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How many levels need to be fused help

Mark RileyMMark Riley Posts: 1
edited 07/05/2012 - 12:25 PM in Back Surgery and Neck Surgery
Hi I am only new here but have had a bad back for approx 16 years I am 43 years old approx 14 years ago had lacectomey urgery on L5/S1 level and was still sore but after 6 weeks was back at work so with not too much trouble with my back was pretty good until approx 16 months ago and had a decompression surgery on S1 and have not been the same since I have had 2 steriord injections in my spine no relief two facet joint injections no relief they were from pain managment doctor who sent me to a nerosurgion who said i need at least a one level fusion but i had a discogram done and my L5/S1 is very painful the L4L5 is GOOD but the next level L3 L4 is very painful my physio said that i might need a three level fusion but was wondering any one on this sight has the same problem and do they just do the one level or do they do the three levels to make sure that you do not have to get a operation again please all the advice i can get the better i am very scarded about this op but can not live with this pain for much longer please help thank you


  • Mark,
    Unfortunately there is no good answer to that question. All you can do is have faith in your surgeon and fully trust them and their opinions. Sometimes they don't like to fuse to many levels as for one it is harder to recover but also you loose ROM(range of motion). It is possible if they take a healthy disc out you could still develop pain issues from that area that you didn't have before. Which I why I suggest that you need to have the utmost confidence in your surgeon and what they are telling you. Good luck and I hope it all works out the best for you.
  • I agree with tamtam, there is not good answer. Often a one level fusion will put stress on the levels above and below it. Other times people have no further problems. I had 3 fusions (and before the fusions a laminectomy). The levels above my first fusion (L4/L5) were OK. It was a crap shoot whether or not I would require more fusions. Because my back problems were caused by being knocked unconscious by a snowboarder my spine continued to deteriorate and I ended up being fused L1-S1. Now there is too much bone on my SI joint (I am really good at building bone and have a great fusion).

    I did a lot of research before my surgeries and also got a 2nd opinion. I had an excellent surgeon who I trust very much.

    Good luck and let us know how it goes.
    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • Mark,

    Sorry your having problems. First thing I'd do is to make sure your Dr. is board certified to work on spines and that is all he does. At the point your at you don't want a regular orthropedic surgeon working on your spine. You want a surgeon that all they do is spines day in and day out. Thought I'd throw that out there just to make sure. Does this Neuro you saw only work on spines?

    The answer to your questions lies with whatever the surgeon you decide on says needs to be done. When you start talking about fusions I'd also be looking for another opinion before I went forward. Fusions are a last step type operation and can't be undone except in very rare cases. It would be pretty hard to fuse a upper and lower level without involving the center one. Did he say why he felt you were in need of a fusion and what type of fusion he was suggesting. They can be done entering from the back, entering from the side, entering from the front, or something called a 360 fusion where they enter from both the front and back.

    I believe there is a sticky section on the top of this forum page that might help you with questions to ask and what type of Dr. you might be looking for.

    It sounds like you have been through some pretty painfull tests already but be aware that there are more depending on what a Dr is looking for.

    Let us know what else you find out as I would like to know the answer to your question also. I am fused from L3 down.
  • i had ALIF between S1 and l4/l5 } last dec .i have also had 2 previous surgeries over the last 16 years {i am 46] so we are in a similar boat ! .it sounds to me like you may also need ALIF too .my only advice is find a top end consultant to do the work as any fusion is not the easiest thing to recover from ..good luck
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • I had PLIF on L3/4/5 plus rebuild done in December 2008 but was warned at the time that this would put undue stress on the upper spine. It certainly did for I had to have an ACDF C2/3/4 in September 2010 followed by a Posterior CDF C5/6/7 plus plating to facet joints in December 2011. I am very lucky here in the UK as my Spinal Surgeon is a specialist in spines only. He is considered to be one of the top ones in UK and is also world renowned. Hope this is of some help to you. Due to scar tissue after PLIF operation in 2008 I am getting pain to left buttock/leg/knee/foot areas so have to get yet another Lumbar Caudal Epidural Injections in 2 weeks time. Had one on 15 May and it did help.
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