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MRI shows disk remaining after L5-S1 Fusion??

breitsdbreitsd Posts: 19
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
I had an L5-S1 spinal fusion (posterior) about 11 weeks ago and my pain symptoms are the same as before surgery, but much more intense. At my 3 week post-op exam, I was relatively pain free except for the normal pain associated with all of the hardware. The doctor felt that something went wrong either with the hardware or perhaps scar tissue was adhering to the nerve root. He ordered a CT scan which confirmed that the hardware is fine. He ordered an MRI to see what is happening with the soft tissue. I obtained a copy of the CD because I have had two previous discectomies and I have learned how to read them (at least somewhat). What completely shocked me was that the images showed a partially intact disk at the L5-S1 level on the left side!! I'm still waiting to hear from my doctor about the official MRI results, but I thought that it was standard procedure to remove the entire disk for a fusion. Why would he leave part of the disk intact? I would think that it would interfere with bone growth. Does anyone know more about this? Thanks!!


  • I may be wrong but it is my understanding that a lot of times the disk space is just gutted with a cage and matrix put in its place. I don't believe that the entire disk needs to be removed as some of it, the perimeter, being there isn't going to hurt anything

  • Most probably he did not left your disc with purpose.

    If he did TLIF pusion from left side, it is hard to reach right side of the disc. It is always possible that some part of disc will remain
  • You do not mention what type of fusion you had. There is a way of doing fusion where the disc is left intact. Sometimes a slurry is made from ground-up bone pieces that are removed during surgery that is combined with a biologic bone product. This is "painted" onto the disc which causes it to calcify, eventually. Then rods and screws are usually used to reinforce this concoction while it fuses.

    This is one way I am aware the fusion is performed without removing the disc.

    When will you be talking with your doctor to find out what he did? You can always request the operating room notes to learn how he described the procedure. It is a good idea to get a copy for your personal records anyway.
  • There is no fusion when disc is left intact. This is called stabilization and/or fixation, but not fusion.
  • Thanks for your clarifying questions and comments. I guess I don't know all of the types of fusions. He did use a bone graft (autograft) and I can see four pedicle screws in the MRI and CT Scan. His website describes the procedure and it even says that they remove the disk. My L5-S1 disk was a mess after two failed discectomies. I do see bone growth on the right side in the MRI. I've been wearing an Orthofix bone growth stimulator, so I'm pretty certain that he is trying to fuse the vertebrae.

    I just thought it was strange to see the disk on the left side. It may just be the annulus. I hope my doctor calls me on Monday. They were closed yesterday in observance of Good Friday. I'm very nervous because I'm at 11 weeks post-op on Tuesday. At 12 weeks, if my pain hasn't improved, I think this is technically a failed surgery. I remain hopeful about PT. I'm going into my 4th week of fairly rigorous PT and I do see a little improvement, but not enough to return to work fulltime.
  • I had the same questions as you Breitsd after my last Cervical spine fusion when *most* of my symptoms came back. My NS had me get a new MRI at 8 weeks, and his comment was "I want to be sure you didn't re-herniate!" I then asked him..."How can I re-herniate if you did a discectomy and fusion?" He then advised me that not all the disc material is removed during the fusion process, and in the early part of recovery especially, the "good" piece that is left could herniate. Hope that helps. I am guessing the same occurs with fusions in other parts of the spine? Take care.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Well, that is a technicality because as far as the insurance companies are concerned, it is billed as a fusion.
  • I had this L5-S1 fusion to supposedly alleviate disk pain (after two failed discectomies). I asked the same question as Aviatrix: "How could my disk pain have returned if I don't have a disk any longer?". Now I know why the doctor didn't answer my question, because I do still have a large portion of the disk. I'm dumbfounded by this. His website and every other reptutable site that describes a spinal fusion, clearly indicate that the disk is completely removed, not partially removed.

