[Spinal Fusion / Lumbar] L5-S1 Spinal Fusion

[timback]

I'm anxious to see what I can learn here. Prior to my discectomy/laminectomy 9 years ago, I tried the chiropractor, a plaster traction brace, steroid injections, and physical therapy. 4 years ago I had a L5-S1 fusion which had fantastic results until recently. The fusion was against the wishes of my physical therapist. He now tells me it is a question of time before I have a fusion of the L4-L5 level. I really don't want to be relegated to a fusion surgery every 4-5 years. What are my options? Artificial disc?

Male, 43 years old
L5-S1 fusion (2006)

[Katie]

Welcome Tim, and as everyone says when one of us joins, we're sorry for the reason you're here.

I've just had a two level fusion, the L4/5/S1 levels and am just recouperating. You ask an interesting question...whether you should have had a fusion and what to do now. My reasons for having two are complicated. I was severely allergic to any artificial discs available for now, but after several years of research, I think I would still have wanted the bottom level fused then had an ADR at L4/5. So that is a reasonable idea to check out. I think the harder job will be to find an ADR that you like....there are so many to choose from now, all with their own pros and cons.

I'm sure someone with more experience than I have will chime in soon.

[KBear]

I second Katie on having the L5/S1 fused. I have an artificial disc at L4/5. I had a slight herniation on the discs above and below this prior to surgery. I have already decided if I ever need more surgery, I would fuse the L5/S1. I have heard of too many problems with ADR's at that level to be comfortable with it (my personal opinion, as I know people who have had successes too). A lot of people that need a 2 or 3 level have a hybrid done, which is a fusion at one level and ADR at another. My understanding for the reasoning behind this is that a) too many ADRS can cause too much movement, which leads to instability and more problems b) that the ADR at the higher level 'protects' the other levels from going bad and c) that the L5/S1 does not have much movement to start with, so fusing it does not cause problems that you might see with having other levels fused. You may also need a fusion if you have severe facet problems or numerous other reasons that can make you a bad candidate for ADR.

From my experience, many of the chiropractors, acupuncturists, and physical therapists are anti surgery, regardless of the surgery. While I wouldn't just jump into surgery for the sake of it, when you are in so much pain that you don't have a life and in many cases would rather be dead, then surgery is life saving. I had 2 doctors who told me to NEVER have surgery, because I would end up with "an entire fused spine by 50. This is total crap and they just didn't believe in fusing young people. One of these doctors told me, at age 27, that there was nothing else they could do for me and I would just need chronic pain management forever. I begged them to fuse me, anything for relief, they said no. Talk about depressing, I cried like I have never cried before and really just wanted to end it all. If that was my life option, I didn't want it. Then I found my new doctor, who told me about ADR. At that point, I would have stood on my head 12 hours a day if it had a shot at making me feel better. I was beyond desperate. Many well meaning people advised me against surgery, but I knew that I could not live like that. I had surgery and am so glad I did. I have so much of me back and can do things again. I know my chances of eventually needing another surgery before I die are good, but I would do it again in a heartbeat. I would rather have 4 quality years and need surgery, than to have had none.

You are in the right place for answers, research, and brainstorming. While this is obviously not to be taken as medical advice, it can point you in the right direction and arm you with the information and questions you need to ask your doctor and make a decision about your spine. Bottom line, no one has to live with your pain but you, they haven't experienced what you have and you are the one who will live with your decision.
Kathy

[Katie]

Thanks Kathy. I knew someone would pop in and explain what I wanted to say, only better

[timback]

I'm anxious to see what I can learn here. Prior to my discectomy/laminectomy 9 years ago, I tried the chiropractor, a plaster traction brace, steroid injections, and physical therapy. 4 years ago I had a L5-S1 fusion which had fantastic results until recently. The fusion was against the wishes of my physical therapist. He now tells me it is a question of time before I have a fusion of the L4-L5 level. I really don't want to be relegated to a fusion surgery every 4-5 years. What are my options? Artificial disc?

Male, 43 years old
L5-S1 fusion (2006)

Thanks for your replies. I'm already glad I found this site.

[ajj1001]

I'm anxious to see what I can learn here. Prior to my discectomy/laminectomy 9 years ago, I tried the chiropractor, a plaster traction brace, steroid injections, and physical therapy. 4 years ago I had a L5-S1 fusion which had fantastic results until recently. The fusion was against the wishes of my physical therapist. He now tells me it is a question of time before I have a fusion of the L4-L5 level. I really don't want to be relegated to a fusion surgery every 4-5 years. What are my options? Artificial disc?

