L4-5 L5-S1 fusion?

[Hurtmedic]

Hello all I am new to the forum and as i read i find that I am fairly new to back pain comparatively. I'm sorry that all are going through this. A little bit abot my journey. I am 32 years old. I have been a career Paramedic/Firefighter for 14 years now. I have pretty much seen it all. i have lifted patients from 2 lbs up to 900 lbs and always used proper body mechanics. I worked lots and lots of hours and this february i guess my body decided enough was enough. I was lifting a large patient with a partner( a back pain patient ironically) when I felt an awful pop on my back. I then became a patient myself and was transported to the hospital. I was unable to even stand for weeks.

I was sent then to a local worlers comp doctor. He thought throwing valium and hydrocodone at me was the answer. He wanted to blindly administer an epidural shot which i refused. Next he offered therapy still with no diagnostics. I contacted my claim manager and demanded to see an ortho doc. They pulled one over and me and instead sent me to a pain mgt. doc in an ortho group. he finally ordered an MRI showing two herniated discs. I went through several weeks of therapy and high dose pain meds before he finally sent me to a neuro surgeon.

The surgeon looked at me like I had 2 heads for months, even suggesting that I see a pyschiatrist and and neuro doc outside my workers comp. I persisted and went through more therapy, an EMG and even he sent me for a functional capacity test to return me to work. My test revealed that i was giving maximum effort and now am degraded to only lifting a max of 50 lbs occasionally and 30 frequently.  He then started taking me serious, a mere 6 months after my injury. he then decided to send me for a discography study. If you have not had one of these it is simply legalized torture. I am 6' 200 lbs man who could formerly bench 415... I was newar tears with 75 mg of demerol and 5 of versed onboard.

I got my results from the discogram yesterday, confirming that i'm not crazy and that he was wrong about me all along. I have an annular tear in my l4-5 and another in my l5-s1. He gave me two options, continue as I am or have a 2 level fusion. Either way I was told I would never return to the job I have loved for 14 years. This loss and the pain meds and my general experience has taken a huge toll on my family life as well. Has anyone had this experience and would you do the surgery. I would love to hear from anyone who has had this experience. I need help in my decision.....what should I expect for recovery of lifestyle.

[Lbrown68]

I would recommend surgery but not for surgery sake because it can lead to so many more problems. Would they be using your bone (autograph) or cadaver  (allogragraph)? There are so many thing you need to make yourself aware of before surgery. I had a fusion at my C5/C6 (autograph) at the time there was not a lot of literature on the negative effects of the autograph procedure, you do not want that not just because it makes things worse but also when you have a fusion it puts the motion and weight pressure on the upper and lower level discs which will quickly deteriorat as they were designed to do the job at their level. Also, there is hardware that can be introduced that will allow you to maintain the natural curvature to your spine. There are also disc replacements my research only has me as far as the brand or name; Pro-disc-synthesis. I would encourage your to explore these options vs. bone.  I have also had L5/S1 discectomy, laminectomy & ??????. I'm now on fentanyl 100 mcg 8 hr patch and was on methadone but that was killing my body a bit faster so now diladid 4 mg ev 6 hr plus zanaflex and a multitude of sleep aids they all help but I'm bed ridden my pain is so severe I'm in tears everyday and the dr treating you as a crazy person well you've only hit the tip my friend my back problems started for me at age 26 and I'm just 44 with no help in sight. It sounds as though you'll be able to get disability and compensation which trust me will help your frame of mind. But don't take to long and just find out what your options are sometimes the first isn't the only or the best but definitely stay with a dr that is validating you!  I would like to add that you may want to see a Dr. Of Osteopath for some manipulations and see if you can get relief from that please disclose all info to them and with your size look for one who is about equal to you in height and weight. Most people have never heard of D.O.'s only chiropractors who are really dangerous! A M.D. or Doctor of osteopath has all the skill if not more than chiropractor and they're legit M.D.s but they believe more in- less is more and a more holistic approach to medicine.  They are really the best of both worlds if you get a good one they are not fans of meds and want to get to the root of any problem and are armed with more info than your basic PCM to include manipulation therapy which they would only do if it was in your best interest. They may be the only ones taking the oath these days "First do no harm"
I sincerely hope this helps, I'm told by loved ones I suffer to help. I hope I'm able to help you or someone else.