    So, I just realized that everybody puts their medical history. I'm not sure I understand all of the acronyms being a Newbie to this site (not to back pain!). I promise to abbreviate next time. I did want to mention how great I felt after my first discectomy. I was a new man.


    9/12/08 - Discectomy at L5-S1 due to severe herniation and impingement of nerve root which caused numbness in foot and foot-drop-- extremely successful surgery results in terms of pain relief and improved leg function (except the disk had no integrity).

    5/26/09 - Repeat discectomy at L5-S1 due to re-herniation from riding a bike on steep hills; pain never subsided; later diagnosed as disk pain due to severe disk degeneration

    1/19/10 - Posterior Lumbar Fusion at L5-S1 with instrumentation to alleviate disk pain -- pain symptoms now far worse than prior to surgery. HOWEVER, leg function has improved significantly, probably due to the larger foramina opening? Fixing one out of two issues ain't bad?

    4/3/10 - can't wait to hear from the doctor on Monday!!

  • I really wouldn't worry too much at this point. Many people take a great deal of time to fuse. It may not seem so to you, but twelve weeks is still fairly early in the process.

    Many surgeons do not give up for at least the first year.

    If you were feeling better, except for the surgical pain, for the first three weeks, it is possible that this is a problem with scar tissue. Epidural fibrosis usually shows up in a small window of time...from about 3 to I think ten or twelve weeks. It is possible this will show up on the MRI. Obviously, you will need to talk with your surgeon about this, and hopefully, he can provide some answers...but he may just tell you to give it time.... These are the frustrating experiences of surgery.

    There are other reasons for the continued pain besides a disc problem. You could have continuing nerve pain that is not caused by the disc, for example.

    Try not to jump to conclusions. If you continue on as you are now, you will just need to keep asking questions and searching for answers, if time and healing is not going to take care of the issues.

    Most people are not aware how long it can take to fully recover for a fusion or even some of the smaller procedures. If you look through other threads, you will see that it takes over a year before some people have had all their issues resolve and they are finally feeling the way they thought they would right after surgery.

    Try to be patient...at least until you get some answers!

  • Thank you, Gwennie.

    That is sage advice, and I have to say that if my doctor had given me that kind of guidance, I would have been in a better frame of mind in the first place. I was led to believe that I should be off of all meds and comfortably back to work fulltime by 8 weeks. So, I pushed myself in earnest to get there, only to fail miserably.

    Your guidance offers me a healthy perspective, realistic expectations, and preserves what precious little hope that I have left in me.

    I think I can actually enjoy my Easter weekend now.

    Again, Thank You! Have a great weekend.
  • Please see a post I made awhile ago...

    I really believe than more patients than not go into surgery believing that recovery will be much faster than it turns out to be. If you had been on the board longer prior to your surgery, you would have seen many stories that would help you realize that timing is all over the place, but very few people recover in the couple weeks that some are led to believe will happen.

    If I've written once, I've written a hundred times on this board...you are still early in your healing...be patient...maintain a positive attitude. There are some people who have instant relief with a microdiscectomy but it is not the huge amounts we all are led to believe.

    The nerves go through quite a beating during surgery and they get ticked off in the process. Even if they were not injured prior to surgery, there is often some residual irritation after surgery. This is normal, and, it is also very normal for nerves to heal at a very slow pace.

    Discuss your concerns with your surgeon. Ask him all your questions....None of us are spine specialists, after all...but we have heard enough stories from others and many of us know personally that recovery from back surgery is a LONG process. It is often baby steps...with two steps forward and one back...particularly when we "overdo" things in our zeal to recover faster.

    The best thing you can do for yourself is to keep walking...don't push it too hard...if you have pain walking, make the walks shorter and slow down the pace, but try to walk shorter distances more often...several times each day for maybe ten minutes at a time...on a level surface.

