Should I have an L4-L5 Fusion

[Rick]

About 6 to 7 years ago I injured my lower back by leaning forward and lifting a large weight improperly. Since that time it has been prone to re-injury, and I seem to have a relapse about every 6 to 12 months but occasionally shorter. The pain is primarily limited to the lower back, although sometimes I will have very mild numbness or very mild pain in my legs, but not always and it is never severe or really much of an issue. The lower back muscles lock up during these episodes and I cannot stand erect, sometimes for as long as several weeks. The longest period I have gone without re-injury is about 18 months. Recovery/rehab is varied and takes between 2 weeks to 6 months. After recovery I can do pretty much anything I want with reasonable care. During these times I lift weights and do Judo, but I am careful to protect my back, for example I do not do dead lifts or squats or do very much stand up work in Judo where I might be thrown in an uncontrolled manner. The re-occurrences seem almost random, for example several have occurred when I simply leaned over to pet my dog or pick up a sock.

MRI indicates that the L4-L5 disk is degenerative(It is black and shows a slightly less inter vertebral space). There is also a slight bulge posteriorly at this level. All other levels look completely normal. X ray during back extension (leaning over backwards) shows reduced space between the vertebrae posteriorly as opposed to anteriorly. Forward and side flexion

[Kerouackat]

I would hold off!!  I had 2 back surgeries on my lumbar spine, I belive the first surgery caused the second!  After the first surgery, I still had many of the same symptons in my right leg that I began with, I never had a backache before the first surgery, it was all leg.  They did a "partial laminectomy" which I believe weakened my back and less than a year later, I had a rupture in the same place with a piece of the disc resting directly on my sicatic nerve, again another "partial laminectomy" which did relieve the severe pain I was experiencing. Now, here is why I say hold off, I am now dx with MS, and I belive my first leg problems where of an MS nature, and I should have never allowed surgery, now I have extensive fibrosis, and am in pain, due to the scar tissue, and must wonder what symptoms at this point are MS or from botched surgeries.  Let me also mention that now, 10 years later, the last MRI I had on my lower spine still shows a herniation at the same place!!  So, I have no idea why I went through all that suffering for nothing!  Please wait, till you have exhausted all avenues!! And most of ALL, get a second opinion!!

[ellenleslie]

A related discussion, Should I have back surgery was started.

[mandy n]

Ive had 4 lots of back surgery. The first was a lamenectomy - L4/5 , another for L3 , a discectomy and 5 months ago i had a spinal fusion - anterior and posterior. I deceided to have this done -the pain was terrible and the sciatica was ruining my life. Im a mother of 3 kids and i felt like i wasnt there for them - things like bathing them , taking them shopping or to the park - my husband had to do most of it himself.  I was so scared before the fusion - i nearly didnt go through with it because of so many scare stories. My advice is - everyone is different and we all respond to treatment in a different way. Just because someones surgery didnt work doesnt mean that yours will.  I was in theatre for 12 hours - i was in intensive care but the pain wasnt as bad as i thought it would be. The worst pain was actually in my arms - because i had to lie on my front for several hours while they operated on the back - my arms were above my head and the pain was awful - i needed weeks of physiotherapy.  I went back on the main ward 2 days later - i had a morphine drip in place -- and i had an epidural for the first 2 days - and that really helped me - i didnt have it with the other ops - and they werent "big" ops like the fusion was -and yet there was alot less pain. I was up walking - slowly - the next day - i needed a fitted body brace for when i was mobile to protect the spine - i wore this for 2 months. ( i hated it!!).  I came home after 8 days - i was told id be in for 2 weeks so i was pleased to get home. I rested for 5 weeks - my husband took time off work - he wouldnt let me do anything at all!  Now - 5 months later im returning to work - a pysical job in the prison service -i get no pain - maybe a bit stiff at night but im feeling fine. I need regular x-rays but thats ok. Ive beed like this now for about 3months -its took 4 ops to get me at this stage - some may say im mad to even consider so much surgery , especially as the first 3 didnt really work. ( a pregnancy was the cause of ops 2, 3 ).
I say  - if your pain is causing you distress and youre exsisting - not living - consider the surgery.
Good luck whatever you decide. Love mandy x

[keith]

i had L4,L5,s1 done may 17 2000 and it releived a lot of pain and numbness but my last flex xray 4 days ago showed i cracked one of the cages in back and am scheduled to go in february to correct it and complete the 360 on my back.the doc is going to put 4 screws,one metal rod and abone graph from my origional site in,consulting with other doctors to find out if he needs to put a metal plate over that.but all in all mine went very well.and i knew after the first surgery i might have to have a second.i had the same problems as you but i was dealing with this for 12 years until jan 10 2000 when one of the disks exploded the other ruptured,and still have one bad disk left in my back no problems with it so far.some people come out fine with no problems and others have complications.

