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L4-S1 Fusion - 10 weekss - my journey

Below is an overview of my L4-S1 spinal fusion, to give other people preparing for same an idea of the process and the recovery.

15 Oct 2018 Monday

See Osteopathic Surgeon who sends me for MRI. Results are conclusive to him: “Spondylolysis (crack or stress fracture in one of the vertebrae) with associated grade 1 spondylolisthesis (vertebra slips out of place) of L4 on L5. Disc degenerative disease of the lumbar spine with associated radiculopathy (pinched nerve or neuropathy resulting in pain, etc) at L4-L5 and L5-S1.”

Surgery urgently recommended: Spine fusion (arthrodesis) 2 levels L4-S1. Insertion of spinal implants or instrumentation. Bone grafts. Spine surgery (Laminectomy). Repair of nerve (neuroplasty). Laminotomy with decompression of nerve roots including partial facetectomy, foraminotomy (enlarge passageway where spinal nerve exits spinal canal) and excision of herniated intervertebral disc. 

Authorisation obtained from Medical Aid. (Thank goodness for medical aid as the entire exercise will eventually cost in the region of $35,000. )

Chest X-ray and blood tests done pre-op, standard routine.

16 Oct 2018 Wednesday

Check in at hospital at 05h00. Enter surgery at 08h00. Anaesthesiologist connects me up to drips and heart (chest electrodes) monitor and blood pressure monitor. (My) surgeon (osteopath) works with a neurosurgeon. The one focuses on the “bones” and the other focuses on the nerves. Another team member sucks up blood during surgery and this is put back into the body afterwards. Wake up in Recovery room at 11h00. Pain. I’m given a morphine trigger in my hands and told I can manage my pain by hitting the trigger every 5 minutes, or longer intervals if possible. Spend night in ICU. 5 minute intervals felt like 5 hours - couldn't wait for another pain relief "hit".

Post-op:

Week 1 -2 : Pain is bad. Physiotherapist shows and helps me move, do exercises, walk with walker. Wear brace when out of bed. Exercises and walking to be done every day, several times. Regular strong opioid painkillers.

Week 3 - 4 : Pain is under control, but makes sleeping difficult at night. I became very weak, which is obviously counterproductive and makes a slip-up more possible. Lying around becomes depressing. Still taking opioid painkillers.

Week 5 - 6 : A new issue occurs - restless legs & burning feet (mostly at onset of nightfall), numbness in right foot & toes. Makes resting and sleeping more difficult. Apparently this is “normal” and happens as a result of surgery interference with sciatic nerve that now starts recovering. Mostly weened off opioids onto paracetamol.

Week 7 - 8 : Feeling stronger, sleeping better, but lower back is still tender. I did a 12 hour long-haul flight at the end of week 7 and the only way I coped was because I had a fully reclining seat. DO NOT recommend anyone in a similar situation flying in an economy seat. Perhaps only after 10 weeks post-op.

Week 9 - 10 : Walking and doing general activities with confidence. Lower back still needs rest by day end.

Conclusions

1. I had no option, I really needed the surgery or I would have had lower back pain and sciatic pain for ever, which (according to doc) would have become worse until I lost feeling in my leg/s.

2. The procedure was PAINFUL during the first two weeks post-op. But, the heavy painkillers helped.

3. The onset of restless legs and burning feet was disconcerting and irritating, but this too passed after week 4 or 5.

4. There were bouts of depression, which is normal apparently, be warned and confide in your partner or friends.

5. I am only ten weeks down the road, but the immediate future looks good. I have no sciatic pain and no (original) lower back pain. But, my back is still sensitive as the fusion heals and the lumber heals and the muscles learn to rework.

6. Given the option to do this procedure knowing what I would go through , I would do it again, as the end result is worth it. BUT, I don’t want to go through it a second time. So, to anyone out there, who has this surgery procedure, be VERY careful post-op not to damage or hurt yourself! You don’t want to go back to theatre for re-work! On day 4 post-op when I was at home, I forgot I was wearing my pressure stockings (they go over the feet as well) and started walking downstairs (smooth cement) and almost slipped! Fortunately, I was holding the railing with both hands. Had I fallen, I would have been in deep deep trouble. Advice - think twice before doing anything or making any movement.

7. I have read that recovery works like this: 6 weeks for bone fusion to get through first stage, initial binding wispy growth, 3 - 6 months for bone fusion to get through second stage, fusion gets strong and solid, 12 - 24 months for bone fusion to get through final stage, where the bone “does a tidy up” of the work it’s done. There is a study paper done by a team of doctors available on the Internet for people who want to read the serious technical jargon.































8. GOOD LUCK with “your” journey and drop me questions and I’ll give you my own experiences. But remember, everyone has different experiences and can heal differently. Anyway, that’s what I have read on multiple sites. These sites have been VERY helpful when days were dark and I reached out to see what had happened to other people in similar circumstances. - Terence

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Comments

  • Thank you for your post.  I had synovial cyst removal//bone removal on left side on 6.28.18 and then on 12.13.18 had synovial cyst removal on right with L4L5 spinal fusion.

    Reading this has helped to see the different phases you went through and is normal.

    How are you doing?

  • I’m doing ok now, but 2 weeks ago I overworked my back doing DIY on the roof. Big mistake. Pain for 10 days. ALWAYS remember to think twice before doing something and don’t hurt back. I forgot my own advice. Thought I was superman. ;-)

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  • I to am looking at that same surgery and have an appointment with a surgeon next week. I am so torn about this, I am not working any more and have limited myself to what I do and am able to tolerate pain much better but... my back is not stable along with your diagnosis I also have spinal stenosis. I am 55 years old and am 7 years out of bilateral knee replacements due to arthritis and now this, that surgery was hard to decide on this one seems to be a harder decision. 

  • Thanks for sharing. Looking at the same surgery. I already have numbness and weakness in feet and legs. I like your timeline tracking of your thoughts. Not looking forward to any part of it. Do you find your motion severely limited, now, after fusion? 

  • smartens162smartens162 Manitoba, CanadaPosts: 446

    I am 2 weeks post-op from MIS TLIF at L5-S1.  The last 2 days have been horrible with leg/foot pain, I recognize it as nerve pain.  I am clinging to the hope that this is temporary, and a good sign that the nerves are still alive and learning how to function properly again.  I take Amitriptyline 40-50mg and it is to target nerve pain.  If this hangs on too long, I will ask for a stronger RX.  I used gabapentin a couple of years ago, and it was effective for nerve pain, but I had severe depression as I weaned off of it.  Despite how awful the nerve pain is now, overall I feel optimistic.  Thanks for sharing your experience so far

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  • Your post was very encouraging and useful to me.  I had a L4-L5 fusion in October 2018 and my recovery seems similar but much slower.  Can you provide the reference for the "study paper" you mentioned?    Regards. 

  • Yes, the nerve pain can be bad.  I had the same surgery except from L4-S2 due to grade 3 spondiolethesis.  I let mine go too long and have permanent nerve damage.  Be sure to share what is going on with your dr.   During my first surgery they used a tricyclic antidepressant to help with the nerve pain and it worked wonders but I had a burst fracture at T12-L1. During the 3rd surgery at L4-S2, they used a combination of slow release morphine and low dose Valium to get me back up and moving.   Ironically the more I was able to move the less the nerve pain.  The worst nerve pain I ever had was when the spinal cord woke up and I thought the bottom of my feet were on fire.  Talk with your health care provider as some pain represents nerve reconnection while other pain can be due to more serious issues - which only your health care provider can distinguish between.  

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