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one-level ant/post fusion @ L5-S1 for high-grade spondy?

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:22 AM in Back Surgery and Neck Surgery
Most of the surgeons I've seen for my grade 3 spondylolisthesis at L5-S1 recommend two-level fusion from L4-L5-S1. Some recommend posterior only, but most say anterior and posterior for solid 360-degree fusion.

However, one highly-regarded orthopedic surgeon recently recommended one-level only, at L5-S1, with anterior/posterior. I'd definitely prefer one-level fusion over two-level, but am concerned about whether or not this would work well, given that everyone else has said I need two-level. (BTW, L4 and above are in great shape, no disk problems, no signs of any problems.)

I've just started researching on the Internet, but haven't yet really found the kind of information I want (specifically addressing this type of fusion for my type of condition).

Has anyone ever had one-level fusion at L5-S1? If so, for what condition, what approach (ant/post), and how has it worked?
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Comments

  • I decided on the 2 level. My L5/S1 was pretty bad and my L4/L5 was not so bad but was going down hill. My NS thought that L4 would need a fusion in the near future. Recovering from a single level is easier on the body, but doing it twice would make it harder..... I don't know if that makes any sense????

    I had the PLIF- my scar is about 3-4 inches. I am feeling much better as far as my old symptoms go. The healing is another story.

    Another idea is that in the next few years ADR's will be more main stream and you may be able to get that at the L4 level.

    Good luck,

    Julie
  • Heidi, what is the rationale these surgeons are giving for fusing L4-5 as well if they are healthy. I just had PLIF L4-5 for Grade I unstable spondylolisthesis 11 days ago, so the jury is still out. My original hip and leg pain is gone so far, new back and SI pain from surgery site will hopefully resolve. I had PLIF with POLAr. This is a technique using an interbody fusion cage at an oblique angle from the back to acheive anterior column support. My surgeon didn't want to fuse any other levels because they were healthy at this point. Down the road, of course we are at risk for adjacent level problems. Sue
  • your L4 is in great shape as you stated(showing no problems) why are they saying you need a fusion at L4-L5?

    Christina :)
  • Most of the spine surgeons seem to think I need L5 fused to L4 for additional stability. Because L5 is slipped so far forward of S1 (75% off), they've said fusing just L5 to S1 probably wouldn't be enough.

    The latest surgeon who said he would just fuse L5 to S1 works on professional athletes, so I'd think he would understand spinal stability! But it certainly makes me wonder when 4 guys say L4-S1 and only one says L5-S1.

    I think the latest surgeon is also talking about reducing the slip a bit more than the other guys. Some say they wouldn't try to reduce at all, some say they would a little, and the new guy says he'd reduce it as much as possible, up to 50%. Maybe the extra reduction would allow just L5-S1 to be more stable?
  • Hi Heidi
    My grade fell between 2-3 when measured out. I had PLF with BMP only @ L5S1. I was supposed to have 3 rods and 2 screws for fixation.
    When I woke up I was told the rods were not possible due to the steep angle without involving the disks that were normal above. So he used 2 screw to stablize my spine where it was and the BMP. My orthropedic said that he had done this numerous time this way and his patients have done well. I'm almost 6 months out and so far it has been a positive surgical journey. I have follow the rules to a T..:) Good Luck with your decision.
  • I'm so glad to hear about someone who's had this approach done. It sounds like you're doing great! Did they reduce your slip any at all?

    Good luck with the rest of your recovery.

    (BTW, does the _ga in your screen name mean you're from Georgia?)
  • Only minimal reduction could be done. But it was enough to elevate the foraminal region and indirectly decompressing the foramen. I live in South GA but my surgery was done in Atlanta @ Northside.
  • My husband had a 4 level fusion on 7-31 of this year. He is around a little over 2 weeks out. The pain is bad in the hips and lege, but the back seems some better (he says). The Surgeon was very open with us and how the surgery would go and so we haven't really had any big suprises. He had his neck done in September by the same surgeon and it helped alot. But this last surgery is just a brutal surgery to the body. It is not kind in the least. About a 12 inch cut and 19 staples. But he is straight in standing for the first time in 2 years. I believe he will be better, it will just take time to heal.
  • Hi there,

    I started with one fusion and 12 mths later ad another level done. Reading around the web literature seems to me (and I am no expert, just someone like you looking for help) that it is a 50/50 desision whether they fuse the upper level for spondy cases. There is a high risk of degeneratoion in the future if they don't fuse it and if your doc is planning a reduction then my untrained mind agrees that supporting a higher level makes sense.
    Ask.

    I know the literature says more than 2 levels is questionable. Do your homework. This site is great. I hope you find your answers.
  • I blew out my S-1/L-5 in 2000. I was bone on bone with approx. 50% slippage. Doc did anterior fusion with bone from my hip with just a plate and two screws. Doc got almost all the slippage out but the fusion never healed clear through so had to have posterior fusion at same level 9 months later with rods and screws to stabilize level so it could completely heal which it did eventually do. I would probably just have one level done but have a 360 done to make sure it heals because eventually you will probably have to have the next level done if you are active at all and they keep coming up with new things all the time. Good luck!
  • In addition to varying info from spine docs (ortho and neuro) on fusing L4-L5-S1 or just L5-S1, I'm getting contradictory info about whether the fusion can be successfully done as posterior only, or must include both anterior and posterior.

    Most spine docs I've seen over the years say mine requires anterior in addition to posterior. But, some say they can get to the front of the L5-S1 area from the back and get just as good fusion as if they did anterior. That doesn't seem to be what I've read; I've read that you can only get full circumferential (360 degrees) fusion if you do both anterior and posterior, and that PLIF only (or PLIF + TLIF) can at most give you fusion of 270 degrees.

    I'd like to avoid adding anterior if possible, but I definitely want to get the best long-term result (not take chances of having to do a 2nd surgery because posterior alone wasn't good enough), even if I have to undergo both anterior and posterior.

    Anyone have comments on this?
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