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Old 03-27-2011, 09:04 AM   #1
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L3 L4 L5 S1 fusion

Hi everyone I am looking for some information on this type of lumbar fusion I had a fall 3 years ago and underwent all kinds of treatments injections a 3 level laminectomy then a spinal cord stimulator...and now after I am getting worse and worse I went and had 2 more oppinions on my back "1" from a neurologist and "2" from a pain mngmnt/neurologist they did another EMG and reviewed all my records and info.. and both felt that I needed a fusion due to the severity of my back so they referred me to "2" of the best Neuro Surgeons they felt there was in the area one from Robert Wood Johnson in New Brunswick, NJ and the other from the University of Penn in Philladelphia I chose the Dr. at Robert Wood Johnson as I heard both were two of the best around...After getting a new ct-scan and seeing the Dr. with all my reports and past images he told me my back was so bad he could not believe it and completely went over everything he saw on my new CT-Scan and told me what he felt should be done he was very thorough and nice he felt the only way to relieve back pain and maybe butt hip thigh and foot pain was to do a complete laminectomy removing all the bone from L3 - S1 opening up the canal and then fusing everything together he just said screws pins etc...we did not get into everything as he said to go back to my Surgeon who did the previous 2 surgeries and let him know what we discussed (( he said he would never just opperate on a patient unless he felt it was needed and was very honest in saying he respected my Dr. and said he would talk to him and or send the report to him )) and he then said if I wanted to do this either have my surgeon do it or he would love to help me...This is the 3rd Dr/neurologist stating I needed this type of treatment.... my diagnose is I had several herniated disks bulging disks severe degerative disk disease with 2 disks touching 2 with to much space etc...nerve damage and severe lower back pain in which it pounds/stabs into my butt hip thigh calf and foot in which my toes are always dead like either burning with nasty pains...I am very scared about the surgery as I here so many bad things but on the other hand what choices do I have I have tried everything there is with no help and being 45 yrs old all I want to do is be able to live a somewhat normal life coach our son at T-ball and other sports be able to have fun again with my wife I am torn....I am looking for some input on from some of you who are or were in this similiar boat...

Thank you for your help and I am sorry about all my typing errors I hate typing...lol

Thanks, Bob

 
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Old 03-27-2011, 10:52 AM   #2
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Re: L3 L4 L5 S1 fusion

Hi Brody. I'm sorry you find yourself in this position. It does sound as tho your back is in pretty bad shape and I don't see how anything less than fusion will help you. A 3 level fusion is a pretty big deal, so I'm glad you have gotten more than one opinion and that they all agree.

I have never had a 3 level fusion, but have had several 1 level with bone spurs removed at other levels. The healing process is a long one, especially when you have nerves that have been pinched. It can take them a long time to repair themselves, so you will find that you are going to need a great deal of patience.

Here on this board, at the very top, are 2 stickys...one for post op and I think you will find it very helpful. The most important things is that you trust your doctor, that you follow all orders to a T on discharge, and that you have a positive frame of mind going in. You must also dedicate yourself to walking short distances every day. At first it may only be a few steps but as you heal you will be able to walk for longer periods. Walking is the most beneficial thing you can do for yourself...it helps keep scar tissue pliable which will help prevent entrapment of nerves. It also keeps the back strong.

Please stay in touch with us and let us know how you are doing.

Carol
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Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels

 
Old 03-27-2011, 06:53 PM   #3
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Re: L3 L4 L5 S1 fusion

I'm a little surprised you had a 3 level laminectomy to begin with, as this often leaves the spine unstable. From your description of your issues, a fusion would be the logical next step in an attempt to address your issues.

It seems that you have only consulted with neurologists and neurosurgeons. You might want to have a consultation with an orthopedic spine surgeon before reaching a decision.

I had a 3 level fusion in June and some reconstruction at L3-4 as well. It is a big surgery and you can expect to be in recovery for the better part of six months, and extra vigilant for the first year. While you may show signs of bone growth early, it takes at least a year for the bone to set up and grow strong.

