitely talk with two or three neurosurgeons.

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