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L3 - S1 PLIF 3-level Fusion help

ScreentexSScreentex Posts: 20
edited 06/11/2012 - 8:41 AM in Back Surgery and Neck Surgery
I have scheduled a 3-level L3-S1 PLIF fusion and am having second thoughts.

While researching it seems like all I see is that a 3-level is almost never recommended. Alot of the research results seem to turn up older posts around 5 years old, so I wanted to get some feedback from people who have recently had this procedure.



  • Ask 100 people and you will probably get 100 different answers. Did you get other opinions?
  • It is a statistical fact that the success rates go down with the more levels that are fused. However, if that is the only procedure that is going to address your problems, what choice does the patient have?

    Several people on the board have recently had a 3 level fusion at the same level...and I am scheduled for next Tuesday but was just notified that insurance coverage has been denied. I imagine I will eventually get approval, but I don't think I'll be going in on 2 March. I think SpineAZ had a 3 level fusion, for one.

    Have you gotten one or two other opinions? What else have you tried? I would say if you are unsure, you should wait. Back surgery is almost always an elective procedure unless there is bowel or bladder involvement or sometimes, when there is spinal cord involvement...but that almost never applies to lumbar surgery. You can afford to wait if you are uncertain. If you have any other options, I would encourage you to pursue them. This is MAJOR surgery and there is no turning back once the surgery is complete.

    One thing people sometimes do not understand is that any back surgery will not restore the patient to the way they were prior to injury or onset of pain. It is done for pain relief and for stability, if the spine is unstable, as in spondylolisthesis. Doctors never promise that you will be pain-free after surgery. It is not something you enter into lightly without considerable thought.
  • Five years ago it was suggested I have a 2-level fusion and I got a second opinion from the TX Back Institute and they suggested a 2-disc disc replacement. I was going to have the disc replacement untill insurance denied it.

    I was tying to wait to see if insurance would eventually approve it, but that has not happened.

    My pain has got continually worse and I decided to go to a well know surgeon in my home town. He gave me my options, one of which was the 3-level fusion since I have more damage now. I have a high tolerance for pain and feel I am always at a pain level of 3-4, but if I do something as simple as hanging up clothes it shoots to about an 8 within 5 minutes.

    The 3-level seemed like a possible solution and I have the surgery schedule for March 17th. I've been doing alot of research lately and can't find any good up to date information on 3-level fusions with success rates. Most I have found are dated around 1995 and those show VERY low success rates. I just wish I could find some updated information that would give me some kind of success rates.

    I know the technology has improved, but to be able to put some kind of number to it would make my decision a little easier. Even the test studies that are currently accepting applications exempt people from the study that need more than a 2-level fusion.

    I'm just very unsure now, but am miserable and frustrated with my quality of life. I'm 46, was a college athlete and have a 6 and 7 year old. I try to just play catch and have to get a stool within 5 minutes to continue.

    If this gave me say a 75%-80% chance of being able to have an actual game of catch with my kids or help to coach their LL team I think it would be a no brainer.

    Anybody that knows of any studies they could direct me to, that would be great.

  • Thanks Kin,

    Those are the kinds of things I want to hear. There is just not that much info out there about it.
  • maybe contact the physical therapy group where your surgeon refers to. The therapists usually have the inside scoop on success rates, successful docs, etc. I'm sure they would be happy to help! Hang in there. It is very stressful, but if you can, you don't want to delay it like I did. The longer the nerves are compressed, the longer they take to heal and there is a chance the damage could be permenante. If I could go back in time, I wouldn't have been so stupborn, I too have a high pain tolerance! Take care~Shari
  • Personally I wouldn't focus so much on the numbers. After I had a fusion two years ago, I was surprised to learn what the medical definition of "success" was. It certainly was not the same as I had been thinking.

    I was complaining one day to my physical therapist about the amount of radiculopathy I still had when she interrupted me , asked me a series of questions and made me realize that my expectations for surgery were not in line with the medical establishment's definition of a "successful" back surgery.

    She asked me what my surgeon had set out to accomplish and whether he had done what he said he'd do. I had to admit that he had. He had performed a one level PLIF using a PEEK cage, pedicle screws and rods. He had decompressed and freed up the nerves. I had zero complications post-surgery, healed and fused beautifully. My surgery was a success.

    The fact that I was left with almost the same amount of radiculopathy was incidental to the definition of success. It is this definition of success that is used in the statistics you are seeking.

