Bone on bone at L5 S1...will it auto-fuse?

[Ravenous]

I have been dealing with low back pain like the task master I am for nearly 3 years.

I am 35 now and have a strong family history of back mayhem. I thought I had back pain until new year's morning 2009... I woke up with waves of pain and had a limp for 2 1/2 months. I saw the world's greatest PT for back pain. No imaging. I started working out after three months and lost 25 lbs and am now in the best shape of my life. It got about 85-90% better. Working out actually still makes the pain subside...for a day or two. I had and still have calf pain in the leg that had the limp...exercise makes it stop.

9 months ago things started to slowly get worse. My low back seizes up if I lay on my back or stomach. It also gets irritated if I stand still. Sitting is fine. Walking or moving around is fine. No jumping or jarring activities and if I do anything where I am leaning forward...packing boxes, my catering, pretty much any of my hobbies... It starts seizing up. Most mornings I can barely get dressed but am ok once I am up for an hour or two. Coughing will bring me to my knees. Other than having to toss and turn all night I pretty much just adjust my activities, suck it up and do what I do. I am not a still person.

Three months ago it got another notch worse. I can now do recumbent bike or mat work (abs, leg lifts, etc.). Mornings also got a little worse and catering is a little more irritating. Still not bad enough that I would go for drugs, but I notice my back all day every day. It gets exhausting.

I finally bit the bullet and went in for imaging. Multiple PTs thought it must be atrophied stabilizing muscles from the blowout since I am so active and have poor body mechanics.

Turns out I have no disc left at L5 S1 and I never saw it coming. Ortho guy said "wow, that is bone on bone" and immediately started telling me about my surgical options. I have NO other bad discs and my si joint is perfect.

It looks like it might be starting to fuse on it's own. I have some pain but it is all in my low back. No radiating pain or numbness other than my twitchy calf. What are the chances it will just auto fuse and stabilize on it's own? There is no disc left at all and it is perfectly aligned.

I think the probable fusing on one edge means disc replacement is probably a bad idea. Should I get a fusion now before it escalates further? Should I wait a bit (my personal preference)? I am doing core work with my PT. I don't want to get surgery and just trade one kind of pain for another.

Since I have no other issues with any other discs at all I fear surgery will just start a chain reaction and lead to other issues. Quite frankly the pain I feel probably is the multifidus and ligaments already. Surgery is probably not going to help...or will it. I am apparently the ideal surgical candidate.

I have too many options and all seem full of potential bad outcomes. If it is a month of recovery pain and then I can jump around again...I would do surgery. If I suck it up for a year and it is going to resolve itself...I can totally do that too. I have a circus freak high pain tolerance.

Anyone have any advise??

[mmglobal]

The fact that it's bone on bone or starting to fuse does NOT mean that you are not a good candidate for ADR. (Although you may not be for other reasons.) I have seen many completely flat, non-existant discs have successful ADR. At your age, it's probably still highly mobile even though it's flat and looks like autofusion has started. As I understand it, it may lose a lot of mobility and ultimately fuse well, but not for many many years and continued motion (even if it is micro-motion) can engage pain generators especially in systems with severe stenosis caused by the collapsed disc space and everything that goes with it.

Spine surgery should be avoided if possible, but don't rule out non-fusion options unless you've been evaluated by a quality ADR surgeon who is NOT subject to reimbursement issues or low experience level driving the recommendations.

Let me know if you want some help with your decision making.

Mark

PS... note that auto-fusion can lead to auto-adjacent segment disease, just like fusion increases the risk of adjacent segment disease. If it's not moving, it's overloading the adjacent segment, whether or not the fusion comes from surgery or nature. (however, the continued micro-motion can make it less stressful to the adjacent levels, but it may come with pain too.)

[Maria]

Ravenous,
I was 28 when first injured my spine. I had L5S1 discectomy ('89) 7 years after initial injury and L4 percutaneous discectomy several years after that. Continued probs. Worsened DDD and continuing narrowing space at L5S1 that many times was described as bone on bone but as Mark pointed out there must have been enough micro motion there that L5S1 was my worse pain generator for many a year to follow... like until 2006.

Now my L5S1 have autofused and I do have much less pain and other probs that I experienced for many a year. Not completely pain free by any stretch of the imagination because L4 is still not good and L3 has an annular tear however pretty much I do think L5S1 caused most of the pain as the autofusion seems to have greatly alleviated much of my pain/symptoms (and yet I still take a low dose opioid pain medication 1x/day for pain alleviation).

So my best guess is that you may have a good number of years where the micro movement as Mark stated could cause you pain, flare ups and symptoms that would make for a long haul waiting it out.

I'm in my late 50s now so I went from being in my late 20's with back probs to being in my early to mid 50s for this autofusion to occur. I feel it was worth it to wait however I did have surgery in between this time (2 in fact) and I think that you may still have quite a long haul in front of you re autofusion.

Get more opinions. Speak to Mark~ he helped me greatly and many others re decisions on what to do, where to go, who to see and so forth. Definately someone worth talking to!

[Ravenous]

I guess my issue is that I never saw this coming. I was sure it was just some weakened muscles. I have done everything they have told me to do and it had worked fairly well. Even my PT said she was 95% sure it was not disc related since I don't have any ratiating pain (I did in 09). Second PT concurred. The pain is more arthritic in nature and it does not hurt all the time. It only hurts when I do certain things...ok that list seems to be growing, but I can sit at my desk all day. I can walk all day.

I ran back to my family doc and he is nudging me towards accepting that surgery is likely going to be necessary (he really is wonderful). At present I am churning on all of it and am in a holding pattern to see if it is going to get better or not if I continue with exercise and PT.

