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L4-S1 fusion - 2 months - my journey

Started by Terence on 12/23/2018 3:30pm

10 Oct 2018 Wednesday

Visited my GP - lower back has been sore for months now. Sciatic pain in right leg started last year December (2017) after arriving in Cape Town after driving car (non-stop) for 14 hours, pausing briefly to fill up with fuel twice. I weighed 99kg in March 2018 and decided to lose stomach fat to relieve pressure on lower back - now down to 86kg (13kg down) after heavy walking on treadmill.

But, today, X-ray not good news. L4 does not “line up” with L5 & S1. Also, discs between L4 & L5, L5 & S1 look “depleted” when comparing to other discs further up the spine. (Using my simple language here. Official terminology to follow. GP refers me to Specialist Orthopaedic Surgeon for his opinion.

15 Oct 2018 Monday

See Doc Tollie Oosthuizen who sends me for MRI. Results are conclusive to him: “Spondylolysis (crack or stress fracture in one of the vertebrae) with associated grade 1 spondylolisthesis (vertebra slips out of place) of L4 on L5. Disc degenerative disease of the lumbar spine with associated radiculopathy (pinched nerve or neuropathy resulting in pain, etc) at L4-L5 and L5-S1.”

Surgery urgently recommended: Spine fusion (arthrodesis) 2 levels L4-S1. Insertion of spinal implants or instrumentation. Bone grafts. Spine surgery (Laminectomy). Repair of nerve (neuroplasty). Laminotomy with decompression of nerve roots including partial facetectomy, foraminotomy (enlarge passageway where spinal nerve exits spinal canal) and excision of herniated intervertebral disc.

I’m pushed into the front of the queue for doc’s Wednesday scheduled procedures / patients.

Authorisation obtained from Medical Aid. (Thank goodness for medical aid as the entire exercise will eventually cost in the region of $35,000. )

Chest X-ray and blood tests done pre-op, standard routine.

16 Oct 2018 Wednesday

Check in at hospital at 05h00. Enter surgery at 08h00. Anaesthesiologist connects me up to drips and heart (chest electrodes) monitor and blood pressure monitor. (My) surgeon (osteopath) works with a neurosurgeon. The one focuses on the “bones” and the other focuses on the nerves. Another team member sucks up blood during surgery and this is put back into the body afterwards. Wake up in Recovery room at 11h00. Pain. I’m given a morphine trigger in my hands and told I can manage my pain by hitting the trigger every 5 minutes, or longer intervals if possible. Spend night in ICU. 5 minute intervals felt like 5 hours - couldn't wait for another pain relief "hit".

18 Oct 2018 Thursday

Day 1. Pain is bad. Moved to General Ward. Physio person visits and puts my pressure stockings on. To prevent DVT (deep vein thrombosis) or blood clots.

19 Oct 2018 Friday

Day 2. Pain is bad. Physio person visits. Shows and helps me move, do exercises, walk with walker. Wear brace when out of bed. Exercises and walking to be done every day, several times.

20 Oct 2018 Saturday

Day 3. Pain is bad. Painkillers help a bit. Need a sleeping pill at night. Helps for 3 or 4 hours then toss and turn all night. Very uncomfortable.

21 Oct 2018 Sunday

Day 4. Pain is bad. Nurse removes half the staples. Drain removed from my back. Catheter removed. Wound is 20cm, middle lower back. Doc says I can go home.

22 Oct 2018 Monday

Day 5. At home. Pain. (Painkillers and sleeping pills and tossing and turning will last for a few weeks.) Only permitted prescribed painkillers, not allowed any medication that treats inflammation (anti-inflammatory), like NSAID’s or Ibuprofen. Can have Paracetamol. Inflammation is (apparently) good naturally to promote bone growth and healing.

23 Oct 2018 Tuesday

Day 6. Pain. Have not had a bowel movement since op. Apparently the heavy painkillers and surgery anaesthetic slow the bowels down causing constipation. Drank a tablespoon of Normacol twice. Eventually successful movement, but painful initially. Will drink Normacol morning and night for the next 3 weeks with lots of water, while on painkillers.

