[Spinal Fusion / Lumbar] Questions: 2 Level TLIF L4/L5 & L5/S1 and DSS L3/L4 in Australia!

[Badgolfer]

Well folks after seeing 4 Neurosurgeons in Perth Australia and talking to two outfits in Germany we have found a Dr we trust to do a 2 level fusion (L4/L5 & L5/S1) and stabilization with TLIF technique (sigh!) I have a 'pars fracture' at L4 and a Grade 1/ 2 spondy so ADR was contraindicated . Since L3/L4 has a bulge but is otherwise OK we are going to do a DSS (motion coupler) to protect that disc but still allow some mobility. We have had trouble finding a Dr as Perth, and Australia, is not known as a 'spine center' and most of the Dr's didn't address all my problems. And my favorite Dr committed suicide (sad). This last Dr was our last hope and then plan to return to Houston and start the search over aain.

Unlike most of you here I am not in pain, but I have leg numbness and my right leg is slowly wasting away....so need to get this done. I had a previous laminectomy in 2002 and that worked very well...until 2009 when DDD progressed even further. Surprisingly I got rapidly worse between Mar & May when I believe the 'pars fracture' occurred...but no 'incident' I remember.

I am a 56 yr old senior mechanical engineer and my wife is a zoologist so we have done tons of research and can talk to a Dr comfortably. I am a long time lurker (2 years) and recent member.

I have a few questions,
What is required for pre-op? They have me checking in the day before to 'get me ready'.
Without much pain before the op will my post-op pain reduce faster? This is my biggest 'hope' that recovery won't be prolonged.
How uncomfortable is being stretched back to original height?...when does that feeling go away?
After 30 days is the surgery pain all gone and then dealing with back recovery issues?
Has anyone else (besides Justin ) had a DSS for stabilization of a 'damaged' disk? Did that work long term (well since 2007 when they were introduced)?
How much has a 2 level or 3 level fusion impacted your golf game? My wife is the good golfer and I will be a "golf widower" if I don't play.
How much has a 2 or 3 level fusion effected your bicycle riding? Did you switch to a recumbent or feel comfortable on a regular bike? I was doing 100-120 miles a week before it got too bad.

That is enough for now...Surgery planned for 14 Sept...and the feeling of fear and dread is growing...

Dan

[Kimberly]

Badgolfer,

and .

I am sorry to hear of all the problems you've been dealing with but I'm glad you found this forum. It is a wealth of information, support and kind-hearted folks with loads of experience. And I'm so sorry to hear about your Dr. Very sad. My condolences.

While I can't address all your questions, I also have L3-S1 as my "problem" levels. I am 9 weeks post-op from a 2 level ALIF (L4-S1) with residual problems at the L3-L4 level. As for Pre-op, most of mine was done in the weeks prior to surgery (blood, EKG, etc) with my primary care Dr. I checked in the morning of surgery. As for the pre-op vs. post-op pain...I'm sure this is different for everyone, but I had significant lumbar and sciatic pain pre-op and found that most of my post-op pain was "new" pain. Pain related to the surgery and not my long-term problems. This made me VERY optimistic. I think that hoping all surgical pain to be gone at the 30 day mark is a tad optimistic. This is pretty major surgery and the body takes a while to recover from that. I am at about 9 weeks and am not pain free, but am significantly better than I was a month ago. Recovery takes time.

As for the golfing and biking, it is still too early for me (but I'm not a golfer anyway) BUT my surgeon assured me that people who have my type of surgery DO actually go back to playing tennis and golf.

Again, Welcome
Kimberly

[Badgolfer]

[QUOTE=Kimberly;25266]Badgolfer,

Kimberly thanks. A couple of follow up questions,

I am 9 weeks post-op from a 2 level ALIF (L4-S1) with residual problems at the L3-L4 level.

What are your residual issues at L3/L4? Why did you leave that joint until later?

I am at about 9 weeks and am not pain free, but am significantly better than I was a month ago. Recovery takes time.

How long until you were back at work or 'life' whichever is better ? Where drugs and mobility allowed you to do things on the road back to full activity.

