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L5-S1 fusion...

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  • L5-S1 fusion...

    I'm getting that done in a few weeks. After dealing conservatively with the condition for 6 years, it's come to the point that fusion will be a good choice. Well, it doesn't feel good, more like scary - but my successful pain reduction regime is not working anymore so time to accept surgery

    I'm not concerned about getting back to riding, it's been off the plate for the last three years or so and I've accepted that. If I can ride a bit, great, but we've switched to driving...so am quite happy there. But today is a blue day (must be the March snowstorm) and need to hear from others who have been through the procedure. How did you feel afterwards? How did the lumbar corset work out for you? What level of activity were you able to regain and what kind of time frame? I was addicted to yoga and it brought a significant amount of relief (until the disc degenerated more) and sure hope I can get back to that... Were you able to get back to simple farm chores post surgical recovery? Need to hear from some horsie folks...Encouragement welcomed!
    Home of well loved ponies...

  • #2
    This is cut & pasted from a previous post: I had my first fusion in 2001 (I was 22 years old). L5-S1 was fused; had 4 pedicle screws placed with vertical rods connecting them. They did take a block of bone from my iliac crest (back of pelvic bone) as a bone graft - that was the worst part of the recovery. The back felt better long before the pelvis did.

    My second fusion was in 2004. This time they fused L4-L5. The S1 pedicle screws were removed as that fusion was solid and they weren't needed. They used the existing L5 pedicle screws, added screws to L4 and placed vertical rods and a horizontal crosspiece connecting the center of the rods. This time they removed the L4-L5 disc and placed a block of cadaver bone in it's place.

    Recovery from the second surgery was much quicker. I've had no problems since, I have excellent mobility (can still touch my toes while keeping my knees straight!), and I can ride without any problems. I do mostly dressage work with my OTTB who is prone to "Thoroughbred Moments" when he thinks something will jump out of the trees and eat him.

    I do not ride with a back brace. Both surgeons said it would not help and if anything, would hurt me in the long run as the muscles would become dependent on the brace. Strong core muscles (esp. abdominal muscles) will protect your discs above & below the fusion, not a brace. I did not have a brace or corset after either surgery.

    I do a lot of routine work around the house; gardening, bending over, waxing the cars, stacking firewood... I might be a little sore after waxing 2 cars in a day, but who wouldn't?

    I do have a patch of permanent numbness on the outside of my thigh; that's been there since the first surgery. And I do get goosebumps in odd patches on both legs....both were chalked up to nerve damage.

    One more thing: My first surgery was done by an orthopaedic surgeon who specialized in spines. My second was done by a neurosurgeon. If possible, use a neurosurgeon. My second surgery was 8.5 hours long compared to the first (3 hours) and I really feel like the neurosurgeon was very thorough and meticulous where the ortho was just concerned with finishing the surgery. You need to find a doctor (ortho or neurosurgeon) who does a LOT of fusions.

    Full recovery was about 6 months for me, but I am a very active person. If you have a desk job, I'd say 3-4 months, MAYBE two.

    Both my surgeries were done posterior (through the back). The surgery and recovery is TOUGH. I spent 5 days in the hospital each time. It was about 2 or 3 months before I was cleared to drive as I lost all the reflexes in my right leg.

    Best to you, please feel free to PM if you have any questions....

    Currently, I am waiting for a surgery date as one of the screws broke off a bit of bone that is impinging on the central spinal canal. But - it's been 8.5 years since the last fusion - and to look at me and the work I did until recently (caring for 4 horses daily, riding up to 10-12 miles), you would never know I ever had back problems.

    I do not think getting back to yoga would be a problem. Just don't do it until your doc says it's ok.

    Feel free to PM with any questions, etc...



    • #3
      I am 3 week post-op today. Had S1-L5 and L5-L4 fused with pedicle screws and rods on each level, along with an iliac bolt into my right hip.

      I spent 7 days in the hospital (more due to the blood clot I developed more than the surgery itself). I had an ortho doc do my surgery after the top Barrows Neurosurgeon here in Phoenix said that due to the position of my vertebrae, he felt it was too complex for him and referred me to an ortho doc (whom I ended up using for my surgery). So as a blanket statement, to say you need a neurosurgeon as opposed to an ortho surgeon, I would highly disagree.

      Each day is better. I was issued a back brace at my pre-op appointment, however was never told when to wear it, so I have yet to put it on. I too have lost quite a bit of motor function in my right leg and cannot walk well without a walker yet.

      I had severe nerve compression prior to the surgery and now all the nerves are firing at full force, so I am dealing more with severe nerve pain more than back pain. My nurse likened it to putting a tight rubber band around your finger for a long time. Once the rubber band comes off and your finger regains feeling, it is really sensitive for a while.

