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Why wouldn't my NS do a 3 level fusion?

sagehenssagehen Posts: 221
edited 06/11/2012 - 8:28 AM in Back Surgery and Neck Surgery
I had a 2 level alif last May. My NS knew the disk above the 2 being fused was torn...but he said "we don't do 3 level fusions" I said ok.....now I am in so much pain I can't stand it. New discogram shows level that was torn is now completely ruptured....PM Dr was amazed my NS took me off pain meds...Needless to say I'd had a rough couple of months before getting something for the pain.I was getting SI joint injections to see if that was the cause; so I thought ok....no pain meds will tell me what's going on.
Anyway...After my fusion I talked to a woman that had a 4 level fusion....so tell me was it just my specific situation, or is anyone else hearing the same thing? I am a bit distressed about it all, I just went back to work in October after being off for about 4 years,(had a acdf and shoulder surgery in 04,05)I thought I was doing so well immediately after the surgery last May....(now I know it was the drugs talking)I hurt so bad now...some days I just cry.( While I'm driving down the highway to my next sales call.) I see my NS this month about this development, I'm not sure I can take another surgery. I'm on Norco right now and that will take the edge off enough to take a shower in the morning,if I have to take anything stronger than that I won't be able to do my job.I'm very bummed......


  • there are many reasons why docs wont do more than a 2 level LUMBAR fusion...
    the success rates are...95% for 1 lvl, 75% for 2, 50/50 for 3 lvls, and a for like me, is 30%...

    add in other factors like progressive DDD, chronic herniations, type A personality that is likely to push past dr limits and re-injure, weight, and other risk factors all play a part in whether or not doctors will operate on certain patients.

    I totally understand your frustration, as i had to have this spelled out to me by a physician myself...i may have one chance, but that is just a bi9t to funny to imagine...

    picture this...im 5'7"...350lbs...the doc is like 5'....latino...little guy...prolly gonna hafta sit on me to operate!...lol...i don't think so! :T :))(

    all i can say to you, is hand in there, change what you can, accept what you can't, and tomorrow is another day!

  • I'm sure my Ns had his reasons,like you said, my DDD is progressive,my weight was not too bad,although I am working on losing right now, I just want to me again...Tall and thin, always have been until the last 4 years. No work so I cook ,bake, eat, cook, bake eat! I am having alot of thoracic pain now too, I haven't even addressed that with my surgeon yet. Will have to though. Sounds like you have a funny situation. Si senorita? Will you be having a four level fusion then? If so when?
    Thanks for the reply. Sagehen
  • My NS told me he wanted to do 1 level in July and then in a year he would do a second level.

    I had 2 ruptured discs and a third one that is almost as bad.

    Luckily we had done a discogram and he found that the disc he thought was the worst was NOT the one causing most of the pain.

    In any case I told him he better do both if he thought they needed it because there was no way he was talking me into a second surgery just one year after the first.

    I feel for you having to go back in for another level - that really really sucks.
  • My spine specialist is an Ortho....he only does spines.

    I had a 4-level PLIF. According to him (and his PA) a 4-level is not rare.

  • wouldnt do a three level fusion, because he uses the reasoning that the more levels done at once, the greater chance for failure. I had three levels with tears, but only 2 were positive pain generators on the discogram. He said he would rather go in later for the third one as long as it wasnt bothering me and have a better chance at sucess. I agreed with him. Hopefully the third one will never give me a reason to be done. Thats hopeful, knowing it is already torn and right next to the fusion. But a girl can hope right.
  • But from all that I've read.....and I've read a LOT,it seems to me that most surgeons simply want to continue going back in for future surgeries.

    I'm open to debate or even disagreement on this topic if y'all wish to discuss this-I can handle disagreements w/o taking it personal.It is after all,only what I've read.I'm not an actual surgeon :))(

    Dawn,when you say 95% for 1 lvl, 75% for 2, 50/50 for 3 lvls, ...To me that's really not so different as the people who have one lvl-then are likely to need another lvl either above or below their original sugery,and then later possibly even another.Do you understand what I mean-maybe it's another way of describing the operations or the risks/chances,but the same idea?

    I'm just trying to figure all of this out,but Drs.,they are all so different in their ideas and methods & even what they think works best.So many deciding factors I guess.

  • no...as fun as it sounds to take the 30% chance of the 4 lvl fusion working and having a tiny latino operate on me... =))...I not THAT much of a gambler. I remain inoperable as within a few years of the 4 lvl fusion, the lvls above would then degenerate, and need to be fused as well, and then.... :''(

    I must instead wait for someone to come up with a new idea...a brighter tomorrow ...until then, I do the best I can with what I've got today.

  • and my spinal surgeon here in the UK has said that it is unusual to do three levels at one time & this is most likely the most he will do unless something else happens & it becomes life threatening! - always nice to know especially when I have undiagnosed pain in my back radiatoing to my legs! My surgeon is a no nonsense type of guy, lays it on the line & says it as it is - he certainly wouldn't bugger me about - but then again I have seen him for 14 months & not scheduled too either & I haven't seen ayone from pain clinic since July last year & not due until the 17th of this month - sorry getting a bit bitter as i'm having a really bad day!! Also I alsways meant to mention this but i've never seen a neurosurgeon since I injured my back - don't really get a choice is a othorpedic spinal specialist i see or nothing - have never been given a choice.
  • First, I am not a doctor, so my comments are worth what you paid for them. But I am a pretty good engineer, and this, at its most basic level, is an engineering question.

    Think of your spine as a bow, and bending it like drawing the bow. When this happens, each segment of the bow, smoothly flexes its own little bit, with the drawing force evenly shared all along the bow. However, take some screws, rods, etc. and make a significant portion of the bow completely rigid, and then draw the bow again.

    The bending that used to be evenly spread through the length of the bow, or spine, no longer is. This accumulated bending force formerly shared by many vertebra and disks is instead applied to the first free joint next to the fused ones. The more segments fused, the greater the bending load applied to the disks immediately to the fused section. One disk is not designed to carry the bending load of several. This is why doctors want to minimize the number fused.
  • Though I'm no engineer-not a Dr either,but my mathmatics skills alone can help me understand the concept.

    So-this would explain why the surgeons want to start with one lvl at a time.But still,if a person has 2 or 3 obvious bad discs.and the surgeon knows that the patient will need future surgery in months or a year tops..do you suppose it could be an insurance question?

    What say you?

    lol ☺
  • Obviously it is an individual case and sounds like Dr. decision,and with the possibility of further disk issues above and below the ones fused, but ...oh to think of another surgery. My incision (scar) is 11 1/2 inches long ,on my belly. It still hurts.And as I mentioned,I just started back to work in October,I will have to quit.I wish my NS would have taken the risk and did 3 levels. But that's neither here nor there now. The human body is an amazing thing,that it can tolerate the things we do to it in the first place!Thanks for all the comments...I will have to really think about this.In the meantime...just another nasty painful day.But I hear spring is coming......that helps. Take care everyone Sagehen
  • I just had a 3 level done and have done just fine. As my surgeon put it to me frankly, your issue is L4-L5 right now, but a few years from now L2-L4 will start giving you issues as well due to buldges.

    So we fixed it all at one time. Much safter as far as I am concerned then MULTIPLE surgeries. I could not imagine going in for multiple fusions :(
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