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

[lanua]

Remember that one surgery will leave you open for more surgery.
Unless you really cannot tolerate the pain..don't have surgery
as it will weaken other areas of your spine..that is my experience.  I have degenerative disc disease 3 herniations, 1 surgery and the surgery was NOT successful and left me prone to having more.  In addition i also have a complete herniation at l5S1...i will live with the pain.  think about it.

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RICK- I would advise to hold off on surgery as long as you can. You stated that you reoccurances are random and you can go a long period without a flare-up. My back condition went on for about 5 years with random occurances that would put me down for 2-3 weeks. Then I would be ok for another several months. The next 5 years were different. I was pretty much in unbearable pain all the time. My doc had talked to me about surgery, but knew I wasn't ready. I was hospitalized several times, and finally a severly ruptured disc did me in. I had a Discectomy and Laminectomy in 1996, and continued to deterioriate until I had a spinal fusion with BAK implants in 1997. App. 8 hour surgery. I was in a body brace for 4 solid months. It has been app 3 years, and IA am stil in constant pain. I was hospitalized 2 months back for severe pain. Doc now wants to do another fusion with BAK on L5-S1, The last surgery was supposed to make me better- why would I do it again? Every case is different- but if I had to advise you- I would say- if there's any possible way to get by without surgery- do it. Surgery is certainly no gaurantee that you will be better.Also- if you are not in bed more than you are out of bed, you may want to work on conservative methods as long as you can. P.T., Exercise, maybe a chiropractor ( I went to one regularly for the first 5 years) medication, rest, etc.)Just be very careful- spinal surgery is very, very difficult with a long, long recovery. I really don't think you could go back to extreme Judo and lifting after a fusion with implants, as you have to be very very careful. I am 3 years post-op, and still am not supposed to lift anything more than 10 lbs. good luck!

[Rick]

dm5940
Thanks for your input. What was your situation like before the surgery? What kind of fusion did you get anterior or posterior? What is the problem now? Thanks much.
Rick

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do not have surgery it might be worse, i had l4&l5  worked on,i am in worse shape now can not do nothing.so think about it first'

[CCF Neuro[P] MD, RPS]

Dear Rick:

I am sorry to hear about your back.  I am not a big fan of surgery.  When it is the last choice, then one has to undergo the knife, or when there is mechanical damage and pain (such as in a radiculopathy).  My feeling is to get vigorous rehab with PT and rehab strengthening the muscles and learning how to do all the things to promote better spine alignment in lifting and everyday living.  So, my opinion would be to try this route initially.  Read the postings and listen to what people have to say.  The MRI you report is not indicative of severe degeneration.  But in the end, weigh the pros and cons, get a second opinion (especially from a rehab specialist) and then make a choice.

CCF Neuro MD