      I am very optimistic for a full recovery, including riding endurance (3-5 days in a row of 50 miles each day). The ortho surgeon I used just happened to have a brother in law who rides endurance and he seemed to think there would be no issues whatsoever in getting back to endurance riding once I was fused (6 months'ish to a year).

      I too enjoy Yoga and don't see an issue resuming once I'm walking straighter and get the nerve pain under control.

      Right now I've settled on doing minimal activity other than getting on the computer and .....looking for another horse. Yes, it's an addiction.

      Oh, and as far as "horsie chores"...I was told absolutely no bending and/or twisting for 3 months in order for the fusion to "set up" if you will. I also was instructed not to lift more than 5 pounds. That took away most of my horse chores which are now delegated to my barn boy, ahem, husband. I did feed lunch yesterday though (1/2 flake to each pony which were under 5 pounds!)

      I wish you luck! Let us know how it goes or feel free to PM me and we can commiserate together since you won't be that far behind me!


      • Original Poster

        Oh, thank you SO much sign of Grace and tarynls!! Both your situations sound eerily similar to mine. I will PM you, no worries - it'll be so nice to chat with people who has been through it AND who are horse-active.

        I have also heard the neuro vs. ortho debate as well, but the ortho surgeon I have does 3 or 4 operations a week so I'm feeling quite confident with him (and my family doc thinks very highly of him too).

        Once again, thanks for sharing your stories and offering your support...you have made my day
        Home of well loved ponies...


        • #5
          S1-T10 fusion speaking, at just about 6 months post surgery.

          Fusion was for scoliosis that had been getting progressively worse. Vertebra were collapsing along with the angle worsening.

          I had an ortho do mine. From what I understand neuro's used to do the scoliosis surgeries but would have to bring in ortho do to the bone work until finally ortho's started just doing the surgeries themselves.

          My surgery was actually 2 surgeries over 2 days. Day one was the anterior work to insert the spacers (L1-L5). The spine exposure work was done by an internal med surgeon. Day two was the fusion (rods/screws/etc) work from the back. Each was about 11-12 hours of surgery.

          Got rid of the clamshell brace at 5 months after being cleared by surgeon.

          I am currently dealing with the after effects of nerve compression so just learning how to stand up again and progressing to walking. Have been also doing the physio ball to relearn balance and core muscles.

          Presurgery nerve pain from the disc degeneration is gone. My back is STRAIGHT!!!

          Some nerve pain still from the nerves healing and 'reconnecting' after the compression damage.

          Let me know if you have any questions
          You can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something… S. Jobs


          • Original Poster

            Wow, that is a lot of fusion...I'll be cheering for you . Thanks so much for sharing Where'sMyWhite!!
            Home of well loved ponies...


            • #7
              Tc, good luck with yours. No way to know in advance but I don't think you'll regret it. Just do all therapy as directed and follow all cautions as specified by the surgeon.
              You can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something… S. Jobs


              • #8
                I will be six months post-op on the 24th for an L4-S1 laminetomy/facetectomy and fusion. I have six pedicle screws with connecting rods. If you look at my x-rays, it looks like I have a hole in my spine, they took out so much bone (no more facet joints, laminar or spinous processes). I had a combination of problems - hyperlordosis with resultant spondylolisthesis (the L4 vertebra was actually sliding forward, causing stenosis and horrid arthritic changes in the facet joints), and the disc at L5-S1 went from "bulging" to ruptured. Looked like a squished jelly donut on the MRI.

                I had managed the pain successfully for a long time - about six years. Right up until the disc let go, I was riding three or four times a week. Sciatica was a way of life, but the only time I was relatively pain-free was in the saddle. Funny, that. I guess it was just that the hip angle and way I was sitting took the pressure off the nerves. Anyway, in the six months prior to the disc rupture, I had been having worsening neurologic symptoms. I knew something was going on ... but stop riding? Who, me? Nah.

                I had a wonderful spine surgeon - orthopedic - who put me back together. He had operated on my 85-year-old father just six months earlier. Dad fell, fractured his spine all the way thru at T-4/T-5, and this doc saved him from paralysis. Dad's now toodling around with his walker. Dad ended up fused from T-2 to T-10, with rods and 16 screws. Anyway, I trusted this doctor absolutely, and the spine unit at the hospital was wonderful.

                I feel great now. I was out of my brace at 3 months (Christmas Eve), and I started physical therapy in January. The therapists just discharged me. I have no pain anymore, only a slight loss of sensation in the heel of my right foot. Considering the pain I was in before, I'll take the small residual numbness. I'm getting ready to get back on a horse, starting in April. I'm just going to take it slow, and build back up.

                I second the advice on do your therapy as directed, strengthen your core, and follow your surgeon's direction. I'm not going to kid you and say it was easy - it wasn't. Muscles can be vindictive! And in the first few weeks post-op, there are days that feel like hell. But for me, every day was progressively better. I think it was really at about 3 months that I started to feel normal again.

