Spinal Fusion

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I just had a one level PLIF at L4-5 two weeks ago. I had a grade I spondylolisthesis and stenosis that caused a great deal of sciatic pain. I couldn't walk or sit for more than a couple minutes, but I got instant pain relief when I sat or lay down. For this reason, I kept trying to find a solution to my pain that didn't require surgery...but I kept consulting with various fellowship trained spinal specialists. I went to one physiatrist, 2 neurosurgeons (one was head of the fellowship training program at the local university) and 5 orthopedic surgeons. My experience was that the neurosurgeons recommended fusing 3-5 levels. The orthopedic surgeons each told me I needed a one level fusion.

I also tried a variety of alternative treatments. I ultimately decided I needed to have surgery to take the pressure off my spinal cord...but I went with someone who wanted to do the least amount of surgery. I figured we could always go in and fuse more if need be.

It's much too early to know how this will work out...but, so far, so good!!
 
Thanks for all of the replies. I am scheduled for a epidural next week in an effort to reduce my symptons. The ortho said I owe it a try since i've lived with this (mostley pain free) for 25 some odd years.

CW
 
I have a question for all those who have had spinal fusion. I have Grade 2 Spondy involving L5-S1 and am considering surgery. I have seen a neurosurgeon and an orthopedic. The neuro doc wants to fuse L4,L5 and S1, he said fusing the level above it would ad more stability. The ortho doc said the "jury is still out" on fusing the level above. The disk and space at L4/L5 looks good. The ortho doc said it is a greater risk of complications from fusing the extra level and questions whether or not it aRAB any more stability.

Any comments would be appreciated.
 
good morning, having had 3 fusions L5/S1 with instermentation my dr a spine specialest ortho. he told me approx 35% of all this type fusion may need the leval above fused due to instablity . But I really dont know. I wish you good luck I hoped this helped.
 
Let me tell you my story. I had my first fusion at levels L-4, L-5 S-1. My L-3 was 50/50 (good-bad). DR decided not to fuse L-3 since more levels involved more problems it causes and longer recovery. I fused beautifuly, my instrumentation was intact, had no problem with it. It was a different problems due to my car accident damages.
I heard this from many DRs that they prefer to leave levels alonge if they are not severely damaged. Every surgical area starts growing scar tissue, inflammation and of course arthrities. So why to risk a perfectly healthy level? Honestly I never heard about it, I believe you need a second opinion of a good DR, in a different group (who does not know your previous DR).

With my second surgery at HSS I had same thing: they decided to leave a level above for the same reason even though it's also 50-50. Dr told me it's better to leave 50-50 than to do fusion on it when it's still not severely damaged.
Time for another opinion!!!!:)
 
Usually the insurance companies want you to have an injection before they'll agree to a surgery. In some cases, they do provide enough pain relief that the patient can get by without a fusion or some other surgery. And it is worth a try. Just don't let anyone talk you into one series after another of these shots, as the jury is still out on at what point the steroid starts causing damage.
 
Don't know if this will help. I've had to surgeries on L 4/5. First a clean out and second a fusion with all the hardware. He is one of the best in Colorado Springs and did a great job but never listened to me after surgery but I did get some great drugs. Had pain in left leg (new) and nurabness in right again but after 5 months went away then got a pain in back beloew belt line. He dissmissed that as "it may take a year". Went to regular DR who studied with Dr Weil or whatever his name is in the AARP magazine and took 85% of the pain away in one treatment. Cancelled the steroid epidural and have been walking 4 miles a day when 1/10 of a mile was my old limit at a time. Still have some pain and all but seems stable enough and hope it stays that way. If you have surgery and can take it I'd do what I did the first time and get my core strong. Also don't be an idiot like me and start throwing 20 pound logs around and lifting WAY to much.
Surgery- So glad I did it and DON't want to do it ever again. Good luck.
 
My husband's neurosurgeon said just last week that changes in stability can occur in the levels above or a below a fusion as early as a year after the surgery. It's been 2 1/2 years since dh had his fusion and the back pain is back. His neuro did not fuse the levels that weren't unstable but his opinion without an MRI is that dh has increased severity with DDD which was to be expected.

So, in other worRAB, dh's neurosurgeon opted not to fuse L1 while he was in there. We've been pleased with his dr - especially since he has recently been named as top neurosurgeon in SC and in the top 5 in the country.
 
CrippleCreek777 said:
Don't know if this will help. I've had to surgeries on L 4/5. First a clean out and second a fusion with all the hardware. He is one of the best in Colorado Springs and did a great job but never listened to me after surgery but I did get some great drugs. Had pain in left leg (new) and nurabness in right again but after 5 months went away then got a pain in back beloew belt line. He dissmissed that as "it may take a year". Went to regular DR who studied with Dr Weil or whatever his name is in the AARP magazine and took 85% of the pain away in one treatment. Cancelled the steroid epidural and have been walking 4 miles a day when 1/10 of a mile was my old limit at a time. Still have some pain and all but seems stable enough and hope it stays that way. If you have surgery and can take it I'd do what I did the first time and get my core strong. Also don't be an idiot like me and start throwing 20 pound logs around and lifting WAY to much.
Surgery- So
hope for your sake you won't need more surgery,but in time those other levels begin to give out,and its back in again.sounRAB like one heck of a good time this surgery
Click to expand...
 
OK Cripple Creek ~ What was the one treatment Dr. Weil's protege did for you? Can you describe it? I'm assuming it was some sort of manipulation...
 
I had tons of pain in a new place not that I can spell it but sacroliliac looks good on the screen and thats where he fixed it. I think the brace I wore with the metal insert was what got me. Like I said surgeon said not to worry so went to MD. Asked where the pain was and had me lie on my stomach. He put pressure on the point and then moved my right leg asking me if it flet better or worse. Not sure what he was doing with the leg but when he was done poof it was mostly gone. Better than a needle in the spine where I told my surgeon it didn't hurt. I changed to this guy because the first guy didn't listne after surgery. I take it oyu know who I'm tslking about DR wise. Does other strange stuff too.
 
I was in the exact same boat... needed a fusion at L5/S1, but the disc above it has significant DDD as well. I discussed it with the surgeron and he said that, because of my age (44) he thought that we should just do the L5/S1. He said that if I had been older and in worse shape, it would've been a different story. I'm hoping that the above disc doesn't go, but odRAB are that eventually it will. But that is a risk I just had to take; I was completely disabled from my sciatic pain, so the fusion was a lifesaver.

Good Luck!

-David
 
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