Thanks again,

Dan

[KanRunMo]

I cannot answer your questions except for the golf bit. My husband and I play golf with a social group. Last August I had an MRI and talked with an orthopedic spine specialist. He was no help but I did tell him I hoped to get an ADR to preserve my mobility for golf and tennis. He said, "you have no mobility in your back now." That indicates to me that having a fusion should not bother your golf any more than your current condition.

[Kimberly]

Badgolfer,

I had DDD from L3-S1 but my surgeon felt that the L3-L4 level was not diseased enough (and not a current pain generator) to be included in my surgery in June. Believe me, we talked for a looong time about this little disc. I wanted him to include it (let's just fix it all while we're in there) but he said that he had gone round and round with this decision and he just didn't feel it was bad enough to include. He said it would change the surgery and recovery significantly (going from a 2-level to a 3-level fusion) and he felt that it had some more life in it yet. He said that one of the hardest things about being a good surgeon is not knowing where to start, but rather, knowing where to stop.

As for my progress.....I would not say I am "back to work/life" yet. I am still off of work and slowly coming back to the life bit. I am still not driving and have not yet started physical therapy. I have an appointment with my Dr. next week and I am hopeful that he will clear me to drive and prescribe PT. I am still quite fatigued and find that I rest on and off throughout the day alternating activity with rest (e.g. go for a walk, rest. Do the breakfast dishes, rest. Tidy up the room, rest.) My Dr. advised me to carve out at least 3-4 months for this surgery and recovery so I don't think I"m off track. I'm sure if you've been reading posts here, you'll see that everyone has a different recovery time but everyone pretty much agrees that "slow and steady wins the race."

Kimberly

[Badgolfer]

I had DDD from L3-S1 but my surgeon felt that the L3-L4 level was not diseased enough (and not a current pain generator) to be included in my surgery in June. Believe me, we talked for a looong time about this little disc. I wanted him to include it (let's just fix it all while we're in there) but he said that he had gone round and round with this decision and he just didn't feel it was bad enough to include.

Kimberley
That describes my situation very well too. But my concern, like yours I am sure, is that the L3/L4 will be under a lot of pressure in a year or so when I start golfing, riding a bike, and maybe even running again. In our case the Dr is going to install a DSS like a shock absorber that should help protect that disk but still leave some mobility. This is not covered by National health insurance here in Aus so not common here...but he has done it before...and showed us some CT of another patients "after" back which didn't look too bad .

We saw 5 neurosurgeons and 1 said "too hard" I am not your man, 3 said "L5/S1 is self-fusing anyway...I am going to leave it alone" and only fuse L4/L5 where I have spondy, and finally the last one said what I wanted to hear L5/S1 is a mess, needs to be cleaned up, L4/L5 spondy has to be addressed and "what to do about L3/L4?....lets try DSS. Since I have numbness in both legs from 'multiple levels' of nerve damage this really was the right answer long term.

Thanks

[Justin]

What is required for pre-op? They have me checking in the day before to 'get me ready'.

Pre-op usually involves some blood work, EKG for your heart, a focused history and physical, some pre-op x-rays and bowel prep (they will give you something to "clean you out"). Also, you will be able to meet with your surgeon(s) and ask any questions that you may have. You will sign documentation related to the surgery.

Without much pain before the op will my post-op pain reduce faster? This is my biggest 'hope' that recovery won't be prolonged.

I would say "yes." If you are not experiencing much pain before surgery, then you should have less pain post-op. There are always exceptions.

How uncomfortable is being stretched back to original height?...when does that feeling go away?

After my two-level artificial disc replacement surgery in 2003, the pain from "being stretched to original height" (frequently called "distraction pain") can be quite debilitating and last anywhere from a couple weeks to 1.5 - 2 years post-op. Everyone's anatomy is unique and we all respond and react to pain differently, so keep that in mind.

After 30 days is the surgery pain all gone and then dealing with back recovery issues?

30 days comes fast post-op. Your body experiences a very traumatic event going through surgery and the pain can take quite some time to resolve. The initial surgical pain (incision pain, inflammatory response, etc.) usually subsides in ~ 10 days. The neuropathic pain takes a much longer time for your body to "tease" out.

