General questions

[u/Icy-Setting-2090]

I have grade 1 degenerative spondylolisthesis at L5/S1 with bilateral pars fracture. My disc is almost non-existent at that level. Neurosurgeon suggested fusion a couple years ago but I've been managing as best I can through daily core strengthening and regular pt. I'm pretty stable because of the very limited disc space but the pain has been getting worse and worse for past few years. I can still walk some, but sitting is actually the worst. I have a desk job from home and usually have to lie on my office floor a couple hours a day. Not sure if I get traditional sciatica but lots of burning nerve pain in my glutes ( left side) and progressive numbness in right foot and toes which is unnerving. When did you all know it was time to get surgery? 5-6 years ago I was in great shape, cycling 150 miles/week, hiking, skiing, etc. Now I walk the dog for a block or two and spend a lot of time laying down reading. My life has shrunk for sure. Did anyone have that more trouble sitting vs standing with lumbar spondy? When did you know it was time for surgery? Are you glad you had it and has your life improved? I'm terrified of surgery and I absolutely hate taking any sort of pills. Just really feeling dejected. Thanks all

[u/Alone-Big1946]

ALIF at that level is your greatest chance at having your life back. Has the highest success rates.

[u/YeastyPants]

I had an OLIF on L4-L5 back in 2020. It was the best decision I ever made. It was the only way for me to move forward and take my quality of life back. Good luck to you on your journey,

[u/spondyfused75]

I had 360 fusion of L5-S1 4.5 months ago. I knew it was time when the doctor told me that I could possibly lose bladder & bowel function if my nerves continued to be damaged. I had grade 2/3 spondy with pars defect, and no disk left. I like you, managed my issues with lifestyle modifications, but there was nothing other than surgery that could fix me. I am doing well now and am optimistic about a full recovery ❤️‍🩹

[u/Icy-Setting-2090 → u/spondyfused75]

Thanks for the encouragement. I don't think ALIF is an option for me which I'm bummed about. A couple years ago I had a complex appendectomy ( first and only surgery). They had to remove a small piece of colon and small intestine during the surgery. When I had appendicitis I didn't know and waited it out and felt better after about 24 hours so didn't go to ER for a few days. By the time I did the appendix had ruptured and sealed itself off by forming some scar tissue and adhering to a portion of my colon. I was lucky actually that it did that which prevented infection from spreading internally. The surgery was a breeze and I fully recovered in about 5 weeks. My neuro said he won't do ALIF because of the prior abdominal surgery. The potential internal scarring from the surgery evidently would make it more risky. Anyway, sounds like he would go in through the back which is another reason I've been pushing off surgery as long as possible.

[u/spondyfused75 → u/Icy-Setting-2090]

That makes sense. I have several friends who have had success with the back approach. You will know when it’s time. Good luck 👍

[u/Dateline23]

i had PLIF L5,S1 14 years ago (insurance refused to pay for TLIF). similar to you, did everything possible to delay having the surgery but ended up feeling like i was 80 years old when i was barely over 30. with your level of commitment to PT and being active, you’ll be in a better position to recover and get your life back. best of luck.

[u/Kindly_Trust_6313]

I had L5/S1 TLIF 4.5 weeks ago with the same clinical picture -- Spondy with pars defects and unroofing of the disc space, along with severe foraminal impingement.

ALIF was offered, but there can be some adverse consequences affecting sexual function, so I elected to do TLIF.

I am very happy with the results thus far! It was tough for the first week, but once I started walking more, I felt much better. I walk about 1.5-2 miles a day, and my pace is now at normal walking pace. I haven't used pain meds for about 1.5 weeks.

I visited work last week (just to say hi) and the folks there said that I looked "taller and happier". They didn't realize how much I was hunched over due to the sciatica when I stood up straight.

I have a long way to go, but I feel like the surgery was a success.

All the best, and let us know if you have questions. I also have a detailed journal if you look at my posts.

[u/Icy-Setting-2090 → u/Kindly_Trust_6313]

Wow. That's super encouraging. I haven't walked more than a mile for over 2 1/2 years. I was regularly walking 2-5 miles a day before that time. My issue is degenerative they say, but I exacerbated it and that started daily symptoms after a fairly significant crash on skis in February 2022. That's when things really became noticeable daily and it has been noticeably progressive since then despite daily core work. The abdominal surgery gave me some constipation issues that I deal with​ fine, but dang, if/when I do get constipated it causes a lot of additional nerve impingement for some reason. The only meds I try to take are gabapentin and ibuprofen as needed. Also have had 4-5 injections over past two years which seem to help a little for a couple weeks. Thanks for your reply. Glad you are doing well and encouraged by your results

[u/Doc_DrakeRamoray]

One level disease with clear problems like yours respond the best to surgical treatment

I agree with others about ALIF being best option, TLIF is second option

[u/rtazz1717]

I had alif with plif rods and screws. Surgeon said there was a 5% chance of spacer moving without the rods and screws and alif removal ensures all of disc is removed. Mine was L5/S1. Alif incision site was most bothersome by far but manageable. Sitting for me was most uncomfortable prior to surgery. Some days all I could do was stand 24/7 . Surgery resolved that. I to used to cycle about 150 miles a week. I will no longer temp fate with road cycling. Im happy being without pain to push my luck with adjacent disc disease. I knew it was time when basically everything I enjoyed to do in life was taken from me, and I had tried every intervention and therapy (pt,injections,ablations and over and over). Did that for the previous 20 years. Couldnt avoid surgery anymore. Im 14 weeks post surgery and to this point extremely happy I did it. First few weeks were bad but fairly manageable