As far as I am concerned, the most important aspect of this surgery is the selection of your surgeon. This is not a surgery you will have an opportunity to "do over," so you want to do everything in your power to get it right the first time. If you select a neurosurgeon, be sure his primary focus is on issues of the back and neck. You don't want a neurosurgeon who specializes in brain surgery, as he will not have the necessary experience for a complex multi-level fusion, no matter how good he is with the brain. Doing a few multi-level fusions here and there is not enough to keep up the necessary technique.

You may want to ask the surgeon how he plans to do the surgery. Will it be from the front or the back, or both? Will he use a cage, or what kind of hardware? Will he use your bone, or one of the biologic bone products? Or perhaps you will prefer not to know any of the details....

I will mention that doctors usually inform their patients that there will be some loss of mobility with a 3 level fusion from L3 to S1. L4-5 and L5-S1 are the levels where the spine has the most mobility, so when it is turned into one solid block through fusion, it will be noticeable. I was told if I played golf or tennis, I would notice it. Luckily, I don't, so I haven't really noticed any change. But, some people do.

But, as you said. What other options are available to you??

If you have specific questions, I'd be happy to try to answer them.

 
Old 03-27-2011, 09:02 PM   #4
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Re: L3 L4 L5 S1 fusion

[QUOTE=tetonteri66;4716993]I'm a little surprised you had a 3 level laminectomy to begin with, as this often leaves the spine unstable. From your description of your issues, a fusion would be the logical next step in an attempt to address your issues.

It seems that you have only consulted with neurologists and neurosurgeons. You might want to have a consultation with an orthopedic spine surgeon before reaching a decision.

I had a 3 level fusion in June and some reconstruction at L3-4 as well. It is a big surgery and you can expect to be in recovery for the better part of six months, and extra vigilant for the first year. While you may show signs of bone growth early, it takes at least a year for the bone to set up and grow strong.

As far as I am concerned, the most important aspect of this surgery is the selection of your surgeon. This is not a surgery you will have an opportunity to "do over," so you want to do everything in your power to get it right the first time. If you select a neurosurgeon, be sure his primary focus is on issues of the back and neck. You don't want a neurosurgeon who specializes in brain surgery, as he will not have the necessary experience for a complex multi-level fusion, no matter how good he is with the brain. Doing a few multi-level fusions here and there is not enough to keep up the necessary technique.

You may want to ask the surgeon how he plans to do the surgery. Will it be from the front or the back, or both? Will he use a cage, or what kind of hardware? Will he use your bone, or one of the biologic bone products? Or perhaps you will prefer not to know any of the details....

I will mention that doctors usually inform their patients that there will be some loss of mobility with a 3 level fusion from L3 to S1. L4-5 and L5-S1 are the levels where the spine has the most mobility, so when it is turned into one solid block through fusion, it will be noticeable. I was told if I played golf or tennis, I would notice it. Luckily, I don't, so I haven't really noticed any change. But, some people do.

But, as you said. What other options are available to you??

If you have specific questions, I'd be happy to try to answer them.[/QUOTE]