                Good luck! PM me if you'd like. Fusion ain't easy to go through, but if done right, the relief is well worth it.
                Why do I like most horses better than most people?


                • #9
                  ShaSamour---thanks for your story. I don't mean to take over the OP's post, but I enjoy reading the "come back" recovery stories as well, since I'm only at week 3 post-op.

                  TwinCity, when do you go in actually? I'll be praying for a complete recovery for you. FYI, first couple days SUCK. No other way to say it. But it *will* get better!!


                  • Original Poster

                    ShaSamour - thanks so much for sharing your story too. Awesome that you are getting back to riding, I'll be cheering you on from Alberta

                    sign of Grace - April 18th is the day! Some days are really good, and then when the nerve gets tweaked, boy, it really re-inforces that the decision is a good one. And yes, not looking forward to the first month or so, but my daughter (the newly graduated nurse) will be around to take care of her mom and husband now works closer to home so lots of help!

                    I have a mare due to foal May 7th, so timing of the surgery wasn't great, but lots of friends are around to help me out. Love, love, love them!
                    Home of well loved ponies...


                    • #11
                      TwinCity, we'll also be recovering together. I just got the call that surgery to remove all the L4-L5 hardware, find the bone chip & remove it, "clean things up" around the nerves and explore the L5-S1 disc (fused, but they did not remove the disc & it's herniated) will be on April 17.

                      So I'll get my hardware out and you'll get yours put in the next day. I'll be thinking of you.

                      Best wishes!


                      • Original Poster

                        I'll have a surgery buddy!! Best wishes - and will be thinking of you on the 17th!
                        Home of well loved ponies...


                        • #13
                          Taryn and TC, best of luck to both of you! I'll be sure to jingle the ol' curb chain for you both!
                          Why do I like most horses better than most people?


                          • #14
                            Hi guys,
                            I thought I'd just give you a little update: I rode for the first time yesterday. I did about half an hour of walk-trot, and I felt really good. I was surprised that my legs weren't like jello, and my core felt very stable. And best of all, I had no discomfort while riding, and I'm not feeling any this morning, about 24 hours post-ride. I really felt like I'd never been out of the tack. I just have to be careful not to overdo it.

                            I'm convinced the physical therapy did wonders to get me ready. So do your exercises, and push yourself as much as you can (within reason). Walk as much as you can, and do your core exercises as often as possible.

                            I'll be thinking of you both on the 17th! And if you have any questions or need encouragement, just send me a PM!
                            Why do I like most horses better than most people?


                            • Original Poster

                              Good to hear!

                              Awesome to hear!!

                              As much as I'm dreading the surgery...it will be so much better than what I have now. Fortunately walking has been OK, so now that the weather is trying to melt all this extra snow we got dumped on us the last couple of weeks, I've really been trying to walk a lot...must get in some kind of shape before the 18th! Treadmill inside is OK, but just not the same as some sun and fresh air!!
                              Home of well loved ponies...


                              • #16
                                It was awfully nice to get some horsey time, now that the snow is melting off here in New Hampshire. It's my first winter in New England, lots more snow than I had imagined. In the last two weeks we got another 14" of snow. I thought it would never stop! My yard is still covered in at least 6". Ugh! But it was warm today, and I went to the barn and lunged Missy. I *really* missed my barn time!

                                I want you to know there is a light at the end of the tunnel, and it isn't the headlamp of an oncoming train. It's nice to have a little group of us, all at different stages, going through the same thing. We're all different, and will have different experiences in our recovery. But one thing is the same: horses are part of who we are, and we won't be right until we can get back to doing horses. This weekend is the first time I've felt like myself - really like myself - since the surgery. When I was in the hospital before the surgery, I thought I was done with horses, and it was devastating. I've been riding since I was 5 years old. It's part of my identity. Once I got into P/T, and told them that my goal was to get back on a horse, I felt like I had a chance at normalcy. I'm starting down that path now.

                                Sunshine, fresh air, and the smell of horses! Heaven!
                                Why do I like most horses better than most people?


                                • #17
                                  TwinCity and Tarynls--thinking about you guys!! Good luck with your upcoming surgeries!


                                  • #18
                                    Jingles and good wishes from NH! Hope your surgeries are uneventful and successful!
                                    Why do I like most horses better than most people?


                                    • #19
                                      Thanks for the good wishes. Check in time at the hospital = 6:30 am. Anxious yet more than ready to get this over with!


                                      • Original Poster

                                        tarynls - thinking of you today!!

                                        ...and thanks for all the good wishes everyone!! Like tarynls...nervous too, but I've had a few rough weeks so time to get this dealt with
                                        Home of well loved ponies...