OT Lumbar Fusion

[.RJ]

Originally Posted by makoti

Your back is a mess.

I heard somewhere, and I dont recall where, that everyone's joints and body is a mess as they age - you dont expect your face to stay young, why expect your spine? I think unless you have many years of imaging history to see trends, its hard to look at a snapshot in time and discern whether things are good or bad or getting worse.

[makoti]

Originally Posted by .RJ

I heard somewhere, and I dont recall where, that everyone's joints and body is a mess as they age - you dont expect your face to stay young, why expect your spine? I think unless you have many years of imaging history to see trends, its hard to look at a snapshot in time and discern whether things are good or bad or getting worse.

No. There is a very clear difference between a spine that is "normal" and one that is in bad shape.
The problem is that simply having discs that are squished, a cord pinched, or other issues doesn't mean that's the cause of the problem. I've seen people with textbook looking spines that could barely move and others with multiple disc protrusions who were in for follow-ups with no issues.
Having a history of scans does help point to what the issue might be, but you don't need them to tell that there are issues.

To your other point, I once had a knee scanned and asked the Rad to read it for me. I asked if she saw any tears.
"Of course I see tears. Everyone has tears. You could scan probably anyone in the hospital over 30 and we would find tears. It's not that there is a tear, it's where, how big, how recent. And in that scope, I don't see anything"

[kramnnim]

My wife had (has?) scoliosis and had her spine fused at 16-17. I think it’s the whole spine. At 20-21, the steel hardware that had been left inside caused a very bad infection, she had to have her back cut open again to have the hardware removed. The cut was left open for multiple days with drainage hoses, and she was on antibiotic infusions for weeks afterwards.

That was almost 20 years ago, she hasn’t had any notable issues since then.

[StayingUpright]

Originally Posted by .RJ

Unless there are structural problems in the adjacent joints I dont know why it would cause more fusions.

And in your 40's, you have easily 30-40 more years active if you're fit and riding a lot now and thats too long to put off not being in pain or limiting yourself IMO.

The surgeon’s explanation was it would put more stress on the joints above and below the fusion. Like if you fused the elbow, you would use your wrist and shoulder much more. And I would still have enough good years ahead to wear out the discs above and below. But after 2 microdiscectomies I’m not in a hurry to have any more surgeries.

A new business moved in nearby that looks promising. You go in and they give you a stretching plan, then they help you actually stretch. I can barely make a slight twist. One leg doesn’t work well from the nerve being pinched too long passing through the L4/L5. Mostly just trapped in the vicious cycle of not moving because it hurts.

This could be another thread, but I’m also curious to know if the bike choice changed for anyone. I’ve become sensitive to small bumps much more than thr big bumps, with low frequency vibration the biggest issue. I completely lucked into a Seven that fits perfectly, it feels good even with its little 25mm tires.

[krooj]

Originally Posted by StayingUpright

The surgeon’s explanation was it would put more stress on the joints above and below the fusion. Like if you fused the elbow, you would use your wrist and shoulder much more.

Adjacent Segment Disease - one of the reasons why artificial discs are preferred if possible.

[buddybikes]

Originally Posted by krooj

Adjacent Segment Disease - one of the reasons why artificial discs are preferred if possible.

this is only done limited circumstances, you have no major joint disease or compression on the nerves of your spine. (which exactly what IS issue for most of us older folks)

[htwoopup]

Originally Posted by StayingUpright

A new business moved in nearby that looks promising. You go in and they give you a stretching plan, then they help you actually stretch. I can barely make a slight twist. One leg doesn’t work well from the nerve being pinched too long passing through the L4/L5. Mostly just trapped in the vicious cycle of not moving because it hurts.

I am not a doctor so…but I went to the new opened up “stretch lab” near our apartment. Loved it. Signed up for multiple times a month. Went for 2-3 months. Thought it was the best thing I ever did other than cycle.

But then one day I literally couldn’t walk. That is when I discovered (or the doctors at hospital for special surgery discovered) that I have L4/L5 compression and spondy something with a bulging disc and the nerve is getting crushed. They said do not stretch anymore because of where some part of something is it will only mess it up more. Did some epidural shot and a 14 months later about to get another (after stupidly tossing my 45 pound grandson in the air). If that doesn’t work then surgery.

But my point is they told me don’t stretch. And when I told Stretch Lab about I wanted to just hold off a month they were like oh no we will just refund you not suspend it. So, not sure the stetching is the best idea and maybe you should talk to your dr/pt about it.

