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Cage versus no cage

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:19 AM in Back Surgery and Neck Surgery
Hello - I have seen two surgeons for a spondy and am having L4-L5 & L5-S1 fused. One surgeon wants to use a cage and the other one doesn't. Any comments on this? I am 46 yrs. of age and in otherwise very good health if that makes any difference. :?


  • first welcome to spine health and if your getting a fusion i thought they had to use the cage to hold the artificial bone or your own donor bone that grows to make the fusion?
    some dont use hardware so mabe thats what there talking about,,,i also had L4 L5 and S1 AND ITS THE BEST CHOICE I EVER MADE, AND YES FEAR KEPT ME FROM DOING IT FOR ALMOST A YEAR.

  • Lucy,

    Welcome to Spine Health. Hopefully you will find all kinds of useful information here.
    Now as far as your question, have you asked your surgeons the reasons why they proposing two different instrumentations? You would really need to know the reasoning behind each decision in order to decide which surgeon to go with. But if it was me, I would not be that concerned about the exact instrumentation the surgeon proposes, rather I would be trying to dig up all relevant information about the surgeon. How many of these kinds of surgeries he had performed? What were the success rates? How good is the surgeon's reputation? If your PCP knows both, ask what I did, namely, if it would be her (or his) surgery which one would she go with?
    There are a lot of good links here to different surgeries also you could do a search on the different types of iinstrumentations. Read everything you can find on the subject, then next time you'll see either of your doctors, you will have alot of intelligent questions to ask.

    Good luck with your search,

  • Thanks so much for your comments. Apparently they don't have to use the cage. Both doctors are "top flight" and my stomach is in knots because I'm supposed to be in surgery at 7:00 a.m. tomorrow! When I had the consult with my doctor about the fusion, he gave me the reason why he didn't use the cage but unfortunately I can't remember what he said.
  • Both surgeons I have seen are top flight with extremely good reputations among other physicians in the community. They are both fellowship trained in complex spinal surgeries. Thus, the dilemma. Thanks for your response!
  • and if so, what makes them choose one approach over the other. I always tried to figure out whether the surgeon's opinion was influenced by the types of surgeries they did or by what the patient needed.

    My husband ended up with a L2-5 posterior instrumented fusion with a L4-5 TLIF so that means he is fused at 3 levels but only has a cage at one level. Multiple surgeons that we saw said that they did not remove the disk and replace it with a spacer unless they needed to. Removing the spacers can be quite difficult (or impossible) for those who have problems with their hardware. Chris went into surgery knowing that it was very likely that he would have a cage at L4-5 since the disc was shot, he'd had a diskectomy on it once and reherniated it. It definately was a pain generator that the OS wanted to eliminate. The OS told us before surgery that he would test each of the other disks with little calipers to makes sure that they were firm and able to hold up the vertebrae until fusion happened. He expeted them to be ok, but assured us that if any of them were bad he would also repace them with cages. They turned out to be ok, so only one cage.

    We did have opinions that would have included cages at each level, and anterior and posterior fusions. Some opinions we ruled out b/c it seemed when we questioned them that it was just the way they did all of their surgeries, regardless of the number of levels or the patient's issues.

    Good luck is the result of good planning.....keep searching until you are satisfied you understand what is being proposed, why it is being proposed and you have complete confidence in the surgeon.

  • Terri, I am pre-fusion, so now you have me wondering what kind of construct was used at the other two levels to achieve a fusion since the discs were not removed? Lateral gutter fusion perhaps? Thanks, Sue
  • Hi LCD!

    Was hoping to see a post op response from you on the boards. How was your fusion? I hope well as I'm scheduled for the same in 2 weeks. I'm a 46 yr old woman with 20+ years of progressive instability (grade 2)so it's time. I just sent my doc a letter asking him why "spacers" vs cage because I have zero disc left. Bone on bone.What did you end up with? Hope all is well. Please share your success and what I should be aware of. Blessings! mamagoose
  • I think the cage allows the surgeon to use some of your own bone for fusion without harvesting from the hip.
  • used both cages and spacers.

    Christina :)
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