Spinal Fusion - L5/S1

[Ozz]

What do you guys know about this?

Just got some bad news from a spine doc....need to schedule an appt with a Neuro guy to check out my options. The spine guy presented a brace (which may or may not work) and fusion surgery...which sounds bad.

I think my riding is done for the year....

[pdmtong]

my wife has c4/5/6 fused as a result of over-aggressive mtb'ing

at some point, the pain and inconvenience become too much. can't live like that for another 40-50 years. we're 4 years past the fusion and back to normal. neck sore-ness from longer or harder rides, but at least she is on the bike again.

worst part was just pushing past the thought of a f-up in the surgery. nick a c4/5/6 and you are a quad....not a good thought

[dave thompson]

My wife had an L5/S1 fusion 2 years ago, after years of pain. She had what her surgeon called 'minimally invasive surgery' where they went in through each side of the spine to insert and secure what looked like a cage that fastened the two vertebrae together. Recovery wasn't immediate but I bought her a recumbent so she could cycle during it. Now she is an absolute animal on her Calfee and her tourer, over 2,000 miles last year including 2 weeks cycling in Europe and well over 1,000 miles this year so far! No back pain at all.

[Elefantino]

Do the fusion if that's what the doctor recommends.

I, too, have had C4-5-6 and L5-S1 jobs, as the result of accidents. No worries.

[Andreas]

NEJM

Read that paper.
Jim is a colleague of mine and does great work in his field.

The growth of fusions done in the US is exponential over the last 10 years. It is well reimbursed.
Of course, there are legit reasons to do one.

Read Jim's paper!

[Tonger]

I would suggest that you see the Neurosurgeon and then consider getting a second opinion from a nonoperative person (somebody that understands spine but does not operate - e.g. a Neurologist or nonoperative Orthopedist). Whether or not to undergo a fusion depends upon many factors including the underlying cause including narrowing of the spaces the nerves run through (degenerative disc disease, facet disease) or alignment problems (pars defects). Your age and severity of symptoms would also help determine whether or not to undergo surgery versus trying more conservative measures such as bracing or physical therapy.

Personally, I would not make the decision to undergo surgery unless I had bowel and bladder issues or leg weakness. If the symptoms are back pain, numbness, or sciatica then you have time to try conservative measures first. The reason I feel this way is that there is a definite subset of patients that have 'failed back syndrome' after spinal fusion. Not only do they not improve symptomatically, they get worse. Also, often times if the symptoms the symptoms will simply resolve over time (disc gets smaller or nerve gets used to the disc) or improve dramatically with an epidural steroid injection.

Best of luck to you,

Tonger

[gasman]

Tonger has some very good points but I wouldn't wait for bowel orbladder symptoms. Fusions are very over utilized in the US for minimal increase in return. I've been in on 100's of fusions and very few return for reoperations but it does happen. You will have more mechanical forces on L 4-5 since the lower vertebra are fused- that may or may not be a problem.
So get more than one opinion and ask how many fusions the surgeon has done. I'd want to see a minimum of 200 IMHO.
Good luck ozz
pm me if you have other questions.

[Tonger]

I think that Gasman has very good points as well. I think what gets lost in the evaluation of back pain is that the pain/numbness symptoms can frequently resolve over time with conservative measures. There is no doubt that spinal fusion is overutilized and there are a definite subset of patients who not only fail to improve, but have new problems that are a direct result of surgery (infection, arachnoiditis, epidural scar, loosening hardware, or worsening alignment).

To clarify, I don't have anything against back surgery in general. It can be a safe and effective treatment when conservative measures fail and patients are properly chosen by experienced operators. For what it's worth, I don't think that reoperations alone are not a good measure of the frequency of failed back syndrome because you never see the patients who 'fail' but are not candidates for surgical revision.

This is just a friendly suggestion to look carefully before you leap. From a risk/benefit point of view it makes sense to try conservative measures first with minimal to no procedural risk. Conversely, the procedural benefit needs to be pretty high to justify the surgical risk involved.

Best of luck and I'm also happy to pm.

[Dekonick]

I would avoid the knife for as long as you can.

[Louis]

I don't know if this is applicable to you or not, but it may be of interest:

Spine Patient Outcomes Research Trial

[HenryA]

My lower back was wrecked to the point that I became non-functional about 50% the time (flat on my back in agony) with periods of painful function between. The neurosurgeon said it would take a triple fusion to stabilize the problem and that I would --not-- fully recover my former very active lifestyle. He suggested that I do what I could to avoid the knife.

I'm now at 18 months of physical therapy guided by an excellent PT. I have performed the exercises given to me as if they were a new-found religion. I learned how to bend over correctly and how to lift. The muscles that control my spine are functioning correctly and together in balance. The result is that I am practically 100% cured and pain free. My core is stronger than ever and supports the proper operation of my limbs. Life is good again.

Here is the basis for what worked for me:

http://www.backfitpro.com/

If you're already injured you need a doctor and a great PT to determine if this is the right approach for you and then to guide you through the process. If you have minor back problems or just want a healthier and stronger back you could simply follow the advice given in the book "Ultimate Back Fitness and Performance" from the above site.

And through the whole thing, don't forget to get a new fit on our bike that accommodates your back situation.

[.RJ]

Bringing this to the top - after exhausting all non-invasive treatments for 3+ years and not being able to train properly for the past 2+, I'm going under the knife for a L5/S1 fusion in about 6 weeks.

Anyone have any experience to share? What about recovery and return to the bike?

[bob heinatz]

My wife put it off for years being in constant pain. Went under the knife last April and is now doing fine. It took her about 8 months to fully recover. 13 months later we spent a month in Italy walking about 8 miles a day. So there is a great chance for a full recovery.

[PeregrineA1]

My ex-wife is 11 years post surgery with artificial disc replacement, 3 total, including L5/S1. She was essentially an invalid and is now ~90% of normal function. We did a ton of research and talked to multiple doctors. Ended up getting it done in Germany for half the cost of the US, including air fare. Ultimately Blue Cross reimbursed us for everything but the air fare-took about a year. Following surgery, she was walking in a day. ~50% in ~90 days and ~75% in ~180 days. Very impressive.


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[eddief]

He almost won and has a new girlfriend.