# L5-S1 Spinal Fusion to fix Stenosis



## wmalan (Dec 8, 2005)

I see others have similar issues so I think I'm in good company...

I'm a 58 years young male having an L5-S1 fusion to fix the horrible stenosis on my sciatic nerve next month. Feels like an icepick into my calf and foot after standing just 10 mins. The procedure will also include stem cell application to the fusion/replaced disc area. The doctor (my second opinion) is a leader in this field so I'm cautiously optimistic about the outcome.

Anyone else here had this specific surgery and recovered to enjoy riding again?


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## elder_mtber (Jan 13, 2004)

Yes, me. I had two lumbar spinal fusions. First, L4-L5. I recovered OK but my original back pain was just the same. No change. Very sad and disturbing. After a couple more years of terrible pain from standing or walking or riding and general deterioration of my body due to inability to get any meaningful exercise I had L4-L5-S1 fusion. Horrible pain after surgery but eventually recovered. This second surgery greatly improved the pain situation and I now ride about as well as before the back trouble started.   

I had the fusion but no stem cell and enjoy riding again. For sure.

Keep us posted on your recovery. I am very interested in the stem cell therapy.

Best wishes,
Terry - age = 71!


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## wmalan (Dec 8, 2005)

71! Good on you! my L4-L5 and everything above it looks great in both the mri and x-ray. The doc said now is the time rather than later. I've always had lower back pain through the years since I was a kid. It wasn't until the horrible sciatic nerve pain that drove me to this decision. I'm hoping that since it's confined to the L5-SI recovery will go ok. How many years ago was the second fusion? Mine in scheduled for Feb 14 (what a valentine gift eh?). I was supposed to be last month but they found I'm having hypertension so I needed to get on meds for a while. I'm hoping once I'm active again, I'll get that back down.
Thanks for the info!


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## elder_mtber (Jan 13, 2004)

Second lumbar fusion was Jan 2012. Five years! Long time to recover and regain riding skill and strength and confidence. Actually, still working on strength. The best thing that happened was, and still is, the weight training I've been doing in group exercise. Should have started this maybe one year after surgery instead of about three years after. I guess the tame conventional physical therapy after surgery helped, but it sure did not prepare me at all for semi-challenging mountain biking.

Keep us posted on surgery and progress.

Best wishes,
Terry


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## mbell (Sep 9, 2008)

Most likely, the stem cells they want to use are to try and help in the fusion process, not a "therapy." Where do you live? Who is your doctor? I'm just curious about people who say they're a "leader in the field."


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## Captain Obvious (Mar 12, 2010)

L5-S1 ~3 years ago after same level disc repair 5 years prior to that. I had a huge herniation into my spinal cord cavity that made the first surgery urgent. My right leg just wasn't working from the knee down. PEEK disc insert (just a plastic donut spacer screwed into vertebral body above and below) filled with ground cadaver bone and rods in the back.

Post surgery pain was intense for about a month. The doctor said it is one of the most painful surgeries you can have, and I believe him. It took about 3 months to feel 50% and a good year to feel back to normal. I do have some lingering "numbness" in my two outer toes. They feel like they are just about to go to sleep.

My back lets me know when I do too much but I can do anything I did before. Riding actually makes my back feel better, not as achy or tired. Not quite at the same level as before but that is due to fitness more than back issues. I do ride road so I don't know how the roughness of a trail would affect it.

I was 41 at fusion so I did have youth and good health on my side considering this is usually an old person surgery.

Don't know what the stem cells add to the mix.

I will tell you a good portion of the recovery is mental. That surprised me a bit but should have not been unanticipated. The initial slow recovery, drugs, inactivity and pain coupled with constant "am I going to be like this for the rest of my life" sneak up on you. Focus on the progress you do make an know you will get back eventually.

Gut issues too. Start a stool softener the day before. Pain pills and inactivity will cork you up solid. You don't need bad back pain and constipation. Real bad combo. Eat some probiotic foods after surgery too. Yogurt did it for me, it took a while to feel like my gut was working right.

that's an awful lot of rambling, but I read a LOT of negative outcomes on the interwebs before my first surgery and I try to counter that with some hope for those facing a daunting situation. Hope that helps.