[jenniferinknox3475]

You are the only one that can make the best decision for yourself and your body.  The last doctor (the ortho) that did my surgery in March never seemed to be able to sit down in the room with us over about 2 minutes, then we had to try to understand what he said as he sounded like a cattle auctioneer!  So, I always had my notebook with prewritten questions with pen ready and I literally would force him to repeat repeat and again repeat until I got an answer I understood, in which case we'd usually end up drawing pictures to help my boyfriend & I understand. In fact, my doc printed off the best picture of an x-ray or whatever test and circled and wrote what the problems were, etc.  This might help you.  Best if luck.

[patriciaannwal]

After 3 level fusion in 2010. L3,L4,S1
After a year I can not stand more then 10 min, I can not sit up right in a chair for more then 20 minutes at one time without chronic pain in lower back, between shoulders, neck, hips, tail bone and pelvis, The longer I sit up the more pain I have along with numbness in my feet, toes and fingers, and more sharp pain radiates down both legs. I must lay down every 30 minutes to feel a little relief.

  This fusion did not work it has left me disabled. I can no longer work. I can not even make my bed or complete simple tasks at home, must have husband assist me in bathing, dressing, putting on socks and shoes, shaving my legs Small jobs now seem to be a huge deal for me to finish but I keep trying. My head is telling me I can do something then my body show me I can’t.  My pain is now chronic pain in the lower back,  hips, legs, feet, radiates to upper spine to base of head causing chronic head aches ever few days. This is more pain then I experienced before surgery. I now experience severe pain in my hips and pelvic region radiating from my tail bone. I deal with excruciating pain daily. A bad sickening pain in pelvis when I sit up, bend, lift my legs or twist.

I take my pain medication 4 times a day. I feel they are no longer working for me. I can not stand up right for 2 or more hours when I get out of bed. I often need to sleep in a reclining chair to get 2 hours of sleep. I am awake in pain every time I move. We have bought new mattresses in hopes this may help. The reclining chair seems to keep me from moving or turning during my sleep. Since this new sickening pain in my pelvis I can NO LONGER enjoy sex with my husband. I just try to avoid it all together and this makes for a very argumentative
and unforgiving marriage.






I have not had one uninterrupted night of sleep since surgery. I need to take 3 to 4 naps during the day in a reclining chair. I am experiencing bad weakens and sharp pain in both legs that causes me to fall often. I have fell 6 times since surgery due to the legs pain and weakness with pain. One fall ended me up in bed for 4 days. Another fall ended me up in a daily use of the walker for a few days. I no longer go out unless I really need to. I no longer visit family and grand kids in fear of falling.  I have gained over 50 pounds Due to being inactive. I noticed I can not even hold my grand daughter any weight more then 5 ponds in the front causes the severe pain to radiate.













When you try so hard to make up for sleep loss due to chronic pain it makes you feel like life is worthless anymore. I can not concentrate on any one thing because of pain. The pain causes severe mood swings. Can not go to store with out something to lean on. I must have my husband assist in Walking or standing more then 10 minutes. I need to still use the walker



I have falling in to a depression in witch I am being treated for. I feel I have no quality of life anymore I am miserable everyday of my life.

[squirtatious]

I wish u the best!!!!! U have the right to be kept fully aware of what will be happening to u and be able to ask any questions u have. Don't give up til ur comfortable and knowledgeable about everything that ur surgeon wants to do.

[Hurtmedic]

Thanks for all the advice. I suppose the disc herniations in conjunction with the tears are causing the numbness. Ive talked with several physicians, past patients, fellow health care providers, and a few attorneys. They all seem to say my surgeon is on heck of a surgeon. He has no personality though and its hard to get him to lay out all the details of my findings as he is always in a hurry to get in my exam room and on to the next. I have an appt with him wednesday where I will give him my decision. I hate the thoughts but I am leaning toward surgey. I just dont know what else can possibly relieve my symptoms. Wish me luck and I appreciate your thoughts and prayers.

