Hi everyone. I haven’t posted on this page in a long time but I’m asking this for my step-son who’s back has been deteriorating for a very long time. It’s gotten so bad that he’s now getting serious about surgery and he has an appointment to an intitial consult at UCSD spine clinic.
This is from his MRI report;
Low back pain with extension along the bilateral posterior thighs. History of spinal canal stenosis at L4-L5.
Redemonstrated is slightly increased levoconvex curvature of the lower lumbar spine with increased narrowing of the right L4-L5 disc space. Additional slightly increased straightening of the normal cervical lordosis. Slightly increased grade 1 anterolisthesis of L4 on L5 measuring 4 mm. Similar minimal retrolisthesis of L5 on S1.
L2-L3: Findings not significantly changed. Tiny disc bulge, mild bilateral facet arthropathy, and ligamentum flavum thickening. Mild canal stenosis. No significant foraminal stenosis.
L3-L4: Findings not significantly changed. Tiny disc bulge, moderate bilateral facet arthropathy, ligamentum flavum thickening. Mild canal stenosis. Mild right and no significant le foraminal stenosis.
L4-L5: Increased 3-4 mm of anterolisthesis (previously 2 mm), severe canal stenosis that has increased, with slightly increased crowding/probable compression of the cauda equina nerve roots, including of the bilateral descending L5 nerve roots. Similar moderate right foraminal stenosis and mild-to-moderate left foraminal stenosis.
L5-S1: Similar disc bulge with superimposed and increased broad base le subarticular-to-foraminal disc protrusion with further narrowing of the le subarticular zone with contact and possible compression of the descending le S1 nerve roots. Similar mild-to-moderate bilateral facet arthropathy. Similar mild-to-moderate right foraminal stenosis. Slightly increased now moderate-to-severe le stenosis with contact and possible slight compression of the exiting le L5 nerve root.
So, has anyone here had spinal fusion surgery? If you have, how did it work out? Did you return to competing?
I like to get thing fixed. I think he should have the surgery. He will appreciate any advice you can give him.
So, a few disclaimers here.
Firstly, I am an MD and work regularly in an interventional pain practice which has most of its work being lumbar and cervical spine pathology.
Secondly, I also have a completely screwed back, with scans at least on par, if not worse, than what you are relaying here.
My advice to you/him-spinal surgery should generally be seen in the majority of people as a last resort, when you have exhausted all other treatment approaches (unless there is a lesion which is clearly better suited to immediate surgical management, which does happen with some massive disc prolapses).
Fusions can be relatively straightforward, but depending on what the surgeons are considering it may require an anterior approach (for L5/S1) and that is a very big operation in itself.
He does have some spondylolisthesis, which can require a fusion to realign or prevent ongoing slipping.
He certainly has enough pathology to account for the symptoms he is getting.
With my back, we are doing all we can to avoid needing to have an operation (fusion), as the outcomes are far from assured and you can end up worse off. A good surgeon will only operate when either clearly indicated initially, or when there has been decent trials of other less invasive options (these can be physio, CT or X-ray guided injections, pilates etc). With my back, the surgeons have seen my scans etc, but it is only when my specialist says yes, we have reached that point, will I then go and see them to talk about surgery. She literally, has my “back”.
My issue was nowhere near his but in June 2021 I had a c6c7 ACDF surgery. I was in a really bad place. It was the best decision i ever made. 350 days post surgery I finished Eagleman with a lifetime best time for a half. It was a long road of recovery but doable. Now I imagine lower in the back could be more issues especially with riding but my dr agreed that the better shape you are going in definitely helps the outcome.
My issue was nowhere near his but in June 2021 I had a c6c7 ACDF surgery. I was in a really bad place. It was the best decision i ever made. 350 days post surgery I finished Eagleman with a lifetime best time for a half. It was a long road of recovery but doable. Now I imagine lower in the back could be more issues especially with riding but my dr agreed that the better shape you are going in definitely helps the outcome.
Just for the OP’s and Matt’s benefit.
Lumbar versus cervical fusions are very different beasts.
I only say this as when these sorts of discussions come up in relation to spinal pathology it is important to get feedback from people who have had similar pathology at the same/similar level of the spine.
I don’t mean any of this to cause offence to klorene, just to ensure the OP has accurate information.
