L5/S1 ALIF + PLIF, Foraminal Stenosis + DDD - Thoughts?

Apr 21, 2014

Posting on behalf of my father. He is 48 years old and developed severe back pain and leg pain from Feb this year. We've been to a spine surgeon specialist and have been getting some advice. We have been given a nerve root block (steroid injection) and we tried conservative treatment (swimming + physiotheraphy) for 6-7 weeks but the condition has not improved. It is looking like we need to take surgical action as I can't image what type of pain he goes through every day. He is currently off work and on Lyrica 25mg + panadeine forte (basically tylenol a bit of codeine).

Here are the MRI findings for his lumbar back summarised:

* L2/3 - mild broad based disc bulge, minimal impingement on thecal sac.

* L3/4 - mild broad based disc bulge, minimal impingement on thecal sac. Mild narrowing of neural exit foramina on the left.

* L4/5 - broad based disc bulge, right para foraminal bilateral annular tear. Bilateral facet joint hypertrophy noted. Mild narrowing of the neural exit foramina bilaterally with potential irritation on exiting L4 nerve root weight bearing.

* L5/S1 - broad based disc bulge with facet joint hypertrophy causing mild impingement on the thecal sac. Narrowing neural exit foramina on left with potential impingement on left L5 nerve root. Mild narrowing on the right with potential impingement of exiting L5 nerve root weight bearing.

The surgeon has told us that it is basically bilateral foraminal stenosis on L5/S1 due to the disc degeneration on the L5/S1 level that is causing the back pain and the sciatica. He wishes to fuse L5/S1 anterior and posterior. There will be instrumentation (rods, screws, wedge). I was wondering if there was anyone out there with similar problems who elected for surgery. If so, how did it go and how much of the pain went away.

Also concerned if the 1 level fusion is actually sufficient upon reading some posts on this forum and the internet. I'm quite scared at this stage and my father even more so. However, the pain is really getting to him and I understand that we are left with no choice.

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ALIF / PLIF :: 3 Days Post-Op - L5-S1

Surgery was 'success' they were originally planning on putting a bracket on the posterior side but said my bone structure wouldn't allow it or something.

So it was mainly an ALIF but they did go through the back to do some bone grafting, so I have incisions on both sides.

So far so good on recovery, obviously very ginger but have been up and moving since 24 hours after and was in hospital for 2 1/2 days.

Have used painkillers when needed but I plan to take it very easy and not push anything. Doing my regular exercises / walking each day has worn me out pretty good but overall so far so good. ANy questions let me know and I will keep updating this thread over the next couple weeks.

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Back Issues :: Anyone ALIF And PLIF Revision?

Would like to hear from someone who has had ALIF and PLIF surgery, especially if it was a revision. I joined this board 10 years ago as I was anticipating my first lumbar fusion (L5/L6 and L6/S1 with rods and screws). It was so helpful to me. Now, 10 years later, I am facing more surgery. CT Myelogram shows that my screws have come loose and are moving, my fusion at L6/S1 is no longer fused, and my L4/L5 now has so much stenosis that it is pinching nerves. [Yes, I have 6 fully formed lumbar vertebrae, so that makes it a little confusing.] I have an appt in 2 weeks with the back surgeon to go over details about the surgery. He has already told me that he would plan to go in through the abdomen and through the back, and also get bone graft from my hip. So I think that means 3 incisions. I can't imagine the recovery from that many incisions. Can anyone share anything to help me prepare? Has anyone had successful surgery of this type? I don't see any alternative to surgery, since my hardware is wiggling around.

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Spinal Cord :: Neck Pain After 1 Year- L3-S1 ALIF PLIF

I am new to the board and am now one year out from lumbar fusion. I am a very physical person and a Personal Trainer as well. My low back pain has all but disappeared however neck and shoulder pain,stiffness and numbness are very concerning !!! I am currently treating with acupuncture and muscle relaxers. I also am a chronic migraine sufferer and believe this is partially being caused by cervical issues.

