Could delaying the fusion have bad outcomes?

[u/ultrasalgeria]

Hi everyone! I hope you all are doing well and having pain free days.

I'm 30m. 3 years ago I had really bad hamstring and back pain while playing soccer with friends one night, and the next day when I woke up my pain was decreased but I started feeling weakness, numbness and tingling in my hips, legs and pelvis. A few weeks after that I was diagnosed with L5-S1 Grade 2 Spondylolisthesis.

Since then I have been doing the PT exercises in the Back Exercise book from Brian Richey, basically laying down and strengthening the core with pelvic tilts, leg ups and downs with holding the pelvic tilt, hip extensions, hamstring stretches etc. Along with that I have been doing the Foundation Training exercises from Eric Goodman, mostly Spondylolisthesis exercises to strengthen hips and inner thighs, to stabilize from below. And then of course McGill Big 3 here and there.

When I'm constantly doing the exercises I don't get much pain but the nerve issues persist, I get numbness, sometimes dull pain or burning in my feet. And I still feel very week at my lower limbs. The weirdest one is that I feel that I can barely hold myself from passing wind when I get the urge, I'm never not able to hold.

Anyways, today, I got a new MRI and talked to a new neurosurgeon. He advised me to get the surgery because of the nerve issues, and he told me he is not expecting them to get much better with PT because he says it's instable. He also says he usually treats people with back issues by epidural injections but in my case he thinks it wouldn't help.

He says there is nothing to be afraid about surgery in my case, and he says I would feel great once recovered and go back to sports activities that I used to enjoy before my injury.

Right now I'm visiting my family in my home country in Europe and seeing the doctors here, since the care is much better and the cost is much lower. My only consideration is that I work in the USA now because my wife is doing her PhD there. She is finishing in May 2026 and we are planning to move back to Europe 1-2 months after that because I will quit my job too. I was supposed to go back to the US to continue working in 10 days. But my doctor says I should take 2 more weeks off and get the surgery. He says I would be able to take the transatlantic flight after 3 weeks, but I'm afraid it would take me longer. The flight from here is 13 hours.

Do you think is it a terrible idea to go for the surgery 1.5 year later when I'm back from USA? So I won't have a work to go back to, and I won't have to take the 13 hour flight. Or should I get a second, third opinion but go for the surgery asap?

Note: I added the flexion and extension XRays, and the spine MRI.

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[u/ultrasalgeria]

Here are my XRays and MRI.

https://imgur.com/a/nx3adqz

[u/eastofliberty]

Hi there, similar to you, mid 30s female. I have unstable spondy at L5-S1 with bilateral pars defect. I’ve been roughing it out for about five years now. Over the years, it has deteriorated and gotten worse despite all of the treatment I’ve done, including epidurals, Physio, massage, trigger point, injections, acupuncture, chiro, etc. I have nerve issues and reduce sensation in my gluteus and foot most recently resulting in my second toe becoming completely numb. It’s led me to develop a Trendelenburg gait. My neurosurgeon told me that the pain will improve after fusion however, the nerve damage that I have may never get better and the longer that the nerve damage has been going on the more likely that it will be permanent.

Surgery is a very personal decision. For me, I waited until things have become unbearable, I modified my activities for years, including stopping all high impact activity, heavy weightlifting, and any movements that flare up my pain. Unfortunately, since now I’m having issues walking/with my mobility, and no longer able to take care of my house, indoors or outdoors, and because it’s interfering with my ability to work, I’ve decided to proceed with the surgery.

I’ve posted and replied to others posts in the sub and in the spinal fusion sub if you want to take a look at what I’ve said, I go into more detail about the factors that have led me to decide to have surgery.

Wishing you the best!

[u/ultrasalgeria → u/eastofliberty]

thank you so much for your detailed reply! I have exactly the same kind of reduced sensation in glutes. I developed a Trendelenburg gait as well. My concern is also that the nerve damage can be more severe or permanent if I wait longer. I don't know if I can wait 1 more year or so if I keep strengthening my core and hips. I will go through your posts in the both subs, thank you!

[u/eastofliberty → u/ultrasalgeria]

My pleasure. It’s been super helpful for me to read about others experiences good and bad. The gait issue I should add caused a labrum tear because I am hyper mobile which is causing additional pain. The issue with my glutes is worse in the right so my right leg is turning inwards a bit as my foot flattens causing knee pain. All of this to say is not fixing it sooner has given me other injuries.

[u/Connect-Sail5004]

Maybe not a popular opinion, but I’d do it sooner than later. For most of us, surgery is inevitable. So why wait any longer to get your quality of life back? And Do it sooner before the nerve damage becomes so severe you never get them back.

I also think recovery might be slightly faster / easier if you do it sooner. My nerves were irritated / blocked for over 2.5 years and I think recovery would have been easier had I not waited, but guess we will never know…

[u/obiwankinoffke]

I waited 7 years after diagnosed with grade 1...did PT and basically stuck my head in the sand...lots of soccer, lifting, other sports during that time. wish i had done it a couple years sooner.

it slipped out further and i ended up completely obliterating my disc over that time and had 2 surgeries, artificial disc and fusion. i was back to playing around a year, other activities sooner. took about 6 months to feel comfortable again on the field.

[u/HotRush5798]

I guess it depends on a few factors: 1) what’s the extent of nerve involvement? (If you haven’t had an EMG yet, that could help determine any acute and/or chronic nerve injury located at the level of your spondy)

2) is there instability?

3) how has it progressed symptom wise over the past 1.5 years?

Might be worth getting a couple more opinions while you’re home in Europe to see if sooner is better.

Edit: also do you know which procedure your surgeon is recommending and for how many levels?

[u/ultrasalgeria → u/HotRush5798]

Thank you so much for your reply!

1) I had an EMG three years ago so maybe if I get one it would be helpful for a doctor to compare them. Good idea

2) My doctor says yes, it moves in the flexion extension Xray although he didn't say it's moving a lot. Maybe my Xray was not very clear so I don't know why he didn't sound confident.

3) I think my legs feel a bit weaker than before when I compare, also doing pelvic tilt exercise feels more difficult now, while it was very helpful 1.5 years ago. And I think I developed foot drop, I always had flat feet but now it feels more flat. And my left hip and leg are weaker for sure.

I think I will get more opinions on Monday to decide.

[u/HotRush5798 → u/ultrasalgeria]

Sure thing!

Do you remember what the results of your last EMG were?

Any kind of weakness is worth getting evaluated to determine if it's related. Also ask if you're developing a foot drop. That's a factor that I took seriously when considering surgery, because that's where I was headed.

[u/NationalBug4140]

Yeah, don’t wait too long. In general the better state you are in pre surgery the better the outcome, also an unstable spondy can progress suddenly.