[Jack]

I HAD L1-L5 SPINAL FUSION IN MAY, 2000. I AM 56. THE RESULTS SO FAR HAVE BEEN GREAT. I HAVE UNDERGONE STEADY INCREASES IN EXCERSISE SINCE COMING HOME AFTER 1 WEEK. AT THIS TIME I AM DOING 45 MIN ON A TREADMILL WITH 7% INCLINE AND 20 MINUTES WEIGHT LIFTING. ON DECEMBER 20, THE DOCTOR SAID I COULD RESUME ALL NON IMPACT ACTIVITIES. SINCE I AM AN AVID GOLFER, I HIT SOME BALLS INTO A NET. THE RESULT WAS 80-90% OF A FULL SWING WITH NO PAIN EITHER DURING THE SESSION OR ANY TIME AFTER.

[Rich Tarangelo]

I concur, had a discectomy in June, reherniated in July, had spinal fusion in August, am in constant pain. Don't do it.

[boofy]

In the past year I have had 2 spinal fusions. I have spondolythesis on L5-S1. In January 2000 I had anterior/posterior lumbar fusion on L5-S1. I felt GREAT! 3 months into healing I began to feel spasms in the lower back, went in for x-rays only to find out that the front of my spinal fusion was collapsing. I had rods and screws placed in back and the disc in front was removed and packed with bone from a bone bank. (the back was fused with graft from me) The back was healing and the front with the donor bone was collapsing. In August of 2000, I went back in for a revision due to the front collapsing, this time grafting bone from my hip and inserting a cage. I feel great and if need be would do it all over again if I had to knowing that there can be relief from back pain. Search around for a good surgeon, it took me 4 months before setteling with mine. I am thankful that everything worked out the way it has. I just wanted to share a success story about someone who has suffered as you all have. Good luck to Rick and everyone in whatever your decision is.

[Cheryl]

To Rick, dm5940, terry, maggie and all others who responded to Rick's original posting . . .   I hope the following information lifts your spirits.  I have come across two articles so far that address the potential use of artificial intervertebral disc.  There are trial studies going on NOW.  According to the information provided, these artificial discs could be used in both persons facing surgery for the first time as well as for persons who did not have a satisfactory outcome from spinal fusion.  One article provides a contact person if you want to know more about one of the studies currently underway in the U.S. Other names are mentioned in the articles that may give you the ability to extend your research concerning artificial discs.  Apparently results of one study were already presented at a meeting of the Congress of Neurological Surgeons in San Antonio, TX.  You may read these articles at: http://www. spine-surgery.com/SSPSC/discreplacementsurgery2.htm and at HealthSCOUT.com, (under New Articles do a search for "Spines of Steel").  Please let the rest of us know what you find out.  Perhaps "CCF NeuroMD" would care to contribute his knowledge/comments concerning these artificial discs.

[Cheryl]

To Rick, dm5940, terry, maggie and all others who responded to Rick's original posting . . .   I hope the following information lifts your spirits.  I have come across two articles so far that address the potential use of artificial intervertebral disc.  There are trial studies going on NOW.  According to the information provided, these artificial discs could be used in both persons facing surgery for the first time as well as for persons who did not have a satisfactory outcome from spinal fusion.  One article provides a contact person if you want to know more about one of the studies currently underway in the U.S. Other names are mentioned in the articles that may give you the ability to extend your research concerning artificial discs.  Apparently results of one study were already presented at a meeting of the Congress of Neurological Surgeons in San Antonio, TX.  You may read these articles at: http://www. spine-surgery.com/SSPSC/discreplacementsurgery2.htm and at HealthSCOUT.com, (under New Articles do a search for "Spines of Steel").  Please let the rest of us know what you find out.  Perhaps "CCF NeuroMD" would care to contribute his knowledge/comments concerning these artificial discs.

[pablo penaloza mac master]

Do you think that multiple sclerosis is a disease that involves a cross/reaction between viral proteins and myelin.
PleASE I need an answer,I have a hipothesis...

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[Linda]

Well you all have pretty much made up my mind for me.  DO NOT HAVE SURGERY!  I've been diagnosed with advanced degeneration  with spurring, extreme arthritis, and herniation with spurs on C-3 thru C-7.  My symtoms are constant aching in upper back, across shoulder and down right arm, with numbness, and muscle cramping.  I do not have excruciating pain though.  Rest and heat helps me along with aquatic therapy.  Mechanical traction worsened everything.  My orthopedic surgeon recommends "extensive" surgery to repair/rebuild my neck.  I have been going half crazy not knowing what I should do, so I looked for a good informative web-site.  I am so thankful.  However, I will be having a 2nd opinion just for my own peace of mind.  I hope all of you feel better soon.