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Spinal Cord :: Neural Foraminal Narrowing

Neck pain for years, suddenly got very bad 6 months ago. I am an active 61 year old woman, have worked as a checker almost 20 years in very busy supermarket. Lots of repetitive lifting and scanning, the constant lifting hurts, I can feel the stress on my neck and am wondering if continuing this is just aggravating the problem or possibly making it worse. Along with the significant cervical pain I am also experiencing paresthesia in both hands with burning also in right hand. This has been for at least 5 years. No arm pain so don't know if this could be radicular. Left toes also have pins and needles.

My MRI follows:-

minimal grade 1 spondylolisthesis of C2on C3 and C7 on T1
moderate to severe disk space narrowing from C3-C7, mild at C7-T1 and C2-C3
multilevel DDD and spondylosis. Mild to mod. facet arthropathy also noted.
At C6-7 spondylosis and disk bulging causing cord indentation and bilateral neural foraminal narrowing rt. greater than lft.
Visualized sp. cord normal in caliber and signal

straightening of normal cervical lordosis. DDD causing cord indentation at C34. C45, C56 and C67. Neural foraminal narrowing which is most sig. at C45, C56 and C67. Facet osteoarthritis on the left at C23 with surrounding reactive bone marrow edema.

I am wondering what is difference between cord indentation and cord compression. I see compression often on boards so maybe indentation is not so bad. Is this a normal MRI for a 61 year old? What about the paresthesia and burning hands? I would love to hear from Web Dozer and anyone else who could shed light on this.

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Cataflam Can Be Taken For Spinal Stenosis?

My mother has spinal stenosis and next month she will go to surgery. But, she has terrible pains. Her doctor prescribed her Codeine, but this drug does not help her. Is there some other drug which will help her to get rid of these pains?

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Tracheal Resection Due To Stenosis

I have Tracheal Stenosis (narrowing of the windpipe) and I'm hoping to get an operation called a resection wherein the narrowed section of windpipe is removed and then rejoined again....

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Foreaminal Narrowing Means Spinal Stenosis?

What does "mild foraminal narrowing" mean on an MRI result? VA clinic denies that my husband's MRI results show any abnormalities, yet MRI results list cervical foraminal narrowing and thoracic osteophytes Doesn't foraminal narrowing MEAN spinal stenosis of some degree? Why does the clinic insist they see nothing wrong on the MRI? Thank you for your help, this back pain battle is 4 years in the running now

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Walking With Arthritis, Stenosis And Synovial Cysts

One of my great loves is walking. I love walking and love walking my dogs and not only that they expect a walk every day! However, I have along with all my spine issues (arthritis, stenosis), I also have three synovial cysts at the L3/4 level. I have a very consistent pattern, I start out the walk great, but by the end of the walk I am in such pain and with very painful spasms.

I am be followed by my pain management specialist who has been doing regular epidural injections, unfortunately there is so much scar tissue it is difficult to give me the injection on one side of the lumbar spine and I am finding the injections are lasting less and less time. The other problem I have is with my left knee and and am seeing an orthopedic specialist for this and just received a Synvisc injection. I am still dealing with a lot of pain in my knee - sometimes I feel like I am falling apart!

The problem I have is I know my basically my next steps would surgery for my spine to remove the cysts and surgery on my knee (not sure what procedure my orthopedic surgeon has in mind). Maybe, I'm just over thinking this - it is just awful to have multiple pain issues. I am just wondering how I would prioritize. At this time it would seem like the lumber spine is the priority, because sometimes I can't even roll over in bed without my husband helping. I am worried what I will like in 15 years - it is a scary thought. :sad: BTW - One thing both of my Doctors have suggested is a stationary bike and I understand that for exercise and it takes the pressure off the knee and spine, however I love getting out and walking with my dogs it is one of pleasures that I don't want to lose - even if I have to crawl home at the end of the walk.

Addition (Added 3/25/14) - Also, I am wondering if anyone has any suggestions to keep me walking - I understand my Doctor's viewpoint that other exercise options are easier on the spine (eg, stationary bike), however I just don't want to give up my daily walk. I am just wondering if there is anything that might help stop the spasms or reduce them.