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## mbell (Sep 9, 2008)

I'm surprised to hear how painful your procedure turned out to be. Typically, and ALIF (Anterior Lumbar Interbody Fusion) surgery isn't too painful. How many scars do you have on your back? Two small scars spaced off the middle, or one large one in the middle?
Also, do you have any x-ray images you can post? 

Stem cells are used to help grow bone. Although not yet proven completely reliable, many choose to use them. Ultimately, stem cells are cells without a direct purpose, until they're given orders for use. I.e.- your body needs bone, so they metasticize into a bone growing cell. They can basically morph into what you need at any time. (Liver, kidney, etc) you just need a signal and need for them. Ultimately though, to get them from a good donor, processing to make safe, storage, delivery, thaw, application... there are plenty of obsticles to pass. 
Personally, I prefer other options.


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## Captain Obvious (Mar 12, 2010)

Mine was anterior and posterior. 3" scar in front at my waistline, 4" on my back in the middle. I'll have to dig up the images.


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## mbell (Sep 9, 2008)

Midline incision on your back typically means a lot of muscle stripping off your vertebrae. That explains the post op pain.


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## wmalan (Dec 8, 2005)

Update: My procedure is in 3 days. I'm told either 2" incisions on either side or a single 2" with one from the front or side (access decision will be made that day). The point is move as little muscle as possible he said. And yes, the stem cell therapy is used to stimulate bone growth. His name is Dr. Bae who works out of Cedars-Sinai and St. Johns in Santa Monica Cali. (he's the medical director of spinal surgery at Cedars)

Btw, I get the mental thing. Pain can play games with you. I've been doing meditation as part of my pain management of the stenosis. At this point I can only stand for 5-10mins before my leg screams at me. No opiates up till now. I use a prescribed lab grade CBD oil at night which helps. I have a pretty good plan for recovery if things go right. Staying positive.


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## wmalan (Dec 8, 2005)

Well I'm back. 2.5hrs in the OR. 2" single incision down the center. Was at the hospital for 2 1/2 days (glad to be out of there). Had a hemo drain on it for 2 days). The one hour ride home in the car was rough. The whole process went really well considering all the surgeon did inside that tiny cut. Turns out he first removed 80% of the disk and misc scar tissue. Then installed a newly developed carbon fiber expanding spacer to correct the stenosis. Finally attached the Ti posterior bracket. All of it is encased with a some stem cell proteins (don't know the details of that). I see him in 2 weeks to see pics and details. I was walking the day after surgery for a short bit. Taking one Norco every 6-8 hours. So far so good. I have a nurse that's coming to the house to check on me.

Overall pretty impressed with the outcome as I can walk around the house (no bending, lifting, twisting) with a brace. 

A side note: The doc said this device is only the 3rd one installed in the US so he's doing a medical write up of the procedure. He's his specialty is minimally invasive repairs and so far I'm pretty impressed. 

I'll give a few follow ups as thing progress as I know a lot of folks here suffer from thses issues as well.


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## elder_mtber (Jan 13, 2004)

Sounds great! Tiny cut, indeed. Only 2.5 hrs in OR also good.

Best wishes,
Terry


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## mbell (Sep 9, 2008)

Post an X-ray image if you have one and don't mind.


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## wmalan (Dec 8, 2005)

mbell said:


> Post an X-ray image if you have one and don't mind.


Will do. I see him in a 10 days. Btw, said i could be on a stationary bike in about a month.


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## Guest (Feb 18, 2017)

Had that done in 2009. You'll want to walk a lot until things fuse. The impact of walking helps things heal. I was walking about 13 miles/day by 30 day check-up. The stationary bike will need to wait until you're cleared to sit more. You want things healed up pretty well. I was back at work 1/2 days at 30 days and full time light duty at 46 days. I didn't have much pain and was off meds the day after surgery.


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## Captain Obvious (Mar 12, 2010)

Glad to hear surgery went well for you. May healing and recovery be as successful and smooth. God bless.


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## wmalan (Dec 8, 2005)

*Hardware in.*



mbell said:


> Post an X-ray image if you have one and don't mind.


