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Domino effect ??

jellyhalljjellyhall Posts: 4,373
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery

Can anyone tell me if the domino effect after fusion surgery tends to go upwards or downwards? Or maybe it goes in both directions!

Has anyone had experience of this?

Is it better to get a multi level fusion, or just one level and see if you need more surgery in the future?


  • I'm not sure about the direction of the domino effect, but as for getting 1 level vs multiple I think it's always better to go with "less is more" if it's feasible. I had two herniations but we decided to only operate on the large one. This was after my discogram showed that most of my pain came from that large level.

  • I think you are talking Lumbar, but my experience so far has been Cervical. I had my C5/6 fused, and then a little over a year later my C6/7 and now 3.5 months later, my C7/T1 is having issues! So for me, the adjacent level issues have been "below" each fusion. Hope that helps. Take care.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • What levels are they planning on fusing? Usually, if you have L5-S1 fused, then you worry about L4 taking the brunt of the stress. L5-S1 when fused is already stable and without much movement. L4-5 takes the most abuse in daily life, for all of us. If both these levels are fused, then L3 will be at greatest risk.

    It looks like you have the potential for future problems at several levels. After fusion, it will be very important that you learn proper posture, spinal alightnment and body mechanics. It will be important to build up core strength and keep the muscles in balance, and it will be worthwhile going to a PT or a kinesiologist or well-schooled trainer to learn the proper exercises and body movements.

    've been going to a guy I call my rearranger for want of a better label. I have difficulty describing his occupation as it is a variety of ones...accupunture, Chinese medicine, body work, etc. He took one look at me when we first met, and beginning at my feet, proceeded to point out how I was standing and walking were causing some leg rotation which resulted in hip rotation, pelvic tipping, which was putting strain on certain segments of my lumbar spine, etc. Due to three years of standing and walking a certain way in an attempt to minimize my leg pain, I was compensating with various muscles in my back -- one side was much tighter than the other. One set of muscles were elongated, while others were shortened, hip flexors were very tight, IT bands were very tight, and it appeared one leg was shorter than the other. I have been working with him for almost a year now and I have trained myself to sit and stand "squarely" without putting more weight on my left side. I am not supposed to cross my legs as it puts excess pressure on the one side, etc. It is amazing how small postural things like this can build up over a lifetime and really create problems in the spine.

    Too many people have some sort of back surgery and as soon as they recover, they return immediately to all the same activities, postures, etc. that contributed to the original problems. People follow "the rules" for awhile, but then stop doing the back exercises to make them stronger, stop paying attention to how they sit and walk, start sleeping on their stomachs again, etc. and eventually they end up back in the doctor's office.

    There are several issues regarding the domino effect or adjacent disc disease. Often people have fusion at one or two levels, but the adjacent segment is also diseased to some extent...and it would require attention at some point any way. The extra stress just makes it happen a bit sooner.

    If you are interested in learning more, I am enclosing a link to a clinic study, reported on in 2007:

  • put stress on adjacent levels once you have one level fused. It is always best to try all conservative measures first before opting for a fusion.

    Good luck and keep us posted.

  • I am really trying very hard to avoid surgery if possible.

    I have been told by one doctor that they might need to do more than one level fusion because of degenerated discs either side of the spondylolisthesis.
    A surgeon I saw said 'why fix it if it isn't broke' so I guess he didn't think it would need it. He said he would do a decompression and fuse L4/L5.

    My chiropractor told me a year ago that I have one leg shorter than the other, one hip high and one shoulder high. Five years ago, a dressmaker told me that one shoulder was higher than the other. That was before I knew that I had back trouble. I just thought that I had done something to make me have pain, and things would settle down, so didn't dream there was a chronic condition.

    Now looking back, I have had problems with my back since I was a teenager. I didn't have pain all the time so didn't take too much notice of it.
  • SpineAZSpineAZ WiscPosts: 1,084
    For my first lumbar and then cervical fusions I was "less is more" as maybe I'd have no further damage.

    Now 17 years later I need more lumbar work (I have lax ligaments and tendons so at least one level of my spine has moved forward and needs to be reeled in). Now I'm at "let's do what is needed" because the more often they go in the harder it gets. So there is a question right now if I need to just at L3 to the fusion or L2 as well. I've told the surgeon I'm giving him permission to make that decision when he gets in there. All the tests in the world (CT, myelogram, MRI, xray, etc) don't always show what is really going on....so if he finds L2 is compromised I want it taken care of now.

    But I'm glad I subscribed to "less is more" earlier in life. It was the right decision at the time.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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