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L5 spondylolisthesis - fusion in slipped location

Finally delurking to post, but first I wanted to thank people for their postings here, it's been a great help to read them.

A little history before I launch into my question:

Diagnosed with l5 spondylolisthesis at 21, had two opinions from two surgeons at the time, (1) get the s1 to l4 fusion or (2) wait as long as you can. Knowing something about the revision rate, I chose to wait as long as I can, now at 39 and after my pain shot up a few years ago I'm rethinking my options.

I've revisited hospital over the last few years to get a view on where I am now and what my options are; obviously the spondylolisthesis has gotten worse (a bit over 50% slip now) along with one disc that is pretty much destroyed and one that is prolapsed but in terms of surgery the main issue is that the vertebral body has remodeled under the differing load over the years.

Effectively my l5 is now considerably more triangular in shape than square, I actually got checked for osterporosis since on an x-ray it looks very similar to an osteoporotic vertebral collapse, thankfully no osteroporosis.

So, after the rambling, the crux of the question. The surgeon I'm talking to is suggesting fusion 'in place', ie. not retracting the vertebrae to it's 'normal' position and fusing it there but fusing it where it sits now (in it's slipped position). I can understand the rational behind it (I used to be a medical science researcher so perhaps a little knowledge is dangerous), but I'm curious if anyone else has had their fusion done this way and what their experiences were?

NOT looking for medical advice here, just curious if anyone else has had a fusion done this way and what your experiences were.

Thanks in advance!


  • I am not there yet, meaning the fusion in situ suggestion has not been made but I do have a little better than a 50% slip, and can understand the mechanical reasons why in situ might be the best option........but as we usually suggest to most patients, it would be wise to visit/consult with at least one other surgeon and get his opinion.......knowing that he may or may not have a different idea, at least it gives you an opportunity to discuss both options or feel assured regarding the recommendations of your preferred consult.
  • Sandi,

    Thanks for the response, appreciated. Thankfully I am able to consult a second surgeon (actually started that process already), so hopefully I'll have feedback on that in a little while.

    It's not so much that grade slip for me that's the issue, more the plastic deformation that's happened to the vertebrae over time due to the change in load distribution from the slip...maybe there aren't that many people who are daft enough to put up with a 50% slip for over 10 years!

    I used to be involved with medical research, so I've already volunteered myself to be a case study for my old department when I do eventually go in for the operation :)
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