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1 or 2 level fusion ...

noseovertailnnoseovertail Posts: 387
edited 06/11/2012 - 8:37 AM in Back Surgery and Neck Surgery
I'm scheduled for a one-level minimally invasive TLIF already. They will be operating on my L4/L5 and leaving my other smaller herniation at L5/S1 alone. We hope that since my L4/L5 is much, much larger and seems to be the source of most of my pain according to my discogram, I will not need them to go back in and surgically correct the other one. At first I was confident in my decision to only get one level fused, but now I'm starting to wonder why I shouldn't just get both done at once?

Can someone tell me what they think about how I'm doing things? My orthopedic surgeon wants to try the "less is more approach" and my uncle who is also an orthopedic surgeon but lives far away has agreed with this as well. I'm sure it has to do in some part with my age, since I'm 26 and nobody wants to do too much to me it seems. :(


  • The reason for this is the more levels you fuse the bigger risk of non fusion. So if not needed, dont do it. It sounds the l-5 isnt very bad, so that is generally the approach most surgeons have. I had three torn discs. 2 really bad and one not so bad. We only fused 2 because of those reasons. Hope this helps.
  • oops, how do I remove?
  • I had the same situation and I got 8 opinions - six said they would fuse one level and the two neurosurgeons said they would fuse three to five...depending on what they found when they went in. Needless to say I went with the one level.

    Everything went well but it did not solve my nerve pain. My imaging testing does not show any nerve compression but, obviously I have it.

    So I think I am going to have more fusion, L5-S1 for sure, and possibly L3-4, too.

    It is a hard decision to make. Do you know if they are planning a minimally invasive fusion? Oh, I see there are! @) Could they do that for two levels?

    I guess I would go with what they are recommending due to your age...if you can put off fusion as long as possible, there may be some new technology invented by then that will be less invasive!!
  • I agree with others who have gone with the one level fusion/least invasive approach. I am three weeks post PLIF and had severe DDD, severe herniation, and bones spurs at the S1-L5 level. My L5/L4 level also has a smaller herniation now with moderate DDD. I am so glad I did not go with two levels as this would have been much more painful. Plus, reading other's experiences, it appears more problems arise with the 2 or more level fusions. I hope all goes well with your TLIF!

    Take good care of yourself (or have someone else take care of you)! ;) ;)

  • One thing to take into consideration is the added pressure that fusion puts on the next level up. The more you fuse, the more pressure.

    My L3 is going to have to be fused sometime - the NS says 1 year to 10, no one knows, but it will need it eventually. We fused 3 levels, S1-L4.

    They used some flexible plastic 'bullets' in my fusion to try and keep some of my bendability - to save the L3 as much as possible. Ask your NS what they are planning on doing to help preserve your other discs.

    Also, glad you have the discogram to confirm what level is the pain generator
  • Thanks for the responses, they all make a lot of sense to me. I certainly don't want non fusion, or to put more pressure on the surrounding discs.

    I hope you are all having a good, pain free day!
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