For the OP as well-there are a number of FB groups dedicated to these issues. They can be a very useful source of information.
Understood. That’s why I prefaced with mine not the same. I know people that have had successful recoveries of lower back surgeries as well…but none were athletes. I still find it amazing that in America most of these procedures are outpatient surgeries.
I had my procedure at 7am and was at home on my recliner by 3pm.
Understood. That’s why I prefaced with mine not the same. I know people that have had successful recoveries of lower back surgeries as well…but none were athletes. I still find it amazing that in America most of these procedures are outpatient surgeries.
I had my procedure at 7am and was at home on my recliner by 3pm.
Thank you, I was hoping my comment came across with the utmost respect, as it was intended.
How have you gone post your surgery??
I often say to my patients that one of the most dangerous things you can do in life is be admitted to hospital…when you look at the avoidable “harm” that occurs from being admitted you really only want to be in hospital if you absolutely need it.
I have not worked in the USA but agree, it is amazing that they do these procedures as outpatient procedures. In the country I work in this is quite different, and we supposedly have one of the best health care systems in the world (Australia).
My daughter had spinal fusion surgery in 2019 for problems around scoliosis. For her it was a last resort. The cob angle was over 75%, she was in pain most of the time and had reduced lung capacity. It affected her club swimming and she quit running as the ck dition worsened. She had the surgery, it went very well, her quality of life improved significantly and she has zero regrets. Recovery is a long one on this kind of surgery. A week in hospital post op before novong home with restrictions on what she could do. She was able to get back into swimming post lockdown. She quit not long after when she went to university so I can’t give any real, long term feedback on performance post surgery .
I’d be happy to pass on more detailed experiences if relevant but it is a very different situation to your step son’s. I think we’re in a different country as well (UK). Your consultant really is your go to person and can talk about the individual case. They should be able to provide honest answers to any questions about the risks of the surgery, possible negative outcomes when the surgery goes well or otherwise, recovery timelines, possible complications and prognosis for returning to sport post surgery. I agree with the comments about finding groups for people with the same medical condition, gone through the same procedure have gone through the same orocedure and shared their experiences. It all helps to get a better idea of how it all works and extra issues to question the consultant on. Our consultant was able to put us in contact with people who had been through the same procedure for scoliosis to share their own experiences. It’s may be something your consultant can help with.
Thanks everyone. Matt sees the doctor on the 24th. He’s in a lot of pain and he’s very close to going ahead with the surgery. My wife is very worried, but if it was me I’d have it done.
Thank you for your response. This reply is from Jim’s wife, Michelle. Jim states he does not know the person you referred to who had spinal fusion, nor how to contact him. Do you have any suggestions on how I can try and reach him here on the forum?
This is from Jim Sweeney’s wife, Michelle. Thank you for your reply to his post. I did join several Facebook fusion groups and boy are they scary. I found one triathlete, Carsten S. Larsen who posted his success after 2 years from his fusion. Very inspirational. Many other posts are filled with long term complications, spasms and pain. Tough stuff.
Has he been able to spend any time doing physical therapy? It’s something that I’ve had to live with now for the last 4-5 months since my back injury (L5-S1), but I am able to ride my bike again and train. If I take more than two weeks off from my stretching and exercise off the bike then the pain begins the come back a little bit for me. You can always go back and do the surgery, but you can’t undo the surgery once it’s done. Unless I injure myself significantly again, I will continue to do my stretches and exercises that keep the pain away.
It took about 2-3 months of everyday pain, it really hurt my quality of life. At first I couldn’t even walk. But in time the pain got less and less, I was getting more flexible again (not nearly to that of a normal person, but the improvement was clearly there), because I stayed persistent with my routine. I will say it looks like his injuries are worse than mine, but I would still implore him to consider physical therapy first. If he hasn’t already spent a significant amount of time (2 months at least) doing physical therapy and being consistent with the work outs and stretches every single day at home (and I mean every single day, no skipping if you want to really improve), then I would implore him to try this route before taking the plunge to do surgery. If the results aren’t showing at all in 2 months, then I would consider the surgery again. Believe me, I get it. He just wants the pain to go away, and the fact is that the fastest way to do that is the surgery. But, it comes with it’s risks so that’s why I choose to not jump into it.
