Spondylolisthesis and pars defect: 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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Profile picture for maryanne7 @maryanne7

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.

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None of the surgeons were candid enough to say that the recovery would be brutal and the surgery might not work. So that's good to hear. I am stuck between getting Spinal cord Stim or trying more alternative methods like Acupuncture and chinese herbs at a training center that is supposed to be very good.

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Profile picture for annie1 @annie1

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

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I had the Medtronic’s unit. I didn’t have calf pain. Lower back pain and burning feet. Along with my meds, the SCS dropped my pain from a 7 down to about a 3.
Only doing the SCS trial cam tell you if it will help your pain. Worth a try.

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Profile picture for annie1 @annie1

None of the surgeons were candid enough to say that the recovery would be brutal and the surgery might not work. So that's good to hear. I am stuck between getting Spinal cord Stim or trying more alternative methods like Acupuncture and chinese herbs at a training center that is supposed to be very good.

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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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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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Profile picture for annie1 @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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Profile picture for maryanne7 @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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Profile picture for Denny T @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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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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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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Profile picture for heisenberg34 @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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