[regina]

I had L4/L5 BAK Interbody Fusion System performed in Leonardtown, MD in March 1999 (four cages in all).  I am in more pain now than before surgery.  I wore a bone stimulator for the last three months (July, August, September and part of October 2000) which was unable to stimulate bone growth around the cages.  How am I supposed to continue working with this kind of pain all day--- I have burning in the lower back, pain in my right hip and down my right leg.  Anyone else out there with similar problems?

[Tammy]

Dear Rick,

I had the L-4 L-5  surgery, two of them  in 1997.... HAVE the surgery....

Its 2000 now, and Of course ill never be 100% again, but.
The pain is a lot less...

I had a titanum disk put in, then had to go back in  for rods and pins.  I was 36.  I am 41 now, I am glad I had the surgery.

The pain was so unbearable.  I have NO pain, but I do feel less
motion in my back  and stiffness. but when I am moving about, it gets better  thru the day...

as far as going back to your old life, sure you can, its all in your mind and attitude Rick. My fusion is solid, I am fine,
I can walk, run, do whatever I want to.  :)

Tammy..........

Please write me , would like to know how you are...

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good luck

[Darla]

since 92 i have had 5 fusions to the l4l5s1 areas. none of the fusions have taken and i had a nice bonus fom the fusions, a total of eight tears in the spinal cord.  one of these lasted 13 months causing me to black out any time  i bent my head toward my chest and the notorious dura tear headaches were always present.i have also been dx with DDD and had decided i would never have back surgery until i could not possibly get around.  well i came to just that point 8 years ago and have not been much better since the five fusions and three spinalcord repairs.  i am in constant pain, am permently disabled,have a 5 lb. lift limit.  not to mention i have to fight the doc. for pain meds cause he

'don't want me to get hooked'!!!!

[amrit lal sharma]

mr imaging of the dorsal spine was performed and high resolution
t1 and t2 weighted serial sections were obtained in the sagittal
and axial plane using phased array surface coil on a 0.5 tesla scanner.t2 weighted sagittal sequence of lumbar spine was also obtained
the study reveals mild degenerative changes evidence by small bony emeburnations at anterior and posterior vertebral margins.otherwise vertebral bodies are normal in size,shape,alignment and signal intensity.
intervertebral discs are normal in height.
mild ventral ridging is seen in thoracic region due to posterior
osteophyte and bulging discs.

no significant neural compression is seen.

the thecal sac is normal and csfdemonstrate normal signal intensity.

spinal cord appears normal.
no intra spinal mass of pre/para vertebral collectionseen
on screeing lumbar region degenerative changes are seen in l5-s1 intervertebral disc as evidence by reduction of bright signal intensity on t2 weighted sequence.small posterior annular tear is also seen.

[amrit lal sharma]

mr imaging of the dorsal spine was performed and high resolution
t1 and t2 weighted serial sections were obtained in the sagittal
and axial plane using phased array surface coil on a 0.5 tesla scanner.t2 weighted sagittal sequence of lumbar spine was also obtained
the study reveals mild degenerative changes evidence by small bony emeburnations at anterior and posterior vertebral margins.otherwise vertebral bodies are normal in size,shape,alignment and signal intensity.
intervertebral discs are normal in height.
mild ventral ridging is seen in thoracic region due to posterior
osteophyte and bulging discs.

no significant neural compression is seen.

the thecal sac is normal and csfdemonstrate normal signal intensity.

spinal cord appears normal.
no intra spinal mass of pre/para vertebral collectionseen
on screeing lumbar region degenerative changes are seen in l5-s1 intervertebral disc as evidence by reduction of bright signal intensity on t2 weighted sequence.small posterior annular tear is also seen.

[Tom Phipps Aug. 27, 2000]

Dear Rick,                                                      Sorry to hear abour your back.It is one of the hardest thing to fix,from what I hear. I myself have had gone under the knife and to tell you the truth it DID NOT work for me either i have been in pain now for three years. my family doctor as got me on so many pills that it is a joke. My family I bleive as got the worst of it. My wife hates to see me in so much pain, and there is nothing she can really do to help me,except to be there by my side and try to help in any way she can,but she doesn"t really understand just how much pain i am in. i love my wife and family but it is a shame they too have to share the pain in a different way. As far as having the surgery that will be your call as you may well know. The best of luck to you Rick and please be understaning to your wife and family they to have to suffer, just in different way.

[patricia]

Gray

[Life with L4/L5 Fusion]

My husband is in great pain with his 8 year post spinal fusion. Recently he has won his social security case but still must live a life in pain.  What are all of you doing with your lives with L4/L5 fusion pain?  What seems to help is another surgery does not?