24 Oct 2018 Wednesday

Day 7. Pain. Walked 700m on treadmill. Overdid it. More pain.

25 Oct 2018 Thursday

Day 8. Pain.

26 Oct 2018 Friday

Day 9. Feeling slightly better. See Doc today for post-op checkup. My wife drives me to hospital. (She has been cooking and feeding me a healthy diet, rich in protein, nuts, oats, etc, which is good for bone healing and growth.) Remainder staples (10) out. Says wound looks good. Swollen. Gets quite painful again later at night. Lower back and buttocks.

27 Oct 2018 Saturday

Day 10. Pain again. Both buttocks. (Bone graft harvesting?)

28 Oct 2018 Sunday

Day 11. Pain slightly less. Rest. Swelling slightly down.

29 Oct 2018 Monday

Day 12. Feeling little better.

30 Oct 2018 Tuesday

Day 13. Slightly better. Last night was still uncomfortable, but slept ok via pain meds and sleeping pill. Pain got worse during the day, think I lay badly while resting on leather couch downstairs. Must rest flat on bed.

31 Oct 2018 Wednesday

Day 14. Two weeks. Horrible night, pain. Feeling a little better in morning.

01 Nov 2018 Thursday

Day 15. Pain in buttocks last night, very sore. Managed to sleep. Slightly less sore in the morning.

02 Nov 2018 Friday

Day 16. Still some dull pain, but manageable.

03 Nov 2018 Saturday

Day 17. Last night was uncomfortable, dull pain in buttocks and hips. Managed to sleep intermittently.

04 Nov 2018 Sunday

Day 18. Sore again last night!

05 Nov 2018 Monday

Day 19. Pain less last night. Weight 82kg (lost 4kg since op!) Weak.

06 Nov 2018 Tuesday Birthday 8=)

Day 20. Pain moderate last night, more uncomfortable rather than painful.

07 Nov 2018 Wednesday

Day 21. 3 Weeks. Restless legs (RL) last night, this is new, sleep not good. Moderate pain in lower back.

08 Nov 2018 Thursday

Day 22. Intermittent sleep. Pain not too bad. Trying to cut back on painkillers. Walk 200m at setting 1.5 (treadmill). RL and Burning Feet (BF) at nightfall. Why does it start at nightfall every day?

09 Nov 2018 Friday

Day 23. Slept from 9pm - 1am then on and off until 6am. Had a Tramacet at 1am. Walked 600m setting 2.5. Weight down to 80kg, lost 6kg since op. RL & BF. Apparently this has something to do with surgeons working with nerve during surgery and nerve is now starting to recover and regenerate.

10 Nov 2018 Saturday

Day 24. Had Panado 2 x 2 x 500 last night. A little sore. Think it was caused by walking on treadmill. Piriformis was sore, (related) slight pain in between right shin & calf.

11 Nov 2018 Sunday

Day 25. Slept much better last night! Low pain in back. Panado 1x every 4 hours.

12 Nov 2018 Monday

Day 26. Slept ok, however pain in right buttock & hip. Panado and Tramacet at 2am. Generally ok.

13 Nov 2018 Tuesday

Day 27. Burning feet (BF) last night. Slept well. Managing pain in back.

14 Nov 2018 Wednesday

Day 28. 4 weeks. BF last night. Some lower back discomfort. Slept ok. Went to Doc McAtamney prescribed Lyrica for evenings for nerve referral pain (burning feet).

15 Nov 2018 Thursday

Day 29. BF & RL (burning feet & restless legs) last night. Walking about with more strength & confidence. Pain in hips / sides.

16 Nov 2018 Friday

Day 30. BF & RL slightly better. Sleep ok. Pain in muscles in back. Suspected “normal”.

17 Nov 2018 Saturday

Day 31. BF & RL last night again. Sleep ok. Had a nap at 10.30 for an hour, first time in the day. Walked to Shops (400m) and went to shops again (400m) . Pain in back very low, walking very carefully! Legs feel heavy and “crampy “.

