Recent L5-S1 fusion

Posted by fine137 @fine137, Dec 22, 2019

Diagnosed with Spondylolisthesis about 30 years ago. Didn’t cause me much pain except for the yearly episodes of throwing my back out and being laid up for a week or so. But 2 years ago morphed into pretty much constant pain, especially when sitting.

Doctor finally recommended surgical fusion option and I had the procedure done 9 days ago. According to him it went well and he is optimistic on the ultimate outcome. I am fairly mobile, doing about 90 minutes of walking each day, but by the end of the day, when it’s time to go to bed, the pain becomes almost unbearable without meds. During the day there is pain, but it’s quite manageable. Why does it peak at night? Am I doing too much during the day perhaps? Or some other reason? I do not take pain medication during the day, but do have to resort to a pill at night.

Overall what does recovery from surgery look like, how long might it take for that whole area to calm down so that most of the pain is gone, even though it will be 3-6 months for the bone to grow? This recovery is not like any I have experienced before, meaning it feels plateaued where I don’t have marked improvement on a day to day basis, but rather plateaus followed by slight improvement. Is that normal.

I know my doctor should answer these questions, but while a highly respected surgeon he seems to have no time for these types of queries.

Thanks

@fine137 My very first back surgery was for a herniated disc at L5-S1. Since that time and in the 10 years following, I've had two more back surgeries. I found that after my first surgery, I pushed it too hard and went back to work much sooner than I should have. If you are walking 90 minutes a day and you're only 9 days out from surgery, you might be doing too much. Hopefully you're breaking up your walking to only 15 -20 minutes or so at a time. I would find that I did too much on the good days and then I would pay for it the next day.

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@fine137 I can't speak too much on the type of surgery you had but I did have a cervical spine surgery on Thursday. In terms of why it hurts more at night, I have always been told with my other orthopedic issues that inflammation is higher at night due to what we have done during the day, which causes the increase in pain. I know I can't take an anti-inflammatory, as it hinders bone growth and it's needed for my fusion. I would think you are the same unless your surgeon feels differently about it. Regarding the 90 minute walk, did they tell you to do that much and is it done all at one time? I am to walk 3-4 times a day but not for that length of time. I think they were looking at 10-15 minutes each time depending on how I feel. Movement is good since it promoted blood flow and thus healing. Just don't want to over-do it.

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I had the L4-L5-S1 fusion in 1995…very successful as not a problem since…walking 90 minutes so soon is way beyond what I was told at that time …I didn't have to take Hydrocodone but a few days after getting out of the hospital.. 5 days there.. but I didn't miss a day of work (Univ prof)..but that Christmas vacation in 1995 was a stay at home.. the Hardware (2 plates 6 screws) were left in.. bone from hip solidified around the fusion well.. I was never a smoker…so that helped… The surgeon cleaned up other potential problems so now at 82 I am getting around very much better than my peers.. good luck.. be cautious not to overdo before the fusion gets solid ..that can take a year I was told.

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@fine137, My story is very similar to yours. Spondylolisthesis diagnosed 30 years ago. The pain became progressively worse but unlike you the main relief I got was from sitting. I had an L5-S1 fusion on Dec. 23rd. I am 13 days out. I had been cycling between Ibuprofen and Tylenol for the pain but was told by someone on this forum 2 days ago that taking anti-inflammatories was not good. Last night was my first night attempting only Tylenol and it was not good. I have shooting nerve pain in my gluts, legs, and feet. and like you it is worse at night and prevents me from sleeping anymore then short periods of time. Also, since the surgery the bursitis pain in my hip has really ramped up. Like you, I found a great surgeon that doesn't want to be bothered with every little question. I don't want to cave in and take Hydracodone because I don't want the negative side effects. As far as recovery time, I was given general advice to take it slow, be patient, not over do it, and walk as much as I can. Yesterday, I walked for 45 min. at one time in the mountains and I will not attempt that again for quite a while. Too much. I was told to just do a little bit more each time I walked. Thanks for sharing your story.

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I am going to offer this: life-long competitive amateur athlete here. Not needy, very well educated. Married to a top amateur triathlete. I've been through seven major orthopedic/neurologic surgeries, she has been through eleven. If any surgeon, at any time indicated that they didn't have time to answer patient questions, it is an automatic 'move on'. Lack of empathy is legend in surgeons and is worst among cardiac, second worst among orthopedist. Do the research yourself. Get a second opinion until you get one that resonates with you. In particular, if your pain involves the spine, demand a second opinion from a Neurosurgeon. They are the brain-trust and will study if your symptoms match your diagnosis. I would be paralyzed if I hadn't done this myself.