Has anyone else (besides Justin ) had a DSS for stabilization of a 'damaged' disk? Did that work long term (well since 2007 when they were introduced)?

I've spoken with a few over the years. We are a rare breed.

How much has a 2 level or 3 level fusion impacted your golf game? My wife is the good golfer and I will be a "golf widower" if I don't play.

This is hard to say, as I know and have spoken to many Spine Patients over the years with multi-level fusions that are still at the top of their golf game to this day.

How much has a 2 or 3 level fusion effected your bicycle riding? Did you switch to a recumbent or feel comfortable on a regular bike? I was doing 100-120 miles a week before it got too bad.

Terry is an SPS Member that has a total of 4 artificial discs in his neck and low back. He's been riding hundreds of miles a year (I think he rides about 1500-2000 miles / yr now). There are a few other SPS Members that are "extreme" athletes in our ranks.

Good luck with everything, Dan! We will be thinking of you on September 14th!

[Kimberly]

Dan,

Just checking in to see how things went with your surgery.

I hope all is well, there were no surprises and you are resting and recovering well.

All the best,
Kimberly

[Badgolfer]

Dan,

Just checking in to see how things went with your surgery.

I hope all is well, there were no surprises and you are resting and recovering well.

All the best,
Kimberly

Kimberly
I had 2 level TLIF L4/L5/S1 with DSS L3/L4 on 14 Sep and had minimum problems. I was allergic to the antibiotic but stopped that and no other issues. I got out of hospital after 5 days and am 'resting' comfortably at home. Walking a little more each day and up to ~1 km per day total after 18 days. Still on 20 mg 2 x day of oxycontin time release codeine and panadol/tylenol 4x per day.

However, I am not entirely satisfied yet. I still have a lot of numbness on my right leg (more than I did before surgery) and I have 'shin pain' on left leg...which is new. My legs still go numb when I go walking which is why I had surgery in the first place. I can't walk much more than 1 1/2 blocks before numbness becomes noticeable.

I am hoping the numbness will go away over time...after 18 days not much change. I am very much hoping the numbness when walking will go away completely or the surgery was a waste of time :-(

Thanks for asking.

[Kimberly]

Dan,

I'm glad to hear that surgery went well and you are home and resting. At not quite 3 weeks yet, you are still very very early in the recovery process. As everyone on this site is keen to point out, recovery from this type of surgery is a long (and usually arduous) process. I am 3 months post-op and I STILL have pain, limitations, fatigue and a long way to go in my recovery. My surgeon told me to expect to start feeling "human" at about one month and to look to feel my best from this surgery at the 6-12 MONTH mark.

Having lingering nerve issues post surgery is fairly common as those can take a long time to heal as well. I also had a lot of nerve "issues" that were not gone immediately after surgery but have pretty much resolved themselves now. My leg pain and numbness are 99% gone.

"New" pain (sometimes in the legs) is also not uncommon. I also had "new" leg pain right after surgery that I worried was from them hitting a nerve or damaging something during surgery. It wasn't minor pain. It resolved itself around a month post-op if memory serves. I think this is fairly common and sometimes referred to as "distraction pain" (from distracting / restoring the disc space height between vertebral bodies).

Saying that the first months of recovery are "difficult" is the understatement of the year in my opinion. I found these first months to be some of the most physically and emotionally challenging things I have had to endure. And as wonderfully supportive as my family has been and for all the meals that friends have brought over, recovery is, for the most part, not a team sport. It's your journey. And that can be lonely sometimes. I struggled to find signs each day that I was getting better - that this surgery was successful. But in the end I found this to be frustrating (like watching the daily shifts in your investments or watching the fluctuations of the bathroom scale - depressing and scary from day to day, but weekly/monthly trends are positive.) During the 2nd month, I discontinued my meds and at the 3 month mark I have found my improvements to be HUGE - I am improving in energy, function and attitude by leaps and bounds now. And I am optimistic that it will continue to get better.

Hang in there. It is very early for you yet. I think in a few weeks/couple of months you will be in a much better place and these early post-op days will just be a hazy memory. :-)

Take care,
Kimberly