18 Nov 2018 Sunday

Day 32. BF & RL last night slightly less. Slept ok. Walking stronger. Shops. Pain low. Right big toe & next toe has been numb since op. Rest of foot has improved.

19 Nov 2018 Monday

Day 33. BF & RL less last night. Pain very low, didn’t take painkiller last night before sleeping, but woke up at 02.00 and took one. Feeling ok. Will walk to Shops again.

20 Nov 2018 Tuesday

Day 34. Slept ok. BF seems to have stopped. RL manifests with small pains in muscles in leg, twitching, need to keep stretching, calms down after 21h30 and sleeping pill. Back seems ok, walking ok, but being very careful.

21 Nov 2018 Wednesday

Day 35. 5 weeks. Slept ok. RL last night (need to keep stretching legs). Back a bit tender (sitting in car?). Pain in back in evening. Took 2 Tramacet’s at 8pm.

22 Nov 2018 Thursday

Day 36. Lower back tender. Frustrating. Up and down recovery!

23 Nov 2018 Friday

Day 37. Slept ok. Lower back better. Walked to Shops. Numbness in right big toe and foot (seems) slightly less.

24 Nov 2018 Saturday

Day 38. Slept ok. Back ok until late afternoon when became a little tender, but not very painful.

25 Nov 2018 Sunday

Day 39. Slept ok. Little stronger. Mostly off painkillers.

26 Nov 2018 Monday

Day 40. Slept ok, on and off. Back ok - much the same.

27 Nov 2018 Tuesday

Day 41. Getting stronger. Stopping Lyrica. ( Fogs my head.)

28 Nov 2018 Wednesday

Day 42. 6 weeks! Feeling ok. Drive car and sat upright for an hour or so. Almost off meds, only Panado.

29 Nov 2018 Thursday

Day 43. (Checkup & x-Ray with surgeon) Doc happy with fusion progress! Cleared for takeoff! (Need to fly long-haul from Joburg to London 11 hours.) BUT, drove car myself today to hospital and back 70km / 80 minutes in traffic and went shopping as well, lower back (sacrum) VERY sore from midday. Long day. X-ray shows six screws into L4, L5 & S1 and interconnections between them. Doc says he did not need to put cages in between vertebrae. Bone graft at back and around back of vertebrae. Apparently the leftover discs become surplus to requirements.

30 Nov 2018 Friday

Day 44. Slept ok. Sacrum area of back feels slightly better, but still sore.

01 Dec 2018 Saturday

Day 45. Slept ok. Sacrum area of back feels slightly better, but still sore. Sharp pains in back, taking Stilpane again. I think I hurt myself while driving car.

02 Dec 2018 Sunday

Day 46. Back sore!

03 Dec 2018 Monday

Day 47. Back slightly better. Went to Shops. Busy morning.

04 Dec 2018 Tuesday

Day 48. Slightly better. Busy day.

05 Dec 2018 Wednesday

Day 49. 7 weeks. Back so-so. Fly to London from Joburg on Virgin Atlantic tonight. Some panic and mild pain, but fortunately managed flight ok and wheelchair through airports. Slept reasonably well. Fortunate to have 180 degree seat recline - special concession - would have been hell sitting and standing for 11 hours! Do not recommend a long-haul flight to anyone in similar condition.

06 Dec 2018 Thursday

Day 50 Arrive in London. Back not too bad.

07 Dec 2018 Friday

Day 51. Back not very sore, but gets stiff/sore with activity. Need rest.

08 Dec 2018 Saturday

Day 52. Back so-so - more muscle stiff and tire easy.

09 Dec 2018 Sunday

Day 53. Back got tired and a bit sore late afternoon.

10 Dec 2018 Monday

Day 54. Was ok for most of the day, quite active, became sore late afternoon early evening. Back muscles.

11 Dec 2018 Tuesday

Day 55. Back feeling better in morning.

12 Dec 2018 Wednesday

Day 56. 8 weeks. Back ok where fusion is, but muscle sore top right under shoulder.