Hi and thanks for your reply I really appreciate it.. My surgeon that did the lammy is an orthopedic spine surgeon and what I had was a partial at L2 L3 a full at L3 L4 and partial lammy at L4 L5 I had some relief in the pain that was starting to go into my right leg but my back pain was still severe and also the pain in my left butt left thigh and left calf was getting worse along with the burning & freezing pain in my left foot along with severe toe pains I can only do small things as everything I attempt to do causes the severe pain to explode and I am then home for a day or 2 until it subsides it sucks so bad I cannot even do anything...I am sure you know what I mean and it is ruining my life so now almost 7 months later me and my orthopedic Dr. talked 3 weeks ago and he felt doing any more laminectomies would not be good like you said it would be to much bone removal he suggested the fusion but said if I wanted another oppinion it would be great so I went to get another oppinion from a really good neourologist and he and his pain mngmnt Dr. felt my back was to bad and only a fusion would help at this time so they referred me to the 2 neuro spine surgeons I mentioned, the one I chose is Dr. Sun Lee from Robert Wood Johnson which is one of the best hospitals in NJ and the area and this Dr. is said to be an unbelievable neuro back surgeons so I went to see him last week he seemed very good and was thorough in his talk with me as he showed me everything going on with my spine he said I had severe degenerative spine disease along with the injury I sustained 3 herniated disks bulging disks and nerve damage with the fall and felt after 3 years of trying so many proceedures the only thing that would help would be to stabalize my spine by fusion I am freaked out but am willing to try what it takes I need to pick up my son again and play golf and go hunting and fishing and be able to do fun things agian with my wife and son I just hope that this can help me what else can I do....Thank you so much for showing your concern and please let me know how you feel also tell me about your injury and how was the surgery the laminectomies were pretty ****** so I am sure the fusion will be worse plus I am very big the Dr. said
being 6' 6 and 290lbs puts more stress on my back. I sit here now and the pain sucks so bad I can hardly concentrate I hate medicine I try hard to put up with as much pain as possible but that does not always work I am totally prepaired and ready to do and listen to whatever the Dr. syas to do to recover and have the best results as I am 45 and need to live the rest of my life some what happy..

Thank You, Bob

 
Old 03-28-2011, 07:07 AM   #5
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Re: L3 L4 L5 S1 fusion

Sounds like you have things well in hand, and have found a surgeon that you like and that is good at explaining things to you. Have you set a surgery date?

I think you'll find that the 3 level fusion will not necessarily be worse than your previous surgery. I think I may have been incredibly lucky, but mine turned out to be a lot easier than my one level fusion, which was the first surgery of any type that I'd ever had. I told my surgeon I thought he was a magician, but he denied it.

I was fused at L4-5 already, so he planned on just removing the rods and then adding on at L3-4 and L5-S1. But when he opened me up (using the same incision line) he discovered the facet joints at L3-4 were worn down to little nubs...something that had not shown up on any of the MRIs. Also, the screws were not compatible so he had to remove them. He had to do some reconstructive surgery at L3-4, and then put in screws at all the levels and longer rods to connect the whole mess.

The first four days were tough, but by the tenth day I stopped taking any medication, and I started referring to my husband as "Nurse Ratchett" because I felt well, wanted to go out for lunch, etc. and he had to work hard to reign me in! I did have a back brace which was a big help in reminding me not to bend or twist, and my surgeon really treated me with kid gloves...actually still is. I went through so much to have this surgery (long story) that I'm sure he didn't want anything to go wrong.

It will be very important that you take whatever time it takes for you to heal properly. Don't set any deadlines for yourself and don't push. You want to do everything in your power to ensure that your surgery is a success! You won't be playing golf this summer, but if you do everything necessary, you should be back out next Spring.

In the meantime, when the pain is bad, do you ice? Most of my pain was in my right leg and often icing was the only thing that would touch the pain...I didn't take pain medications because they didn't do much.

While waiting for surgery, try to take walks, eat nutritiously and drink lots of water. If you are really nervous, there are some CDs that I found helpful. I don't normally go for this type of thing, but I knew this was going to be my last chance to address my issues and I was willing to try just about anything. I bought a CD that I listened to every night before going to sleep. I didn't think to do this until a couple weeks before surgery, so by the time it arrived, I ended up only listening maybe 5 or 6 times, but I think it made a big difference.

They say that it is helpful if you arrive in the OR in a relaxed state. It makes it easier for the anesthesiologist to control things as blood pressure is more stable, and there is less blood loss when the patient is calm. The day of the surgery I was almost scary-calm and was feeling relaxed. When I awoke from surgery, the nurses later commented on how quickly I revived, and was immediately talking and joking with them. My pain was easily controlled and my hospital stay was uneventful. I don't know if the CD made a difference or not, but I had a much easier time than with my other two surgeries. If you want to check it out, I used Health Journeys: A Meditation to Promote Successful Surgery [Audio CD] by Belleruth Naparstek. There are others out there too. She suggests using headphones and listening to the music in the OR during surgery. I didn't even ask my surgeon if I could do that because we had had so many discussions about infection and how it was the greatest danger I faced...that I was pretty sure he'd say NO WAY. Anyway, something for you to think about if you are anxious and feeling stressed over the surgery. It was a simple thing for me to try, and I think it did help.