If he decides to get the surgery, he may not have any issues at all, and I think that is the case for most people. The people you find on the Facebook groups are going to be the loud minority of people who are still in pain post-surgery. I imagine for most people, when the pain goes away, they just continue on with their lives and be less likely to join those Facebook groups.
Please note that I am not a medical doctor and I am only able to speak from my personal experiences.
For reference I’m 6’5" and 28 years old, and these were my MRI results:
Thank you. I appreciate your response and totally respect your commitment to PT for pain management/improvement. I will pass on this info. I hope you are pain free forever!
From Michelle, Jim’s wife, Matt’s mother. I too have similar back pathology but I refuse to have fusion since I can still run, swim and deal with the daily pain/ discomfort, while bending, lifting etc. I manage with occasional NSAIDS and cortisone injections when needed for my extreme sciatic pain- every few years.
I had a spinal f
usion in 2010 after a bad motorcycle accident when I fractured my spine. I can’t tell you much about exactly what was done because it happened in Norway and I lived in Sweden at the time and I can’t find any of the medical records. I was basically paralyzed from the waist down and was air lifted to the hospital where they did the fusion.
I used to be a pretty competitive triathlete but had not done much five years prior to the accident so my baseline of what I wanted to get back to was much lower. My objective was to run a marathon in 2011 and I did. The recovery was long and I remember feeling like I was literally re-learning how to walk and run but I kept track of my progress which helped a lot with motivation to keep going. I have never been able to run pain free but I’ve found that age is more of a limiting factor than my fusion.
Below are images of my fusion for reference. Happy to answer any questions about my experience.
Thank you for your response. This reply is from Jim’s wife, Michelle. Jim states he does not know the person you referred to who had spinal fusion, nor how to contact him. Do you have any suggestions on how I can try and reach him here on the forum?
Hi Michelle,
HalfSpeed is a Slowtwitch forum member. He’s a really good swimmer. I’ll message him suggesting he look at this thread. Feel free to give me your email too (you can click my username and send me a private message) and I can put you in touch that way.
You can also message him yourself - search “HalfSpeed” and if a thread by him doesn’t pop up, click a “Swim thread” from, say, August 2021 and he will have replied to that, so you can click his name and message him that way.
-Allison
Thanks TC. My diagnosis was very similar with the problems stemming from scoliosis. Surgery should be last resort, for sure. I started my path when my right leg went numb and I lost some motor control. After some PT work it was better, but not by much and I’d have relapses. Moved up to Cortisone epidurals to both my spine and some facets that had virtually nothing left between them. Over a couple of years, this helped. I asked my pain management doc how long I could continue this. He said as long as it works. That day came and now I was looking at surgery. I had an 8mm disc protrusion at L2-L3. We fixed that using an ILIF fixture and I was good for several years, doing some of my best racing.
One day, at the beach, swimming in, I got hit by a wave at just the wrong angle. I could hear and feel a pop in my back. I couldn’t straighten up and had to be helped up the beach. MRI revealed a huge mess (all the same technical issues the OP has) and I got booked into surgery pretty rapidly to have the ILIF removed and replaced with rods and pedicle screws from L3 to L5.
Surprisingly, after a quick recovery, I could still compete about the same. That lasted about 6 months. I don’t know what happened, but I was in excruciating pain. Back in for emergency surgery. Rods and screws removed and replaced with new ones spanning only L4-L5. The other screws had come loose, causing more problems than solving.
I healed again pretty quick, but this time, I had lost running speed. I can’t pin it, but I was a sub-20 5k and now it would be wonderful if I could break 27. But, while I still have pain, it’s much subdued.
I have other issues that have slowed me down – two heart ablations for a-fib and likely a third will be needed. Some left hip arthritis. And recently, while gravel biking, I wrecked my right shoulder – torn rotator cuff and frayed ligaments. That always hurts. Had two cortisone shots so far and a lot of PT. Was told it won’t ever heal and the surgery recommended will cure the pain and end my athletic endeavors. A total reverse shoulder replacement. Going to continue on as long as possible. It hasn’t affected my swimming too much, but I’m afraid of what choppy water, big waves and kelp crawls might wreck it more. Just hanging in there.
So yeah, when nothing else works, surgery, but realize it’s a hit or miss and be prepared to accept the possible outcome.
