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L5/S1 fusion for DDD, fracture, & spondylolysthesis?

StitchGnomercySStitchGnomercy Posts: 64
edited 06/11/2012 - 8:49 AM in Back Surgery and Neck Surgery
A bit over two years ago I was diagnosed with a fracture of the L5 spinous process, degenerative disc disease in the L5/S1 joint, and a grade 2 spondylolysthesis. The ortho I was seeing advised me against surgery unless I started having more severe nerve problems. He said I was too young for surgery (I was 28 at the time, now 30) and that I would probably have to have the next level fused later down the road (he would do ALIF if that makes a difference).

Fast forward two years and I'm having much more severe pain in my back and my legs, along with weakness, parasthesia, and proprioception issues. I use a cane most of the time, with part time wheelchair use because it decreases my pain. My hesitation with the surgery is that I also have hormone deficiencies that can cause bone density issues later in life, even with proper replacement....from what I can tell, my risk of pseudoarthrosis is decently high.

What do folks think....should I still pursue surgery? I know that this is probably not going to lead to be getting back into doing triathlon or kickboxing or powerlifting (activities I did before the fracture)....but I can't figure out if going under the knife would actually make my quality of life better :-(
1/16/2013 Minimally invasive TLIF with rods, screws, and cage on L5/S1 joint to treat grade 2 spondylolysthesis, pars defect, degenerative disc disease. Dealt with chronic pain & nerve issues since at least 2007.


  • SpineAZSpineAZ WiscPosts: 1,082
    Spondylolisthesis means the level diagnosed is unstable and can move forward. I did have surgery when it reached Grade 2-3 and was experiencing symptoms similar to yours. Unlike surgery for disc problems, fusion surgery for spondylolisthesis serves to stabilize that level so the vertebrae can not move any further. I was very young when they did L5-S1 (1987) and they didn't use any hardware so I did not fully fuse, but I didn't find this out until 1993. He tried to fuse L5-S1 but my L5 vertebrae wouldn't take the screws they use so I woke up with L4-S1 instead.

    L5-S1 is the lowest level they fuse. And it's quite common. It's possible in the future you may need further surgery but much depends on your individual circumstances. There are some that do but many who don't. They have success, and if they've been here on the board they tend to go back to their life and cease posting here. So don't let it worry you that many of us have had a few procedures, we're the ones that stick around to talk and help others.

    If you take care of your back you may be one of the ones who has success and needs no further surgery. I had a fusion L4-S1 in 1993 @ 27 and did well for 17 years until L3 ended up creeping forward( had spondylolisthesis at that level). I had no choice but to do the surgery to stabilize it. I had it done L3-S1 2/2010 @ 44.

    My case is a little different as I have very lax ligaments and tendons which causes joints (spine and other) to move too much and thus have had surgery on feet, knees, lumbar spine, and cervical spine. Thus I have many problems that have led me to many surgeries, so don't let my experience scare you. I'm an orthopedic nightmare from my neck to my toes.

    You say you are unsure of how it would improve quality of life, but if fusion surgery can stabilize that area of your back you could have significant reduction in pain and symptoms. However the longer you have the symptoms (numbness, tingling, nerve pain) the more difficult it is to predict how well you will recover. Nerves heal very slowly so these kind of symptoms need to be addressed as soon as possible. My prior spine surgeon, when seeing my symptoms and MRI, said he'd dismiss me from care if I was not interested in surgery as my left arm was increasingly weak and very painful from nerve "zingers" down the arm. I wish I had acted faster on that one!

    When I had my surgery in Feb 2010 (as with all my surgeries) I tell my surgeon to fix anything he finds in there even if it meant fusing above L3 as I wanted to reduce the chances of doing more surgery. I luckily did not need more than he planned.

    Get a few consultations with some Orthopedic Spine Surgeons and Neurosurgeons and pick the one that you feel has the best plan of action for surgery, future care, etc.

    And if you are in chronic pain please be sure to ask your doctor for a referral to pain management physician. It can be a challenge to find a good one so a few consultations may be needed but my PM doc and his practice are awesome.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • I think SpineAZ said it very well :)

    If you can,I would go get a second opinion from a NS and maybe another ortho before you decide. If you are already using a cane and a wheel chair I wonder how far your problems have progressed. Nerve damage is a bad problem that you don't want to have (that is why I like the NS they seem more concerned about the nerves).

    I had grade 3 retrololisthsis before my PLIF. I have a great NS. He actually found/ diagnosed my problems when everyone else missed it. I had always had "back problems" but suffered along. I went through almost 2 years of treatment before my PLIF and many doctors. I wish I hadn't wasted so much time and money. My low back was much better in 8 weeks following the fusion, 11 weeks I was back to work. I think at 6 months out I was fully fused and 90% better, 100% of the time. It is a brutal surgery and recovery. I hurt much worse after the surgery but I got better and better every day (then my neck went and then I was in an auto accident now I am looking at my options again). But my low back still feels so much better.

    Happy New Year and Welcome to Spine Health >:D<

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