Male, 43 years old
L5-S1 fusion (2006)

Welcome. Have you had any opinions (is a physical therapist a doctor?)? That would be my advice to see at least 3 people (orthopaedic/neurosurgeons)
I had two level ADR and ended up with the bottom one being fused anyway because of problems, you never know what is in the future. Its a question of dealing with whats happening now in the best way.

alison x

[Greg]

I'm anxious to see what I can learn here. Prior to my discectomy/laminectomy 9 years ago, I tried the chiropractor, a plaster traction brace, steroid injections, and physical therapy. 4 years ago I had a L5-S1 fusion which had fantastic results until recently. The fusion was against the wishes of my physical therapist. He now tells me it is a question of time before I have a fusion of the L4-L5 level. I really don't want to be relegated to a fusion surgery every 4-5 years. What are my options? Artificial disc?

Male, 43 years old
L5-S1 fusion (2006)

HEY TIM!!!! (Is it ok to call you Tim?)

to the site and as we all see it's usually never good things that have happened or are happening that bring us together on this site but we are glad to have you hear and I'm pretty sure I can speak for everyone when I say we are here to help . I've got to agree with what everyone's said so far. You've had a previous spine surgery so I'm pretty sure I dont ned to blab on the IMPORTANCE OF GETTING MANY OPINIONS OR STRESS EDUCATING YOURSELF ON YOUR CONDITION/TREATMENTS.

You mentioned you had L5-S1 fused and now L4-L5 is looking bad but what concerns me is that maybe you feel because of the previous surgery that it may be the cause of the adjacent level degeneration. That may be true....I SURE HOPE NOT:thumpup:....but like Kbear said, L5-S1 has almost no movement/motion in your spine so fusing that level is the best one to fuse to not have to worry about passing the stress load to upper/lower discs causing degeneration. There could be a very good chance that given the type of work you do and physical strain you put on your body that L4/L5 was just bound to go bad. I hate to say that but it seems its always around L4-S1 that people have issues with and considering S1 is the 1st of 5 naturally fused vertebraes (your sacrum) it makes sense that that area is highly problamatic. I feel so strongly about this as L4-S1 are bad in my back and I am actualy getting my surgery on them TOMORROW
After I had spent a couple years trying every possible non-surical treatment out there....not to mention putting myself so far in debt but I'd rather be broke knowing I made the right choice than made a mistake that cant be taken back....I knew there was no other option left but surgery. I wanted to do a hybrid (fuse L5-S1 since they dont move anyway and get an ADR on L4-L5) Now of course life would be too easy if I could just get what I want (gotta love insurance) and BCBS didnt like the idea of saving $50,000 and doing an ADR so I am havin L4-S1 fused Anteriorly tomorrow but I'm not the least bit worried about my other discs going bad because the life I live now (which I wouldnt wish upon my worst enemy) has taught me how to really care for my back and I know what not to do and I wont be bending over.....lift with the knees, and I'm really good at that now

Back to the point.....sorry to get off topic but after 8 years of pain I am actually getting fixed tomorrow so I am so excited and had to say it. If your L4-L5 is now problematic and you have to get surgery articial disc replacement might not be a bad idea for you.....unless your disc isnt that bad and they could do something less invasive like a discectomy of something. And I would definitely (if you absolutely have to go to surgery) would start with the most minimmally invasive procedure possible and then work your way up. I just hate for you to feel if you go up another disc then every 5 years your going to have to go up again. Managing your back and most importantly YOUR LIFTING HABITS can play a major part in having discs go bad.


What kind of work do you do or have you done since your first fusion? ...you'll make me laugh very hard if it is fishiing And what is the diagnosis of L4/L5 as that makes all the difference in the world as to treatment options you should consider. And is the physical therapist the only dr you have spoked to about this or the one telling you about you possily needing another fusion. My physical therapist was only there to rehabilitate me after surgery to get me back to normal and that was it.....couple months of visits and done....didnt think they were doctors and medically capable of diagnosing and recommending treatments. What is your pain like now and how long has it been going on? Most of the lucky people who act on their pain in the beginning instead of putting it off forever can be healed through non-surgial treatments. Have you had an MRI on L4/L5 and are you positive that is your pain generator? Are you seeing an actual doctor about this pain? Sorry for pulling a Barbara Walters on you with the 20 uestions but the more we know about what is going on the more experiences can be shared with you.

I look forward to learning more about you as no matter what is physically wrong with you theres probably someone here who's been there to share experiences with. Hang in there, keep your head up and know that we are here for you! Fusion has the scary tale that once you start you'll never stop but I know of a couple people who have had 3-4 level fusions and are doing great without any signs of adjacent level degeneration. Again, to the site and cant wait to hear your answers.