Well here it is 6 weeks in. Going pretty amazing. Sitting for long periods (I'm a programmer so that's a nuisance) is the toughest part. But very much little or no pain. Starting PT next week. Cycling... a bit out but enough to look at a new rig of some kind ;-)

So besides the standard Ti screws, there's a new patented ex-pander where my disc was (left just the lining of the disc). The fusion will be in there when complete. Looks crazy in the pic but I feel great.


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## Guest (Mar 29, 2017)

That’s more hardware than I had, but my surgery was anterior approach (from the front). I’ve found since I had the surgery that sitting for long periods causes numbness or shooting pain in my left leg which is ironic, since it used to be standing I couldn’t tolerate. You may want to check out standing desk options. I stand all day now and it’s the only way I could work. Cycling should probably wait until the fusion is completely grown in (around 6 months). Even a minor fall now would screw all that up. It pained me to do that, but I was walking a half marathon every day by the 4 week mark, so I kept busy as I could. Good luck with your recovery!


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## elder_mtber (Jan 13, 2004)

mbell said:


> Post an X-ray image if you have one and don't mind.


mbell - are you familiar with Syllamo's Revenge?

PS Not a hijack attempt.


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## VTPossum (Nov 20, 2008)

Hope all the contributors to this thread are doing well. I'm 16 days post-op. L4 - S1 decompression and fusion. Posterior (7" incision) and anterior (5" incision) / approaches. Doing alright. Stretching out the time between pain meds, doing laps inside the house, including some trips up and down the cellar stairs. Curious how long before you could ride your bikes again?Any issues with the vertebrae adjacent to the fusion? Any advice?
Just for reference, I ride a rigid fatbike. Slow and easy. I like to take my time poking around fields and backwaters, along rivers - stop and smell the roses type.


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## elder_mtber (Jan 13, 2004)

I had L4-5-S1 fusion seven years ago with a good outcome.

Can't remember how long it took for me to get back on the bike, I'm sure less than a year, maybe six months.

Question about adjacent level(s) - your L3-L4 disc will be under additional "stress" since the other levels will not be helping with twisting and bending.

Do you do any lifting, like squats? You may not be able to squat with correct form, your back will be tllted forward. Three weeks ago I suffered a L3-L4 disc herniation after doing squats. This has pinched my femoral nerve and I am semi-disabled (again).

My advice if you do squats have your form checked. If and when I get well I am not doing squats with weights.

Sounds like you are doing well. 

Terry


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## VTPossum (Nov 20, 2008)

Thanks for the reply Terry,
I don't lift weights. I got enough of that at work. (Concrete form work) I'm sorry to hear your hurt again. Glad to hear the bike doesn't seem to be the culprit. I have my first PT appointment next week, guess they will pull these pesky staples at that time. Hoping for a good recovery in the months ahead. Thanks again for taking the time to reply. It's good to hear from someone who's been there, done that.


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## coyotegulch (Jun 25, 2008)

I had a L4-S1 fusion decompression in mid-February. From a symptom perspective i could not be happier.

I'm 55. My neurosurgeon told me 5-10 years and i will more than likely need another surgery. I am a PT by training and understand that I am now just transferring forces above the fusion to L3. I hope I can make it the 10 year mark.

I was back on a road bike at about 10 weeks. Very gradually increasing time. I started out and until recently, really focused on spinning and not mashing. 

I have been MTBing since about June. Now I am riding just as before, granted a little slower. Using a gear or two easier than previously, but now increasing gearing. I don't seem to be able to get my top end back yet.

I altered my weight training. No axial loaded squats and no leg pressing. I am using light weights and focused on perfect form. Lots of single leg work, i lost strength and size in my R leg before surgery. I also focus on core which i did before. I don't do any rotation work.

I have always been very fit but that didn't help the last 5 years of steadily worsening symptoms. I probably waited 6 months too long for surgery. I did my due diligence though, seeking out 5 opinions. I settled on the most common solution expressed by the 5 and picked the doc with whom I was most comfortable. Once you have back surgery you are in for a long relationship with your surgeon.

Good luck to all.


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## elder_mtber (Jan 13, 2004)

coyotegulch said:


> Once you have back surgery you are in for a long relationship with your surgeon.
> 
> Good luck to all.


Ain't that the truth!


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## Fuse6F (Jul 5, 2017)

feel better


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