[meyatt]

Just thought I'd offer a counterpoint — I was in a car accident several years back when I was 19 (rather, that is to say I was hit by a car while biking) and fractured three vertebrae in my back. The fractures healed without surgery but, I was left with constant pain in my low back for the following nine or ten years.

I tried a lot of physical therapy, exercise, stretching, injections, nerve ablations, Gabapentin, Cymbalta, several other things without much success or relief. I was very pursuant of surgery thinking it was the only recourse, but like many people my MRI was kind of ambiguous about if that was assuredly the issue. It showed deterioration around L3 to S1, but it was explained to me by more than a few surgeons since they don't have a "before" photo, it's often difficult to tie these directly as the source of pain. You can take the same MRI of 100 people and half will present with the same kind of imagery, but they won't have pain. The imaging is just not as conclusive as, say, a broken bone.

On a lark, I saw another physical therapist at a friend's recommendation who instead diagnosed me with SI joint dysfunction. He was quite patient and explained that while I was great at following the PT I was given, it basically wouldn't do much unless I fixed the other 23 hours of my day.

He was pretty pointed that an hour of exercise or stretching wasn't going to fix:

• Sitting slouched
• Sleeping twisted
• Standing with weight constantly shifted over one leg
• Hunching over
• Lifting with my back and not my legs
• Not squaring up to things with my hips

It sounded a bit woo-woo to me, but, I was desperate and I followed his advice quite religiously. It was almost overly simplistic, to the point of being mundane: sleeping on my back instead of my stomach, not waiting in line at the store with weight on one foot. A few weeks later I had my first "pain free" day. Then several of them. After a few months the good days out numbered the bad. Six months later I barely remembered what the pain was like. Every once in awhile I get a flare up if I've been lazy, but I go back to those principals and they've really worked for me.

His entire schtick was about "tolerance" — if you treat your spine and hips with care 90% of the time, it can absorb a lot of poor mechanics and behaviors. However, if you treat yourself like **** all the time, your back will let you know. This is often why people say things like "I was just tying my shoe and my back gave out." It's just the straw that broke the camel's back after a long period of misuse.

It's likely that the ligaments that support my low back were sprained / overstretched in that car accident, but without proper care and guidance they never healed appropriately. Many of the stretches I was subsequently given caused me to stretch them even more, when instead the joint needed stability to give a chance for the ligaments to heal properly.

Now, that's not to say surgery isn't valuable. My dad had a four level fusion around the age of 64 after he basically lost all motor function through his right leg. He really needed it and it was (mostly) successful.

I'm not sure the failure rate of low back surgery is quite 50% these days as they are a lot more conservative with the criteria for surgical intervention, but cervical surgeries are a lot more successful generally. This is because as the spinal column ascends, it bears less load. That's why people with lumbar fusion often have the level above done after some time, because the force is distributed above and below the fusion.

All this is to say, make sure you've really considered every avenue before proceed. I spent most of a decade thinking my pain was one thing, only to find out it was something just slightly adjacent I'd never really considered.

FWIW I'm 37 now, and haven't thought about my low back in more than eight years until I saw this post.

[mdeeds71]

53 years old, very active in ski racing, cycling, soccer etc. 34 years of military service on active duty and the reserves jumping out of aircraft and carrying lots of weight with body armor. As an airline pilot sit for many hours. Over the last 20 years been dealing with lower back issues resulting in sciatica full length of left leg and pain 8-10 on the scale. Just before my procedure I had atrophy starting in my left calf. Lost 1 inch of circumference and 60% of strength where it looked like someone removed the middle mass of my calf muscle.

Went to the Steadman Clinic in Vail. Had several choices and went with L5-S1 total disk replacement. Entry was from front, procedure about 1.5 hours, walked with brace out of hospital same day as surgery.

After 6 weeks back to flying with full mobility. Started riding at 10 weeks, at 12 weeks went from Breck through Vail pass and back on my Pegoretti with no adjustments to drop…in fact have more now…At 4 months took my Army physical fitness test and scored the highest I had since being a LT, 28 years ago. Ran 7 then 8 miles just after that. Played soccer about 3 weeks ago.

Pain free and getting stronger each day….total disk replacement works! But it’s not for everyone’s condition. I was a nay sayer to surgery but my wife convinced me of the need! Actually nearly 1 inch taller given how compressed that disk was. 7mm space to 27mm now.

PM if needing more info.