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Erectile Dysfunction :: Due To Stenosis / Urethral Stricture And Testosterone

I had stenosis/stricture urethra (N35) and some urinary infection because of it during a period of 2 years while doctors didn't give me right diagnosis.

Consequence is low testosterone and erectile dysfunction.

At the end they managed to discover the true problem and performed uretrotomia etc.

I still have erectile dysfunction and low testosterone and I am getting treatment because of it.

Is this condition curable and how long will it take me to recover testosterone and be cured of erectile dysfunction?

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Lumbar Spinal Stenosis? Pain In My Hips - Difficulty Climbing Stairs

I've been suffering with pains in my hips, causing problems with walking and standing. On a bad day the stairs are difficult to climb. This has been going on for about a year now. In the last 6 months or so I have developed a sciatic like pain, only happening when standing up and walking to far. The last few days it's been getting worse and I now have pins and needles in my legs and feet. Sometimes both legs but mostly my left. The sciatic pain is only ever in the left side of my buttock. When I try to stand, I am simply unable to put any weight onto my left leg for a while. I'm 31 years old and a mother to 4 plus work. The doctors keep brushing me off because of my age but I'm sure what I am experiencing isn't right.

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Anything To Help Neuropathy After ALIF Surgery?

Has anyone found anything to help neuropathy after ALIF surgery? It has been 19 months and the pain is increasing. I cannot bear to wear anything except the loosest of clothing, I cannot walk without a cane or walker, I have new bowel and bladder function problems within the last 3 months. Is there anything that would even work temporarily to allow an airport ride? I buy even groceries online. I am in pain management with a respected doctor. I have have PT, water PT, massage, acupuncture, and narcotic medication. The fusion on L4/L5 and L5/S1 is fine; my life is not worth living.

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Pain Management :: After ALIF

I have asked to be removed from all pain medications as they were not helping at all and did not want to just keep increasing dosage. So my PM Dr. suggested i try Ativan or Diazepam before bed and also a muscle relaxant  called Baclofen for spasms during the day (which i had been on in 2013) it did not work, but he insists on trying it over the Soma 350mg i had been on before the surgery.... any input

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ALIF Surgery :: Share Your Experience

I am finally on my way to getting a long awaited L4-L5 Fusion. My doc decided on ALIF due to my previous L4/L5 Laminectomy (2003) creating a lot of scar tissue. That surgery was done posterior and it would not be a good thing to reopen the same L/4 area. I am relieved that this fusion is finally being done. My disc is about 98% gone and I deal with bone on bone pain daily in addition to bone spurs and osteoarthritis. However, I tolerate it pretty well. In addition to the L4/L5 issue, I also have 2 herniations in my neck and another few in my mid back. But these are secondary to my initial problem and need to take care of this fusion first and foremost. I read a lot of negatives about fusions on this board, but I try my best to think positively. Everyone is different and not every situation is similar. My plan is to help anyone I can with my experience and give support. I will try to post my progress after surgery. If anyone had recently (2013) had a ALIF fusion on L4/L5, I would like to hear about your experience. This will be a journey that I will not forget and I am planning on making it the best I can given the circumstances.

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ALIF :: No Back Pain After The Surgery

8 days ago I had ALIF surgery on L5-S1 disc. I can not get over how good my back feels. I never thought that I would be pain free again. I spent the last 2 1/2 years in extreme pain, I had tried everything to relieve the pain but nothing seemed to help even a bit. I had been taking 10/325 norco 4-5 times a day. Now after surgery I have absolutely no back pain, I do however have some discomfort in the stomach area from the incision. I go to get my stitches out in 6 days and still have 3 weeks before I go back to the surgeon for my follow up. I am hoping he will let me go back to work after my follow up. I know that all surgeries are not this textbook but for me it was remarkable. I am hoping that I can do some kind of working out once I have total fusion. I have put on 35 pounds over the last 2 1/2 years and have not been able to exercise. I hope others have had such great success with this surgery.

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ALIF Surgery :: After A Week - Pre-op Advice?