[R Register]

I had back surgery L5 S1 in January of 1999. I had serious defeciencies in my right foot, ankle and leg. I was in constant pain. It hurt to stand, sit or lay. I was to the point I could not function. I opted for surgery. My surgery was very successful. I have felt great and would tell folks to be cautious about surgery but, if the pain is severe enough, go for it! It helped me.

[lane]

I'm glad to see the consensus re: back surgery is Against the operative options!  I'd like to share our story: my husband had pain off and on in his lumber area for 15 years...infrequent visits to the chiropracter always made him better and life went on.  However, back in summer of 1997, his pain became worse and constant.  He was forced to give up golf, slept poorly and walked slowly and with a list;  After numerous Doc's, diagnostic testing,etc...the works, he was told he needed L4-L5,L5-S1 fusion and discectomies x2.  He was truly unable to make a logical choice due to his pain levels, but as I'm a RN, I requested that he see another Neuro MD for a 2nd opinion.  I was reassured that that wasn't necessary!!!  I asked TWICE for this;however, my husband wanted to "get it over with and feel better"...so on to the Orthopod we were guided to who, of course, agreed to the need for immediate surgery. Michael hadn't had any nerve blocks,appropriate meds prescribed,etc. prior to seeing the surgeons involved.  However, they believed that he had already tried "everything" and conservative therapies had "failed".  Well, there had been NO conservative therapies since this latest onset of pain!  Anyway, he went ahead with surgery, against my wishes, and now he is permanently, totally disabled:(.  The MD's put in the hardware and the screws broke thru the pedicles and cut into the nerves, so that he woke up with severe left leg pain. (He went to surgery with back and primarily RIGHT leg pain!)  
So....always, alwaays get a second and third opinion before considering spinal surgery of any kind.  As this forum demonstrates, most times the patient is worse off than before the surgery suggested by these surgeons!

Stay well and research your Doctors well!!

[Tiffany Lauderdale [email protected]]

My husband had L4-L5 surgery August13th,1999 he had 4 screw and 2 plates put into his back..His L4-L5 was sliding forward which is also known as spondolythesis cause by birth.. His doctor didn't try to do anything except jump right to surgery which other doctors could not beleive that his doctor jumped to surgery like he did either, but after my husbands surgery he nearly went into shock he was in so much pain..Before his surgery and even after his surgery he was on so much pain medicine and was eating them like candy he was on anything from lortab 5 and 7.5,oxyicotins and you name it we have any pain medicine there is in our medicine cabinet..Now even after the surgery he still has pain in his legs and some nerve damage and is now on the strongest pain medicine that you can take by mouth form which is Methadone 10mg and it can cause death if you reach so many milligrams.. The methadone makes him sweat bad, have hot flashes and etc.. We have a 18mth old doctor and he can't pick her up hardly or anything..Now my husband is seeing another doctor and they are doing Epidural Blocks to try to reduce the pain, but it has not seemed to work any.. I would not have surgery if I was you my husband has been like a baby to take care of he can't do much of anything and that bothers him cause he can't help me do anything such as lifting or etc. He is now on disablity at the age of 22.. So surgery isn't all it's made out to be.. Well I wish you the best of luck in whatever you choose to do.. Take Care.. Tiffany

[Barb]

Rick,
      I wrote to this forum in May, trying to deciede if I should go threw surgery to have one fusion and a possible of 2. I have lived in pain for 2 years everyday and before that just once or twice a year for 10 years. I had a mri showing deg. disc in two of them 2 years ago, did the thearpy and cortizone shot, nothing helped. I got tired of feeling on a good day that I just kicked hard in the tail bone and bad days I could hardly get out of bed, and 2 years with hardly no sleep because I would have to roll to my other hip or back every 20 min. They did another mri and it showed more damage and the vertabries were hitting each other. I got the best neurosurgen in our area and went for surgey. It's been only 6 weeks but so far I feel GREAT!!!!! I get 8 hours of sleep, the pain in my lower is gone and now I just have a little from where I was cut. After reading everyone's response I hope and pray my pain doesn't come back. I had not had any relief from pain for 2 years, now I feel like a million bucks. I have a freind that had it done 3 years ago and she has no pain just stiff alittle in the cold months. I hope you find something that works for you, Take care

[Christine Dalman]

I am so sorry for your pain. I to got to the stage where I had enough.I have degenerative discs L3L4L5 I had L4l5 fused March 9 2000 and I seemed to be doing well then therapy kicked my butt now I have been told there is nerve damage on the left side and have to go for a new mylogram yuk I dont know if they can repair the damage to the nerves but the left leg has more pain now than befor. I am told the surgery was a sucess but it may not have done me any good. My advice is dont do it unless you are in bed 24/7 and crying your self to sleep.Because thats what I am doing a lot of now after the fusion.Prayer is my salvation and my faith he will not give me more than I can take .Good luck in your decision