    And, enjoy your Easter and promise yourself you'll take a one day vacation from worry!!
  • SpineAZSpineAZ WiscPosts: 1,084
    You can call the hospital or surgical facility where you had the surgery and ask them for a copy of the surgical report. This is a narrative that states what surgery was intended, what they found in surgery, what they did, and the end result. You can also get this from your surgeon. I get them after every surgery I have, just to keep them for my records, I just tell the surgeon's staff "I just want a copy for my records" and they print it out without a problem.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • I read last night that 30 - 40% of the disk remains in the intervertebral space when a fusion is performed. Depending on the type of fusion you have it may be difficult kor impossible to safely reach all of the disk material. I am anticipating having a fusion and my neurosurgeon explained to me at the beginning of the conversation that having a fusion does not mean that you can not re-herniate disk material. I have had a micro-discectomy and lumbar laminectomy both at L4-5 with subsequent re-herniation. It sucks, but it happens and is a known compliction of surgery. once you damage the protective covering of the disk you are at risk for herniations.
  • tKnow, thanks for the info. I had a fusion at L5-S1 specifically to eliminate disk pain and to free up compression of the nerve root. My post-surgery MRI shows both an anterior and posterior bulge of the disk. Maybe I misunderstood my doctor, or maybe he thought I was an ignorant patient and that what I didn't know wouldn't hurt me? I'm frustrated by the misinformation that was given to me prior to surgery. He clearly said that they would remove the disk (not "part" of the disk).

    Thanks again,
  • Have you been able to meet with your surgeon yet to see what he thinks is causing your pain? Whenever I see someone say things were going along OK and then at about three weeks out the old pre-surgery pain started to come back, I always think about the possibility of the formation of scar tissue. Be sure to ask your surgeon what was found on the MRI in that regard.

    Epidural fibrosis is a natural part of healing, but sometimes the tissues develop in a random way, and it can attach itself to the spinal nerve or take up space that would otherwise be occupied by the nerve. Epidural fibrosis can be benign but it can also cause a lot of problems.

    What type of fusion did you have? Did you have something placed between the vertebrae to hold the disc space such as a cage? There are various ways of doing fusion and not all of them involve removing the disc. The surgery I may or may not have depending on what happens with my appeal was a 3 level fusion that did not involve removing the discs.

    Just as in discectomy where the entire disc is not removed, often in fusion, if a disc is bulging or herniated, the damaged part is shaved off before the rest of the fusion is performed.

    I would just ask your doctor what was done and what is it you are seeing on the MRI.

    Obviously doctors do not go into great detail with their patients regarding exactly what they plan to do during surgery. Most people would be too squeamish to want to hear all the gory details!! So I think unless you specifically have a detailed conversation all about that disc and what is planned for it, I can see how a surgeon, in explaining what he has planned, would just say "the disc is removed, and then we'll put in this....and then we'll do this..." He wouldn't specifically tell you what part of the disc will be cut out, from which side, etc. He would probably assume it would be meaningless to you, and with his limited time he can spend with you, there are more important things to cover....I doubt you misunderstood him, or that he was intentionally trying to mislead you.

    But make a list of all your questions, so when you go in next, you won't forget anything that is important to you. Hopefully you will get answers to all your questions...but don't be surprised if you are told you are still early in recovery, it takes times for nerves to heal, and to be patient.

    Take good care,
  • My surgeon went over my new xrays at my 2 week post op appt and I have a spacer put in at the L5-S1 area. I had no disc left according to him.
  • I agree that doctors do speak in general terms rather than gruesome details. I am in the medical field so i tend to ask a lot of specific questions. However, any time a surgeon suggests any type of back surgery he/she should be addressing the risk of failed surgery. my doctor also quoted me stats on the success rates of a fusion under perfect conditions. And he also discussed mitigating factors in my case. If your doc doesn't have time to talk ask if you can make an apt. to come back and ask more questions. If they don't have time for you or want to rush you into having surgery be careful.
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