I have my ALIF L5/S1 Fusion scheduled for Nov. 3rd which is about a week away and I am very nervous/anxious/scared ********/relieved to be having it done. I'm just looking for any advice as to what to expect and also any advice on what to bring to the hospital to help out along the way in recovery.

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Spine Surgery, ALIF At L4 &5 - S1 :: Leg Cramps

I am 18 months out from my 4 th spine surgery, ALIF at L4&5-s1. The surgery has been a huge success, no back pain and only occasional mild aching in my legs with ibuprofen for pain control as needed.

My problem is the continuing cramping in my foot, calf, back of the thigh and buttock on the affected side. One or more of those areas cramp multiple times a day. I lay in bed at night and can feel the Calf muscle twitching, have to keep my foot flexed to prevent cramping. As soon as I doze off, my foot relaxes and the calf immediately cramps, meaning I have to get up and walk to stop the cramping. Anyone else have this issue? Any insight? Muscle relaxants have only minimal effect, and I hate the thought of taking them every night. The problem intensifies the more exercise I get, which is discouraging.

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Still Pain On Back Of My Thighs After ALIF Surgery

Had ALIF surgery almost 3 weeks ago and now bad leg pain on back of my thighs and under left knee. Is this common and when will go away. Back pains I knew but leg is bad.

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Back Issues :: ALIF Cold Foot

I had ALIF L5S1 revision surgery on 12-4-2014

To repair a failure to fuse after TLIF

In 2012. The past week my left foot at various times during day is ice cold. I started using a digital thermometer to measure and the bottom of my left foot would be 84 degree at same time my right foot is 97degree. My left leg and foot is the leg I have had problems for years along with my back pain. My left foot will return to normal temperature and then get ice cold again. I cannot figure a specific behavior pattern that may cause this. Anyone have any ideas? I am having usual back and leg pain as well.

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Backache :: 3 Weeks Post Double ALIF

Had this op performed by Mr Reece at Queen Elizabeth Hospital in Glasgow just over 3 weeks ago. I have 8 screws and two cages in my disc space packed with synthetic bone grafts and injected with bone marrow taken from my vertebrae.

I was up walking the same day, baby steps buy nonetheless, walking. I was in hospital for 4 days (I would have been out earlier if my bowels had moved sooner).

The first 2 weeks were pretty uncomfortable. Very sore to move as the front stomach wound was very swollen and tight. Once this initial period passed things became easier.

I can now get up from lying in bed or on the couch without much pain, it's still there in the background but not all controlling.

I'm walking everyday, not far but doing this a number of times.

I'm taking this recovery very slowly as this is last go at resolving my back pain after having two previous surgeries on the same site (S1-L4).

Only sitting for very brief spells, not driving yet due to wound, plus sitting does bring on the pain. I have had some nerve pain down my left leg, probably every few days or so but it settles after some meds.

I am still on my nerve pain meds as the damage from previous surgeries won't be fixed by the op. Also still on Dihydrocodeine 60mg X 4 daily but I'll try and reduce these over the coming months.

Would I say that it's been successful? Yes! I have greatly reduced back pain which was my dominant pain source.

It is a major decision to have this op but I had been through all conservative methods previously which didn't assist at all.

Hopefully things will continue to improve over the coming weeks and months. I'll report back over this timescale.

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Low Grade Fever Three Weeks Post ALIF (l5/s1)

I had surgery exactly three weeks ago. I developed a fever (99.9-101.8) in the hospital two or three days post op. They gave me antibacterial iv and oral meds from the surgery on. As I developed the fever, they gave me antiviral medication to treat a huge and painful fever blister I developed just two days after surgery thinking that this sore was the culprit. The fever had gone down to low grade but now i'm concerned because it does not want to go away. Im taking Norco and the tylenol in it keeps the fever below low grade but when I don't take Norco ( which i take less and less) the fever and chills/ night sweats keep returning. It is generally starting at noon or afternoon, almost always present in the evenings. Usually 99.5-100.5.

Im very worried that it can be some kind of a stubborn infection. I'm three weeks after surgery, i should not have a temp at all. Plus I'm not fever prone, i hardly ever had a fever in my life, flu or any other illness i pull thru with no temps.

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