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@jtrtexas

I am going to offer this: life-long competitive amateur athlete here. Not needy, very well educated. Married to a top amateur triathlete. I've been through seven major orthopedic/neurologic surgeries, she has been through eleven. If any surgeon, at any time indicated that they didn't have time to answer patient questions, it is an automatic 'move on'. Lack of empathy is legend in surgeons and is worst among cardiac, second worst among orthopedist. Do the research yourself. Get a second opinion until you get one that resonates with you. In particular, if your pain involves the spine, demand a second opinion from a Neurosurgeon. They are the brain-trust and will study if your symptoms match your diagnosis. I would be paralyzed if I hadn't done this myself.

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Exactly right

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@jtrtexas

I am going to offer this: life-long competitive amateur athlete here. Not needy, very well educated. Married to a top amateur triathlete. I've been through seven major orthopedic/neurologic surgeries, she has been through eleven. If any surgeon, at any time indicated that they didn't have time to answer patient questions, it is an automatic 'move on'. Lack of empathy is legend in surgeons and is worst among cardiac, second worst among orthopedist. Do the research yourself. Get a second opinion until you get one that resonates with you. In particular, if your pain involves the spine, demand a second opinion from a Neurosurgeon. They are the brain-trust and will study if your symptoms match your diagnosis. I would be paralyzed if I hadn't done this myself.

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Hello @jtrtexas and welcome to Mayo Clinic Connect. I think you bring up a great point to seek out care by someone who you feel you can trust and ask questions of. I am guessing that for some, it may not be as simple given insurance complications, however when possible it seems only right.

You mention that had you not sought a second opinion by a neurologist, you would be paralyzed. Can you share more about that experience?

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Has anyone had lumbar steroid injections and Si joint injections after fusions. And is there a limit to them

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@suerc

Has anyone had lumbar steroid injections and Si joint injections after fusions. And is there a limit to them

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@suerc Hello and welcome. I am a spine surgery patient, but at the other end of the spine. My physical therapist has said to me that doctors don't like to do more than 3 steroid spinal injections a year. For awhile, my elderly mom was getting them for pain in the lumbar area and I think I herd the limit of 3 a year back then. That would be a question for your doctor.

From your question, I presume that you might be experiencing some pain. Have you had further imaging to determine if there are any findings that may be the cause of your pain?

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@amandajro

Hello @jtrtexas and welcome to Mayo Clinic Connect. I think you bring up a great point to seek out care by someone who you feel you can trust and ask questions of. I am guessing that for some, it may not be as simple given insurance complications, however when possible it seems only right.

You mention that had you not sought a second opinion by a neurologist, you would be paralyzed. Can you share more about that experience?

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Hello Amanda,
You make an excellent point on health insurance – I am fortunate to have a policy that does not force me to a single provider or clinic.

To your question, I consulted numerous orthopedic surgeons who all looked at my x-rays and MRIs and concluded that I needed a C2/C3 fusion.

When I first visited the neurosurgeon he had read the copious notes and the images before I arrived. His first act was to give me a thorough head-to-toe physical examination: reflexes, sensation, muscle strength, … Hands, feet, neck, knees, elbows, … It only occurred to me then that he was the first physician to actually physically touch me.

After the examination, he had me sit down with him at his computer and took me through a guided tour of the MRI's and X-rays. What he told me, in summary, is that he understood why someone would think that C2/C3 was my trouble spot based on the X-rays but the pain that I was experiencing was coming from the C3/C4 facet, not 2/3. It looked less arthritic but was actually narrower at the foramen. A C2/C3 fusion would create more stress on C3/C4 and likely result in additional fusions. So maybe not 'paralyzed' but certainly substantially immobilized.

At any rate, we did the insurance-required epidural steriod injections to prove the diagnosis and then a radio ablation which was highly successful. It is likely about time to do the ablation again but I got more than 5 years of relief.

My story is one of physicians looking at the obvious manifestation vs. identifying the root cause. My personal conclusion is that someone who is diagnosing nerve pain ought to be pretty hands-on.

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@suerc

Has anyone had lumbar steroid injections and Si joint injections after fusions. And is there a limit to them

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@suerc Yes for steroids you can only have 3steriods are also if to many on your kidneys Right now I'm suffering from L5S1sacrelosation they are fused by themselves I ask my pain Dr to give me more pain medication he will if you tell him you don't want steroids he can give you something else where it's every 6weeks I go or sooner of needed I opt out of surgery

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they wont give me to many but I have SI Joint pain ESI injectiond into my L4 as I shattered my spine in a boating accident 3 yrs ago. My rt leg goes numb and down to my knee. When teh disc at L4 I get those symptoms. I have terrible tailbone pain , and terrible back anf get RF's ecery 6 mo. and also for my neck. as I had spinal stenosis and did a fussion there . I feel like a human pin cussion. but so much better after injections. But still have tailbone pain when sitting.Bummer

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