L5-S1 Surgery twice, now facing a 3rd decision. A combination of high pelvic incidence, a Coflex implant and recurrent herniation. Now, to Fusion or not? Anyone been here?
I'm hoping to hear from people who've been in a similar spot, because I feel pretty alone with this one.
Quick history:
- First lumbar surgery at 14, second at 21 (both microdiscectomies, L5-S1)
- I have a Coflex device at that level
- Despite it, I've got a recurrent herniation at L5-S1 again at 34, with left-sided sciatica down to the calf
- Just had two epidurals (not helping much)
- My imaging shows a very high pelvic incidence (87°) and high sacral slope — basically my anatomy loads that bottom level really hard (Roussouly Type 4)
- The three levels above are also degenerated (see image)
- That segment is already really stiff, and it hurts in both extension AND flexion
To not bore you with my whole story right now, I'll just start with this: I've dodged fusion a couple of times already over the last 7 years or so. I've always stayed very active. I know my limits, and how and what to train. So I've done that, and it has kept me strong.
A few months ago I started having more pain than usual. I began sitting less and standing more, changing my training to protect my back and let it "rest." I kept doing mobility work 3 times a day while moving less overall. So I kept scaling my life back to accommodate the pain. But despite all my best efforts, I ended up in the emergency room, because I couldn't move anymore from the pain.
It's been a little over a month since then, and the pain is still very much there. I'm taking Ibuprofen 600 x2, Novalgin 500, and Pregabalin 150 x3 daily, plus a long list of supplements to reduce inflammation. I stopped taking Tramadol 100 x1/day because it wasn't really helping much and I wasn't looking forward to dealing with withdrawal.
Besides that, I'm on my second week of PT, which has helped, but it's too early to say for sure. I'm doing all the exercises whenever I'm not in too much pain. I can sleep, but I have a lot of pain in the morning (9/10), which gradually reduces to around a 5 or 6 after my first round of meds.
I'm working from home and keeping my life as normal as I can, but to be honest, I'm pretty bedridden at the moment. I mention this because it's important: it means I can "afford" to be patient and try the conservative route, doing everything available as therapy before deciding whether to go for surgery or not.
My current goals are to bring my pain down by half, to be able to sit and walk longer, to keep improving strength and mobility as much as possible, and to rest and take care of myself.
I wanted to share a bit of my story and where I'm at right now, hoping to find people who've been in a similar position. I've seen 2 specialists this time, and they both tell me the only thing that makes sense is fusion . that nothing else will take away the nerve pain and the back pain.
I want to end by saying that in this hard moment, I'm just trying to stay calm, take whatever step I can in the present that might help, and make good decisions. I've been trying to play the long game for years, and I feel like a spinal fusion will be the end of me as I know myself — physically, at least. My discs above are already pretty damaged, and I really don't want to end up in a streak of fusion operations. I find myself in the exact place I've tried to avoid for decades. Is there really no other option?
Do you guys think I can get through this without surgery? Right now it feels like I can't. Tell me your honest opinion. Is it possible to cut this pain in half and get back to training?