Considering L5-S1 fusion

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.

So 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...

I, 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.

I 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!

Thank 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.

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.