[jenniferinknox3475]

First let me say I'm so sorry for the pain you're physically and mentally going through.  It isn't easy in the slightest to deal with, but being a very new member here myself I can say you will receive a lot of support.  My brief history, I had the disk at L4-L5 rupture in 1995 with surgery, re-rupture in 2004 with surgery.  At that point I found out the disk at L5-S1 had been herniated, but never rupture, but with what was going on above anything I considered I had to consider for that level also.  So, 10 weeks after my 2nd surgery when I started the pain, numbness & then almost lost use of my right leg we found out the disk at L4-L5 ruptured again and I had to consider a fusion, which I had in 2005.  I was fused at both levels with rods, screws and spacers between the vertebrae (all surgeries by a wonderful neurologist).  This past March I had a bright idea to see if, since I've been in pain for 6 years straight and on heavy narcotics, it was an option to take out the hardware to see if it was causing the pain.  I went to an Orthopedic doctor (first mistake) to find the top 2 screws were moving and had created a hole big enough in my vertebrae nothing could fix it except taking it all out, L4-L5 had NEVER fused (although L5-S1 was fused beautifully) and I now had compressed nerves at L2-L3 and had to have a decompression at that level.  My first thing - do I recommend surgery.  If this were 1995 I'd say yes in a heart beat - although it was a partial diskectomy I was off work 2 weeks, and went back to work and life pain free and happy.  15 years later, not if you can absolutely help it, or there are such pain, mitigating circumstances you have to make that decision.  I came to the point the lack of use of my right leg, the relentless pain with no relief from meds, incontinence, all made me have the surgery.  Now, I'm detoxing from Fentanyl patches that my doctors felt were a great way to manage pain.  Avoid those at all costs - getting off of them is worse than anything you'll go through.  I agree with the post of getting a CT with Myelogram.  They're an irritating test but give tremendous information.  I also would get the advice of at least 2 neurosurgeons in addition to the ortho.  My boyfriend and I were so scared after being told I had movement we went ahead and scheduled surgery instead of a 2nd and even 3rd opinion.  I know you're in pain, god do I know that, but when it comes to opening up your back I would be sure to consult more than one physician.  Good luck.

[kslup]

I just want to add regarding your numbness. If you are begenning to feel numbness in your legs then your nerves are likely pinched, consider a CT scan with myelography (http://www.oispine.com/subject.php?pn=ct-myelogram-028)  to show if your nerves are pinched. My coworker had a pinched nerve in his neck and did not know about if for many years, his arm was going numb and he did not know why. He met his surgeon whom did this procedure and told him, it will only get worse and the longer you take your pinched nerve will just die off and you will completely lose function of your arm. He had surgery on the 21st and is looking at several weeks of recovery.. pain is one thing but extremities going numb is another... Take care!

[kslup]

Hi Hurt.. I  have a similair fusion to yours, L2-L5 fused and rods coneccting me from my tail bone to L5 or above. I had this surgery as a result of a car accident where L2-L5 literally exploded - almost 14  years ago. I was 15. As a result of the fusion i completely lost use of my right foot and most of my muscles in right leg. I had 9 weeks intense therapy in the hospital (there were otehr things wrong, hence such a long stay) and years of physical therapy. Now I walk with an AFO and lost my cane maybe 5-6 years ago. I am at about 85% I can do about everything I did before, but run.

I want to say once more this was 14 years ago, and technology has advanced greatly since then - my surgery took nearly 17hrs. But I did not have a choice. As with everythign in life, nothing is 100% sure, you have to do plenty of research and weigh your options. Take your MRI and get several opinions..  If you opt  for surgery, it will only be as good as the doctor so do your research, speak to previous patients - interview several docs. EIther way I hope everything will work out for the best, living your life behind a cloud of oxy is no way to live!  - Positive Thoughts!! (remember, your brain is a very powerful healing tool!)

[squirtatious]

Surgery has so many variables...its hard to say if its worthwhile and to go ahead with it. Will have wanted to try every conceivable other method first. Have u tried a spinal injection by a qualified dr? They have really benefitted a lot of ppl. Woulodnt hurt to rule all other methods out first as once u alter ur back through surgery, there's no going back. I really hope for the best for u and that ur situation turns itself around!! Take care

[Kalvin]

I'm not sure how long a 2-level procedure would take, the member that posted before me would know, he had a 2-level. Mine was 2 hours, I think, I don't really remember, it was a posterior approach there's more muscle resection with a posterior .  I was in the hospital for 3 days for my 1-level, with insurance company pressure, they don't keep you very long.

It's a big decision, no doubt, take plenty of time to think about it and do some research. Things can go wrong and there's alot of horror stories out there, you can read plenty of them here. In my mind, I didn't have a choice, spending the rest of my life on Oxycontin and Dilaudid and still in pain wasn't particularly appealing, I was your age.