The ortho guy I saw told me my surgical options and said he has done some disc replacement and of course has done hundreds of fusions. He said replacement has quicker healing time...but then said that if it is in fact already fusing on its own (it is hazy around one area) that then they would still have to do the fusion. He told me to research on the internet and let him know what I want. My family doc told me he knows nothing about replacement but if I go that route to get it done someplace that does them a lot and suggested Mayo. He said he has seen excellent and full recovery with fusions.

The idea of surgery makes me tune out the pain more. I am not a believer in quick fixes and it just seems like every person I know who has had surgery once has had to have it again and again and again.

I also keep reading that replacement at L5-S1 is the most contraindicated and that with bone on bone (keep in mind ALL my other discs are perfectly fine) that decompressing to make room for the faux disc can cause issues elsewhere.

I am fit. I find pain to be an excelent motivator. I do not have any nerve issues presently and have not since the blow out in 2009. Should I bite the inevitable bullet and get it over with or should I wait and get an x-ray every few months for a while and see if it escalates??

I am a task master and I just get things taken care of and not knowing what to do is driving me mad. Should I get a second opinion from a different ortho surgeon??

Thanks for the advise.

[Maria]

Ravenous,
I would not have a spine surgery without getting several opinions unless it was an emergency situation I had no control over. So I think what you may want to do is to look into spine surgeons that are able to offer you both options of ADR and/or fusion or see several to see if you are a candidate for either type of surgery.

You may not have had enough diagnostic tests/exams to determine yet if you're a good candidate for both ADR and fusion.

If you are motivated by pain and want to make a sound decision take the time to check out who and where to go to for a few more surgical opinions. That would be my advice.

[dshobbies]

Rav-,

Welcome to the forum. We all were/are too ignorant as to the workings of our own bodies. I had no idea you could actually injure your spine vs. the muscle spasms that continually got worse. A chiro actually forced my first emergency surgery.

Here's my advise to you. Get a second and even a third opinion from surgeons who regularly perform all options available to you. They won't recommend something they don't do.

Educate yourself as to all the benefits, side effects, pitfalls, etc. for any procedure (or not) that is available to you. Only then can you and you alone, make a decision based on your own desires and circumstances.

No back surgery comes with any guarantees and neither does doing nothing. Ask questions, do your research, find the best doctors. You need to be able to weigh all the good and bad. I do wish you luck,

Dale

[nomorepain]

I too had L4-L5 & L5-S1 bone on bone for many years, i had a laminectomy at L4-L5 @ age 24 after a botched spinal tap, and it scared me out of surgery for 30 yrs!! It collapsed shortly after my 1st surgery & the pain was incredible,ankle-foot & leg swelling,sciatic was always flaring,i limped, wore a back brace for 16hrs a day, i walked with the help of a cane and sometimes crutches,some days it hurt so bad it would put tears in my eyes...i still remember the combinations of meds to try and get any relief,no matter how small,i was a candidate for 2 prodiscs at 47,i was lucky,very lucky something was aligning in the stars,the timing,my decision to have the surgery had to be quick & i decided to put all my faith in my Surgeon who seemed to be the best of the best,he put me at ease from the first time we met,he didn't beat around the bush,he told me the risks and possible benefits,he said it might not turn out great,i might have more pain or the same pain as before surgery since i had DDD for so many years.but he did say he thought he could help me. I am in the trials here in the US,i wasn't sure until i woke up if i would have the prodiscs or a fusion.all i knew was i could no longer deal with the meds or the pain, so the moral of my story is check out all options! and be comfortable with your Docs whomever they are

[cherylstewart67]

my insurance agent's c spine fused naturally.

[epqe17]

Ravenous,

What decision did you make? Did you finally have surgery or are you still waiting for natural fusion?

I have been dealing with DDD at L5-S1 only for 5 years (local pain, paraspinal spasms, lean backward while walking).

I am about to get Botox injections into my paraspinals to try and relieve the spasms and improve my ability to walk forward (without the backward lean).

Dart

[shellywdesigns]

I don't even know where to start. I'm a F, 44 yrs old. Beginning is 1982 I had a bad fall on ice in high school that fractured my Tail Bone. In 2001 I was sent airborne on roller-skates only to land in a V shape directly on my tail end. In 2004 I fell on my tail end again on ice and slid 1/4 down an long icy driveway. Then domestic abuse where I was picked up and physically thrown into a coffee table on my tail end. I have been in 2 different braces. Hard case with a leg lock and a soft-hard form brace. I have a Hemagioma that covers the entire lower Lumbar area. L5 has collapsed causing excruciating pain! L4-L3 are on their way down hill. Degenerative Disk Disease, Arthritis in just about every joint in the body (not from lack of exercise either), Vertebral Cysts, Paresthesia now in both legs, sever pain in the lower back and both sciatica that lead down my legs. The left leg is like lead weight and the right is heading that way as well. I am at my wits end. No insurance. Still doing the Aquatic Therapy that my old ortho prescribed . . . coming from the man that said I would be fine . . . When I am in the water, it is the only relief I can get. I have been told by 3 doctors in 2009 I am not a safe candidate for surgery due to the Hemangioma (bleed out) and over an 80% of being in a wheelchair the rest of my life. What can I do besides sit on ice and act like a fish? My pain meds don't even take the edge off at this point and they are about as strong as they get for prescriptions. Help!

[jsewell]

I am so sorry you find yourself in this condition. Have you seen a pain management doctor, if not i strongly suggest you do , they have many things to use to help relieve some of your pain.
I am sorry for all the abuse you suffered too and am assuming this factor is now out of your life for good.
Are you in a wheelchair now or is that what you see in your future?
Prayers sent to you
judy

[jsewell]

Sherry i just realized you were on another person's thread. You really need to start your own to get some notice. Our wonderful moderator might be on to move it for you, but in the meantime you can just post again on your own new thread
judy