[krooj]

Originally Posted by mdeeds71

53 years old, very active in ski racing, cycling, soccer etc. 34 years of military service on active duty and the reserves jumping out of aircraft and carrying lots of weight with body armor. As an airline pilot sit for many hours. Over the last 20 years been dealing with lower back issues resulting in sciatica full length of left leg and pain 8-10 on the scale. Just before my procedure I had atrophy starting in my left calf. Lost 1 inch of circumference and 60% of strength where it looked like someone removed the middle mass of my calf muscle.

Went to the Steadman Clinic in Vail. Had several choices and went with L5-S1 total disk replacement. Entry was from front, procedure about 1.5 hours, walked with brace out of hospital same day as surgery.

After 6 weeks back to flying with full mobility. Started riding at 10 weeks, at 12 weeks went from Breck through Vail pass and back on my Pegoretti with no adjustments to drop…in fact have more now…At 4 months took my Army physical fitness test and scored the highest I had since being a LT, 28 years ago. Ran 7 then 8 miles just after that. Played soccer about 3 weeks ago.

Pain free and getting stronger each day….total disk replacement works! But it’s not for everyone’s condition. I was a nay sayer to surgery but my wife convinced me of the need! Actually nearly 1 inch taller given how compressed that disk was. 7mm space to 27mm now.

PM if needing more info.

Without PM, mind asking which device they used? Prodisc-L?

[mdeeds71]

Originally Posted by krooj

Without PM, mind asking which device they used? Prodisc-L?

Not sure and never asked. When I researched it there were limited options in US vs Europe and positive and derogatory on the three main options.

[cderalow]

L5/S1 naturally fused here with a L4/L5 surgical fusion done with an L3/L4 discectomy February 2024. L4/L5 was because of a herniation that was severe enough to forgo discectomy, L3/L4 was herniated at the same time.

Had to go surgery after months of PT, meds and cortisone shots that didn't resolve sciatic nerve pressure, pain and numbness.

Little less flexibility now than I had before, and a ton of mental 'what if i bend wrong and I herniate another one' acrobatics every time I move.

8 months later and I'm now getting back into riding for 60-90 minutes every few days.

Surgery was night and day difference. Went from being in pain and constant numbness down my right leg doing anything going into surgery to pain only at the incision site. 3 days later even that was gone.

[StayingUpright]

This seems like the place to ask: does anyone have anecdotal or secondhand knowledge of spinal cord stimulators? Saw my chronic pain doc the other day and he said we’re out of conservative options for the damaged L4 nerve root. His suggestion was to start the process for a spinal cord stimulator. Thanks again for everyone’s thoughtful input.

[carpediemracing]

This thread has my attention.

I have a bad L4/L5 disc and apparently a less than great L5/S1 disc. Managing but it's not really easy. For a period I was throwing my back out ever 10 days or so. My doc is a cyclist and a former Marine I think so both pragmatic but can also relate to my cycling wants. I stopped doing 100% sprints because those seem to affect my back. 80% seems okay.

My doc said that I have a "normally abnormal" back. Meaning at my age, it's normal to have some abnormalities. If I was 30, it'd be a problem. If I was 80, he'd think I was in great shape.

I've had to make some life adjustments in the last 5 years. I am really limited to bed choice. I have to be careful not to sit on any uneven surface (wallet in back pocket, coat on half the chair, etc). In my off-center steering wheel vehicle (who knew older Suburbans had their steering wheel a few inches to the right of the centerline of the front seat?) I have to drive one handed so as not to twist my torso. I keep my lower back super arm. I've gone every year for PT for my back, dry needling to loosen up my QL.

But I am optimistic, even if I have to have something done in the future.

I know that the current M50-54 500m TT champ has one or two fused vertebrae from about 20 years ago. He doesn't share his power numbers but he gets a 70x12 going about as fast I can get a 56x14 going, does the 500m 5 seconds faster than me, and has been a contestant on American Ninja I think 2 and 3 years ago.

[ridethecliche]

Originally Posted by Onno

I had an anterior lumbar interbody fusion of L5/S1 three years ago, and it's been kind of a miracle. I had lots of very sharp pain in my lower back for years, and within a day of the surgery I knew that the surgery had fixed it. Yes, the recovery took a couple of months (though I was walking the next day), but I've been 95% pain free in my lower back since the surgery. I was back on a stationary bike within about a month, if memory serves, and back to swimming more or less the same time as well.

There's a reasonable chance that I'll need to have a fusion at some point in life given that I had 2 discectomies at the same level about a year apart in my early 20's. There's a 100% chance that I'll push for an ALIF (or related) vs a posterior approach, unless something has drastically changed in the interim. Disc replacement being the other thing depending on how outcomes shape up over the longer haul.