You do need to get another opinion, a couple things don't make sense. Discogenic problems definitely cause low back pain and they can mimic radicular pain i.e. sciatic type pain but not as a rule. Bilateral leg numbness is usually caused by compressed nerves or canal stenosis. If you have your MRI report, you might want to take a closer look at it. It might be necessary for you to pay for another consult  out of pocket, but I think it would definitely be worth taking your scans and going and seeing another Surgeon.

Take Care

[squirtatious]

Hi hurt, sorry to hear about ur accident. I have spondylolisthesis and DDD which caused severe bilateral foraminal stenosis and significant biloateral root nerve compression at l5/s1. I was in an extensive chiropractic program called The Pettibon System which is a full spine reguvenation program. I had been in the program for 15 months before I began to slack off. It helped with getting 20% lordosis b ck in my neck and helped my back pain. I really regret slacking off on attending my program and doing my exercises at home as I began to have neurological symptoms in my legs resulting in bilateral pain and muscle weakness. My chiro told me he recommended me seeing a neurologist and neurosurgeon after seeing my mri. It took another 11 months before I could find a spine surgeon who didn't want me to "see a psychiatrist for a psychological evaluation" who would really listen to me and believe. An emg study showed acute and choronic l5/s1 radiculopathy. Feb 22nd of this year, I had a one level fusion with instrumentation surgery. Surgery was 6 hours, hospital stay 3 days, I was actually discharged against my will and sent home with low bloood pressure and oxygen levels. I had to wait til my 6 month appt to fuse more before beginning physical therapy. I was able to get in 1 session last month and lost my insurance. So, if anyone wants to share some helpful paraspinal strengthening exercises, I would be very greatful. I was on gabapentin for nerve damage pain in legs. Once my prescription is empty, I won't have anymore. I spent the first 4 weeks after surgery with no leg symptoms. Then the pain began again, and a month later, the weakness. At least I know my nerves are no longer compressed so for that I'm thankful!!:)

[squirtatious]

Hi hurt, sorry to hear about ur accident. I have spondylolisthesis and DDD which caused severe bilateral foraminal stenosis and significant biloateral root nerve compression at l5/s1. I was in an extensive chiropractic program called The Pettibon System which is a full spine reguvenation program. I had been in the program for 15 months before I began to slack off. It helped with getting 20% lordosis b ck in my neck and helped my back pain. I really regret slacking off on attending my program and doing my exercises at home as I began to have neurological symptoms in my legs resulting in bilateral pain and muscle weakness. Will post more in a bit, ph about dead lol

[Hurtmedic]

Thank you and everyone else for taking your time to respond to my questions. It is sad to think that we have all had to go through this but your stories and advice are very helpful. What all has your post op consisted of at that this point? How is your therapy going if you have gotten that far?

[Hurtmedic]

Yes the numbness is in both legs. I am very clumsy with them now as well. But one bright note, when I stub a toe its doesn't even hurt now! Bad humor.... They initially pointed out the herniated discs but claim there was no never impingement. The appeal of surgery is to see just how much better it can be. The disappeal is just how wrong can those guys be and how much can they do to screw me up? Do you know how long I should expect to be in the hospital post op or how long I would be under anesthesia for the actual procedure?

[thedon597]

Hi, my work career consisted of pretty much anything involving heavy lifting.  Occasional tweeks of my back here and there but would go to a chiropractor and get it taken care of.  About 4 years ago it started to get real bad but as I am stubborn/stupid or both I continued the lifting because I needed my job.  First Dr. I went to said I had degeneration of l4 l5.  I had 2 injections that didn't work.  He handed me a prescription for some anti-inflammatories and sent me on my way.  Needless to say I stopped seeing him.

Now, keep in mind my story is not workers comp.  

I finally saw the right Dr. but because of insurance reasons had to have many tests, including a discogram.  That was what let them know my l4 l5 S1, especially l5 was in bad shape.  I almost flew off the table when they shot the dye into l5.  Anyway, insurance approved it and I had a two level fusion 6 months ago.  I was told that I should probably never do the same job I used to.  So no more heavy lifting.  There are also the possible problems that can occur, but they should tell you all of this.  I have heard many success stories, mine is not complete yet.  Still in a lot of pain, l4 is fused completely but l5 is not coming along the way it is supposed to.  I need to wear an electronic bone stimulator for a while to see if it helps the fusion.  If it works, I should be free to start "normal" routines, but if it is not, I'm not sure what the next step is.  I'm remaining positive and will wait to see what happens.