 
Old 06-27-2011, 05:20 PM   #6
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Re: L3 L4 L5 S1 fusion

Hello I am new to this but I need veteran information. having a 2 level l4-l5, l5 s1 fusion very shortly and i was wondering about fishing (billfish) and golf after surgery.

 
Old 06-27-2011, 10:45 PM   #7
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Re: L3 L4 L5 S1 fusion

It is difficult to say with certainty what the results of a fusion will be. The one thing I can tell you is to be patient for the first six months and give yourself an opportunity to heal thoroughly before engaging in too much activity that strains the spine.

Even though you may show signs of bone growth as early as three weeks, it will take about a year for the bone to fill in and become strong (I think of it as "curing".) After this point, when you work your way back to a level of fitness that supports the activities you were engaged in prior to injuring your back, you should be able to resume them. If you push too hard too soon, you run the risk of interfering with the bone growth, or in loosening a screw, breaking a screw, etc.

Many people are able to return to golf. Regarding the fishing, I cannot guess. I imagine it takes a great deal of strength in the back muscles, and upper body to bring in a big fish. I don't know what type of strain that puts on the spine. Regardless, you will not be doing right after fusion, that I can guarantee!

When is your surgery? DO you know what type you are having?

 
Old 06-28-2011, 04:22 AM   #8
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Re: L3 L4 L5 S1 fusion

Hi and thanks for asking....1st of all good luck with your surgery..As for myself I had an l2 l3 l4 l5 revision laminecromy and fusion with instrumentation 8 screws and 2 rods on April 27 2011...now that was on a Wed and on friday I had a setback in the hospital as I was doing great thurs and friday then the pain just went off the charts and I awoke Sat morning with a 103.7 temp and a my BP was like 91/58 this was at 6am and by 9am I was in emergency surgery for 3 hrs where they unstapled me all 23 and took out all the sutures and reground some bone and did some other crap then re-did it all...lol...just my luck...another cathetar.... I was bleeding inside somewhere and had an infection...but all is good it just figures I had this setback....tomorrow Wed june 29th will be 9 weeks post op and I feel good still... but no way would I or could I go fishing on a boat or do any other physical things...I have taken my 6 yr old son fishing but at a pond and small lake from a pier which was very easy I just tired after an hour....I still have some bad numbness in my upper thighs and across from like hip to hip at the top of my but and bottom of incision and have been told this may never go away due to all 3 surgeries It may be damaged so that sucks...I also still have this dead left lower leg and foot from about my left calf to toes just feels dead 24/7 so when I walk it feels like I have to drag me left foot with me which I have gotten use to over the past 3 yr's but overall the surgery was a sucess and I am happy I did it...I can feel I will never be the same as being 45 soon 46 I can just tell my body has been through to much but I am in PT now and walk every day and I cannot wait for the day I can go deer hunting again with shotgun and muzzleloader and also bowhunt and get back on a charter boat or go salmon fishing up in Pulaski...lol...it will happen but not for a while....take it east you have to much to lose good luck and keep in touch...

 
Old 06-28-2011, 06:48 AM   #9
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Re: L3 L4 L5 S1 fusion

Even if your recent fusion had gone perfectly, it would still be very early in your recovery, and your activities would still be limited.

Everyone having spine surgery needs to know going in that they will "never be the same" post surgery as they were prior to the point of back injury or advent of pain. Some people are lucky and are able to get close...but once the spine is operated on, it is never the same.

Good luck with your recovery. You had a set-back at the very beginning, but you can now continue on with your healing, being careful to follow all your surgeon's instructions. Just remember to walk and rest. These are the two most important activities for you at this point in recovery!

 
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