13 Dec 2018 Thursday

Day 57. Back gets tired, but not very sore.

14 Dec 2018 Friday

Day 58. Back a bit sore today, not sure why. Maybe too much activity yesterday.

15 Dec 2018 Saturday

Day 59. Back ok, muscles a bit sore.

16 Dec 2018 Sunday

Day 60. Back ok.

17 Dec 2018 Monday

Day 61. 2 Months. Back ok. Must keep walking every day to strengthen back muscles. It still gets tired towards the end of the day, requiring me to rest in the evenings.


1. I had no option, I really needed the surgery or I would have had lower back pain and sciatic pain for ever, which (according to doc) would have become worse until I lost feeling in my leg/s.

2. The procedure was PAINFUL during the first two weeks post-op. But, the heavy painkillers helped.

3. The onset of restless legs and burning feet was disconcerting and irritating, but this too passed after week 4 or 5.

4. There were bouts of depression, which is normal apparently, be warned and confide in your partner or friends.

5. I am only two months down the road, but the immediate future looks good. I have no sciatic pain and no (original) lower back pain. But, my back is still sensitive as the fusion heals and the lumber heals and the muscles learn to rework.

6. Given the option to do this procedure knowing what I would go through , I would do it again, as the end result is worth it. BUT, I don’t want to go through it a second time. So, to anyone out there, who has this surgery procedure, be VERY careful post-op not to damage or hurt yourself! You don’t want to go back to theatre for re-work! On day 4 post-op when I was at home, I forgot I was wearing my pressure stockings (they go over the feet as well) and started walking downstairs (smooth cement) and almost slipped! Fortunately, I was holding the railing with both hands. Had I fallen, I would have been in deep deep trouble. Advice - think twice before doing anything or making any movement.

7. I have read that recovery works like this: 6 weeks for bone fusion to get through first stage, initial binding wispy growth, 3 - 6 months for bone fusion to get through second stage, fusion gets strong and solid, 12 - 24 months for bone fusion to get through final stage, where the bone “does a tidy up” of the work it’s done. There is a study paper done by a team of doctors available on the Internet for people who want to read the serious technical jargon.

8. GOOD LUCK with “your” journey and drop me questions and I’ll give you my own experiences. But remember, everyone has different experiences and can heal differently. Anyway, that’s what I have read on multiple sites. These sites have been VERY helpful when days were dark and I reached out to see what had happened to other people in similar circumstances. TTFN - Terence

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2 Responses


I hope your pain continues to get better. I had a TLIF of L3L4 in 2012. I went to a chiropractor for about 8 weeks before I finally saw a neurosurgeon. I couldn’t walk, I couldn’t sleep because my legs would ‘jump’ because my nerves were very unhappy. I had the surgery asap after my first appointment with the neurosurgeon. I had the surgery in the neurosurgeon’s outpatient clinic. I woke up in recovery pain free and have been every since. I did everything I was supposed to including wearing a brace through one of the hottest summers on record. I still sleep with a pillow under or between my legs every night. I don’t lay in the couch or in recliners. I don’t shovel snow. I do my best (without being anal) to treat my back well. I hope this helps folks to realize that you have to act quickly, don’t go to pain clinics, orthopedic surgeons, or chiropractors. My neurosurgeon, Dr Robert Gewirtz was personally on the phone with my insurance company to get the surgery scheduled. He understands the urgency and necessity of what is needed to cure back pain.


Terence, we commend you for being so diligent about documenting the first 2 months of your recovery! This is not only helpful for people who are in your shoes (or will soon undergo spine surgery), but this fantastic for you. Sharing these notes with your doctor gives him/her a truly inside look at what you've been through. That's invaluable for you both.

Being an engaged patient--as you no doubt are--is one of the best ways to secure successful spine surgery outcomes. So much is out of your control when you undergo surgery, but taking a proactive role in your recovery is not one of those things.

Thank you for sharing your journey with our Community. We wish you continued success in your recovery and beyond.