It is a big decision, I can't answer for you but there is a lot you can do for research, this forum and the people on here are great.  Talk it over with your family and make sure you are sure of what you want to do.  Looking back, if I had to do it over again I think I still would.  Some people heal very quickly, some don't.  You are still young so your recovery might be quicker.

Whatever you do, good luck with it and make sure you let us know how it goes.  

Thoughts will be with you, and thanks also to all of the members of this forum who have helped me just by reading your experiences.

[Kalvin]

When you say bilateral numbness, are you talking about your legs? The post-op pain was bad, probably a little worse than prior to surgery. I started therapy approx 12-14 weeks after the procedure, I was scheduled to go at something like 6-8 weeks, but I still could hardly stand at that point and I was in a tremendous amount of pain. After about 6-7 months, I didn't feel too bad, and I had decreased my meds considerably. After a year I was fully recovered.

With your symptoms, you have to have a lot more going on than just annular tears. Keep an eye on this thread, I contacted a couple other members so they'll probably be posting sometime.

Take Care

[Hurtmedic]

My pain is about 60/40 back/legs.... I'm sure I do have some atrophy, but my main leg issue is they bilateral numbness. I have tried to explain the feeling to a few poeple but not sure i portray it correctly. They are numb most of the time and at the same time have a burning and aching.... oh well, anyway. How did the initial post op pain compare to your daily preop pain? My doctor told me If I proceed with surgery that I was looking at about two years for total recovery, well maximum medical improvement. How long did it take before you began therapy and how long til you felt like some similance of a real person again?

[Jolie217]

Hi there. I am new to this board as well. For starters, I too had a discogram and it is PAINFUL to say the least. I also had many epidurals. I didn't get hurt at work though, I herniated the L$ & L5 while tending to my kids. After a few years of wear and tear I wound up with sciatica which is also very painful. This is no joke and it does disrupt your whole life.
As far as you going back to work now knowing what the real issue is, can you go on with this pain you are having?
I was at my witts end until I finally decided that I couldn't live anymore in pain and had the discectomy along with a 2 level fusion. I had the first surgery in December, 2 rods and 6 screws later, along with the 2 level fusion. It was no picnic....after a few months of not being able to do much (February), I got hurt in the house- I tripped on my small dog and had to go back in to correct the hardware that was out of place in April. I am doing much better but not 100%....but unfortunately, I don't think I will ever be back to 100%. For the most part, I am better than I was before, it's just taking more time than expected. The last surgery I had to do, or I would not be able to walk.
I had complete deterioration in the L4 & L5 along with arthritis. It did get worse for me so I decided it was time. You need to take time and really think about it, only you can make this decision. Having a fusion is a lot more detailed than just going in for disc surgery. You have to change the lifestyle a bit until you can walk ok. My hospital actually gave a class on this surgery to let patients know what to expect post surgery. I wore a big brace for a while but it wasn't the worse thing in the world- I am actually glad I had it done. My surgeons were wonderful and so was the staff. I am not much older than you and I got through it. It's a matter of what's good for you.  Take care and lots of luck with making your decision.

[Kalvin]

Is your pain primarily in your low back or leg? Your extremely weak from the meds and pain, your muscles have probably atrophied a little, your neurological system's probably gone haywire, and you're probably severely out of shape. That doesn't mean that the amount you can lift now is the most you'll ever be able to lift.

The picture this Doctor paints is a very bleak one and doesn't necessarily reflect reality. That scenario is possible, but it's also possible for you to have the 2-level fusion, spend months and months in Physical Therapy and get back to about 75- 80%. I only had a1 level fusion at L4-5, but I had lost the entire use of my right leg, right before surgery walking was just about impossible. After a very painful and long recovery, 6 months of P.T. to learn how to reuse my leg, I was back to about 80-85%. Everybody's results aren't this good but they are possible. Just keep that in mind and get another opinion too.

I'm going to contact a couple other members who are in the recovery process right now, to post on your thread. They can share some of their more recent experiences with you and give you additional insight.


Take Care