Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

L4-S1 fusion, hybrid, other?

Hello all,
First time writer, long time reader. In short, I am curious if anybody here has had an L5-S1 fusion performed with a hemorrhaged L4-5 disc? Also looking for personal experience of a hybrid L5-S1 fusion/disc replacement L4-5, or double level disc replacement at those levels (overseas).

Back story- I am a 28 year old male, no injuries, car accidents, etc. with persisting lumbar pain for ~10 years (8 acute, 2 chronic). I have daily debilitating pain both flexing and extending at the waist, but side bending is mostly pain free. Herniated discs at L5-S1 and L4-L5 along with a minor retrolisthesis at L5-S1 (sorry, no data on category). 4 surgeons have weighed in, and I still do not have a clear picture of what is causing my pain (I am told by more than one that it is perplexing). Over the last two years I have performed the usual gauntlet of tests including:

-chiropractic care

-massage therapy

-inversion therapy

-6 weeks PT

-lumbar traction therapy

-epidural injections

-medial branch blocks/facet injections indicating I'm not a candidate for RFA

None of the above brought any pain relief or slowed/stopped progression. Some severely increased pain.

In my case, L5-S1 is the worse of the two discs. I am not agreeable to a two level fusion at my age. I am curious if anybody with a spinal instability has had luck with a single level fusion, and, if so, was there any pre-op deterioration at the adjacent levels? Has anybody had luck with a hybrid fusion/replacement for a spinal instability?


  • LizLiz Posts: 7,832
    edited 08/21/2014 - 9:43 PM

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Not sure what you mean by a hemorrhaged disc, but my L5-S1 fusion was done, and I had/have 2 bulging discs above it. Chose only 1 level to fuse.
  • itsanewdayiitsanewday Posts: 4
    edited 08/25/2014 - 4:39 PM
    I was in pretty much the exact same situation as you, also had the facet joint injections (2 sets) at both levels and they only made me much worse, I just had a two level fusion (am a 41 year old male) at L4/L5/S1 5 weeks ago and was the right decision, my original pain is completely gone (so it WAS discogenic) and the pain from surgery is constantly improving. Am now easily walking 3km/day and completely able to look after myself.

    No point in doing a one level fusion as the increased pressure/stress on the unfused and poor quality disc will just make things worse and 90% chance that you'll need to go through a second fusion on that disc at a later time

    Bite the bullet - I'm glad I did and its only been 5 weeks. What do you have to lose? There is little to no loss of flexibility after a two level fusion and your qualiy of life can only imrpove.

    The dramas you read on this site are not a fair representation of the outcome of these types of surgery, the people who have good and successful surgeries rarely visit or post to these types of sites, the ones who have poor outcomes and are looking for answers/support are the ones more likely to visit these types of sites. Get a good surgeon - one who has done at least 200 of these operations and has good success and get her done, then lots of PT and a good positive attitude helps too :) .

    Good luck from NZ!!
  • Hi , I had L5/S1 fusion with L4/5 artificial disc replacement in lieu of double fusion last year. See photo!
    It has really stabilised my lower lumber spine and improved my leg pain and I'm happy I had it done. It's a long recovery but manageable.
    I've had some negative results too, thoracic pain, bladder issues and now fibromyalgia which require ongoing treatment. I'm not sure if these problems would have occurred anyway but they were not issues I considered before surgery.
    I was at a stage were this surgery was absolutely necessary for me, I had an excellent neurosurgeon, vascular surgeon and visiting professor who invented the disc, so I was in good hands. I believe I was the first person in Australia undergoing the hybrid surgery using an ESP/LP disc.
    I wish you well with your decision and hope you have a successful outcome. I'm happy to answer any questions.
    DDD. Married,Mum of 2, Age 45: 2007 & 2008 L5/S1 Discectomy
    April 2013 L5/S1 Anterior Fusion
    & L4/L5 Artificial Disc Replacement
  • dermikeddermike Posts: 3
    edited 08/28/2014 - 7:34 AM
    I'm glad to hear of your positive results so far itsanewday! Did you have a retrolisthesis too and how far deteriorated was your L4-5 level? I ask because my L5-S1 is the worse of the two, with L4-5 only have a slight tear.

    Good luck hybridhattie! I'll have to look more into the type of disc you got. I understand Europe too has more alternatives than we have over here in the US!

    I'm a bit opposed to a 2 level fusion at my age because the doctor's speculate that the added stress will eventually compromise L3-4. A hybrid job should help with the adjacent level stress more than a 2 level fusion, I suspect?

    Ideally a 1 level fusion for stability would be my choice if I knew that L4-5 still had many good years left in it! Is a slight tear at L4-5 enough to constitute replacing it? I was also told this week by my surgeon that an ALIF approach for fusion would be the proper choice, but in doing so would disqualify me from having another anterior approach in the future (and thus meaning I would not be able to get the L4-5 disc replaced if I needed to).
  • Before deciding on adr in the lumbar spine, I would strongly caution you to do lots of research on adr outcomes in the lumbar spine. While Europe , Spain, and Australia, have done some, the outcomes in the US are not as favorable as the reports have been. Revision is a possibility and due the large abdominal blood vessels, in the abdomen, attempting to remove the disc or fuse it from the front can be life threatening. If you have any facet joint issues, it can worsen those or in some patients cause them to accelerate, causing revision to fusion .
    Cervical adr seems to have better overall outcomes but I think that part of the problem is that the cervical spine has more rotation, flexion and extension than the lumbar spine and putting an adr in the lumbar spine with too much of those things causes further problems down the road.


Sign In or Register to comment.