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Thread: L4-L5 fusion

  1. #1
    Join Date
    Feb 2015
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    NTX
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    Default L4-L5 fusion

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    My husband is 9 months post-op today from his L4L5 fusion. Top neurosurgeon in Dallas did the work. It ended up with vastly improved nerve function in the rt leg (he can feel it now, except for some diabetic neuropathy). Disc removed and Pars Defect cleaned up. Apparently that wasn't on the imagery but the doctor explained that it was actually causing the bulk of his issue.

    The fusion has healed well according to the xrays taken around the 6mo point.

    The surgeon isn't even against some weight training, BUT ... only with kettlebells or dumbbells or small accessory bars, unless it's bench press, which he said was ok because the back was fully supported. He specifically said not to put a bar on your back.

    The concern is one of two modes of failure. Either wearing out the adjacent discs causing a cascade failure needing additional surgery, OR, a hardware failure under load.

    However my husband loves training, and really loves squats and deadlifts. We have been doing mobility work to try to get him enough ROM to train with good form. I am reasonably sure he will be smart about his training, as I am certain he never ever wants another spinal surgery!

    Can any SSC or Rip comment on suggestions on how best to get him under the bar again, without undue risk to his spinal repair?

    58, diabetic, currently around 240. Back at his job on light duty until 9/5, them it's back on his regular job (telco fiber installs, including ladder work, attics etc).

  2. #2
    Join Date
    Aug 2010
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    Wichita Falls, Texas
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    2,418

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    Quote Originally Posted by Ridgeback303 View Post
    My husband is 9 months post-op today from his L4L5 fusion. Top neurosurgeon in Dallas did the work. It ended up with vastly improved nerve function in the rt leg (he can feel it now, except for some diabetic neuropathy). Disc removed and Pars Defect cleaned up. Apparently that wasn't on the imagery but the doctor explained that it was actually causing the bulk of his issue.

    The fusion has healed well according to the xrays taken around the 6mo point.

    The surgeon isn't even against some weight training, BUT ... only with kettlebells or dumbbells or small accessory bars, unless it's bench press, which he said was ok because the back was fully supported. He specifically said not to put a bar on your back.

    The concern is one of two modes of failure. Either wearing out the adjacent discs causing a cascade failure needing additional surgery, OR, a hardware failure under load.

    However my husband loves training, and really loves squats and deadlifts. We have been doing mobility work to try to get him enough ROM to train with good form. I am reasonably sure he will be smart about his training, as I am certain he never ever wants another spinal surgery!

    Can any SSC or Rip comment on suggestions on how best to get him under the bar again, without undue risk to his spinal repair?

    58, diabetic, currently around 240. Back at his job on light duty until 9/5, them it's back on his regular job (telco fiber installs, including ladder work, attics etc).
    The biggest risk to this individual getting back under the bar is going to be their value system and how much they interpret the word of their neurosurgeon as being the "one true opinion" on the matter. The fact of the matter is the overwhelming majority of the cases of back surgery are caused by things not in any way shape or form related to lifting, let alone lifting heavy weights. The vast majority of back pain that results in surgery has no identifiable mechanism of injury, and it is a very, very slim minority of back surgery cases that arise from an episode of heavy weight lifting.

    The cascade of failing adjacent discs post-lumbar fusion is there regardless of whether the individual trains or not. Now, what is interesting is that people who regularly train with heavy weights have a demonstrated protective effect from degeneration in the spine, and even more interesting, this is even seen in elite lifters (presumably a population that "overdoes" it). If lifting heavy weights jeopardizes the adjacent discs post lumbar fusion, why does it show a protective effect in a normal spine? Why is this protective effect seen in the most elite lifters who have the greatest frequency of training with supra-physiological loads? It would appear to me, after many years of working in the rehabilitation field, that the biggest discrepancy between the literature and medical practice is due to the threat of litigation, with a surgeon not feeling compelled to stay up to date on the biomechanical studies coming in a close second. Surgeons do surgery, and once they have done surgery, they have to answer for that surgery if anything ever goes wrong with that surgery, so, oftentimes the recommendations are seemingly more to protect the license holder from further litigation, because in a case of alleged medical malpractice, this surgeon would be judged according to what a reasonable surgeon in his discipline would do. There aren't but a few neurosurgeons with a heavy weight lifting background, and therefore, statistics would play heavily into the favor of a peer in his field stating that heavy weight lifting after a fusion is far outside of the standard of care. Reckless. Egregious, even.

    Next there is the issue of hardware failure. The loads placed on the lumbar spine in quiet sitting have been suggested in many studies to be several multiples of your bodyweight. It is highly unlikely most trainees will ever get to multiples of their bodyweight in a squat, not to mention, biomechanically load on your back does not equal load on your lumbar discs because the kinetic chain does not end at the sacrum like it does in sitting. Trauma is more likely to cause hardware failure, but, that is something you can't completely control for. He is more likely to have hardware failure by getting hit by a bus, or, even more insidiously, eventual hardware failure due to osteoporosis due to lack of training later in life. Did the neurosurgeon also tell your husband that the risk of him falling off a ladder and completely destroying the fusion is amplified by the diabetic neuropathy and that a sane person would never, ever climb a ladder should they have a prior lumbar fusion and diabetic neuropathy? Fact of the matter is, training may be the only way to rigidize his spine and provide the work hardening effect to improve his ability to do his manual labor, and, in many ways, may provide a protective effect against the absolute chaos in the real world. Well programmed training is the polar opposite of chaos. It can be tightly controlled to make it safe for virtually anyone. I have trained dozens of patients and clients through the years with relatively radical lumbar spine and cervical spine surgeries without a single negative effect worth mentioning. The one post lumbar surgery client I had that actually may need a second surgery had his exacerbation come about during a period where they wanted to start running in preparation for a marathon.

  3. #3
    Join Date
    Feb 2015
    Location
    NTX
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    Will, THANK YOU for the nuanced and experienced reply! He wants to get back under the bar. I want him back training. My worry has been the unknown level of risk in doing so. I agree most surgeons give a CYA response regarding weight training.

    I will say though, that his MOI was in fact a lifting injury, involving an act of stupidity (his words) involving some very heavy equipment that unfortunately had slid under a 200# rear tine tiller. Estimated total weight would be 450-500#, not evenly distributed.

    So your comments have encouraged both of us.
    Thank you.

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