    I think this accounts for the difference between statistic numbers and the anecdotal stories we here from people here on this forum and elsewhere.

    "A lumbar spinal fusion is most effective for those conditions involving only one vertebral segment. Most patients will not notice any limitation in motion after a one-level fusion. Fusing two segments of the spine may be a reasonable option for treatment of pain if needed. Fusion of more than two segments is unlikely to provide pain relief because it removes too much of the normal motion in the back and places too much stress across the remaining joints. Only in rare cases should a three (or more) level fusion for pain alone be considered, although it may be necessary in cases of scoliosis and lumbar deformity....

    Fusion surgery success rates are quoted at between 70 and 95%. Surgery for painful conditions that arise from gross instability tends to be more reliable. Also, surgery in those individuals that have only one badly degenerated disc (especially L5-S1) and otherwise have a normal spine tend to fair well. Success rates drop for multilevel degenerative disc disease, or in individuals that still have good maintenance of their disc heights." quoted from
  • Thanks everyone!!

    I agree gwennie and thanks for the link. I have already read it. That is the reason I would lke to see more recent data. That atricle was written 6 years ago in January of 2004 and there have been major changes since then.

    To me the surgery is worth doing if there is a GOOD chance that the worst case scenario is that I have no improvement and am not worse off. If that fact is probable then a 50% success rate of me having a better qaulity of life is bearable. If that 50% rate is just based on 50% feeling better and 50% feeling worse, that is when the doubts come in.

    I know there is no guarantee, but I want to make the best educated decision I can.
  • This is an interesting study, but I don't know how relevent the findings are since the people studied were older adults....

    You will have a hard time finding anything current as it takes a couple years to compile data and publish it, as you can see from this study.

    What is interesting to me in this study is the high percentage of revision surgeries that were necessary.

    I'm curious what you would consider "major changes" that have occurred recently with a multi-level fusion?

  • I guess major changes wasn't the best word to use.

    Changes in things like going from stainless steel pedicle screws to titanium pedicle screws. Their bioactivity and more flexibility may improve bone ingrowth and mechanical fixation. One study in 1999 showed a 33% increase in onbone growth with this new screw.

    Going away from the hip harvesting of bone and newer additives to help with bone growth.

    Those are just a couple that I talked to my doc about and then researched.

    I am meeting with him next week to help fill in the blanks on some of the questions I have asked here too.
  • Hey gwennie,

    I couldn't open the link.
  • I had a 2 level fusion L4-S1 2 years ago and also was happy with my results. My L3-L4 was showing signs of DDD at the time but wasn't generating any pain at the time. I to went to Tx. Back Inst. and also denied the ADR by insurance. My next disc above my fusion is starting to cause problems and will sometime in the future have to be fused which will put me in your shoes. I will do it as soon as the pain stays around a 6-8 pain level without any thought. It's a major surgery and is rough for a couple of weeks then things get better and your quality of life will be back. I can play ball with my daughters now and do just about everything I want to do. I did give up golf which my Dr. suggested. You just have to be more careful and think about what your going to do before doing things. My Dr. at the Carrell Clinic in Dallas has been wonderful and I trust what he thinks is best. Go for it if your quality of life is like you say. Six months later you will be much better off. Good luck and keep us posted.

  • Well...one interesting thing I ran across while trying to find some statistics for you were the directives from the Cigna insurance company defining which spine surgeries they will and will not cover. They are quite strict about which multi-level fusions they will cover!

    If interested:

  • I had L3-S1 fusion in 5/08, so in a couple of months it will be my second anniversary. Would I have it done again? In a heart beat! Why? Because my new, reinforced spine is the only part of my body that is well, like new. No pain, whatsoever. If I only could say that about my knees, hips, shoulders and fingers I would be a very happy women. But hey, nobody is perfect! At least I have no more sciatica pain nor morning stiffness in my back.

    So you see, back surgery - even three level - works for many people, myself included.

  • Hi Kinpain: I glad I found your post. It's the first one tht give me some encouragement. I'm having a 3 level PLIF in about 3 weeks and was getting really scared about it.
    Very few of the posts offer much encouragement as to pain after surgery and also complications. I don't expect to be perfect after surgery, but I am hoping for relief from pain so that I can at least walk more than 100 yards without having to lay down. House work or even cooking is a chore and must rest all the time. Skiing is a big part of my life and my Dr assured me that I would be able to ski probably next year (I'm sceptical about this, but I have hope.
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