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s1 l5 l4 Fusion.... but xray shows.... no attempt made to fuse l4/l5

Hi all.

After too many years of running and rock climbing... my lower back gave out.  I tried conservative treatment, then a discectomy, then finally a fusion of s1 l5 l4.  Main problem was the spondylolisthesis... my l5 was pretty far out of position and my whole lower back was unstable and felt like it was grating.

Fusion was pretty horrible, I got a bunch of new symptoms... but now at 3 months and finally seeing light at the end of the tunnel.  At least.. I thought I was... till I saw my xrays,

OK... so I have a cage between s1 and l5.  Screws in s1 l5 l4.  But literally nothing between l5 and l4.  No bone taken from my hip.  No cage.  Nothing.  Only the screws holding it together.

I feel OK... but gee... I am to rely totally on the screws to hold my l5 l4 together?  I had hoped one day to return to running and rock climbing... now looking at the xray i am horrified that the whole section will just collapse.

Has anyone else heard of a fusion done like this?  



  • hi nippi9

    welcome to spine-health

    i would be interested to know what your consultants answers were to your questions.

    i have added two links below to help new members with information and these also contain the forum rules.  there is lots of material to research that will give you the power of knowledge.

    welcome to spine health




    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015
    L4-S1 TLIF with decompression June 2017
  • He says, in his opinion.... there is no difference in outcomes just screwing the l4 and l5 together, vs fusing.

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  • BitzicatBBitzicat PhoenixPosts: 74

    I only just found out after a year that they did not fuse 4/5 by reading the surgery report.  That was the location of  original spondylolisthesis problem.  I am fused the same as you.  It was decided last minute during surgery.  The surgeon never mentioned it to me.  Just had another MRI this week to see why I still have pain and why I am still numb on my left side after 16 months.  I also do not know if I am fused at all.

  • nippi9nnippi9 Posts: 2
    edited 02/19/2018 - 5:10 PM

    I had no pain in my left leg prior to the surgery... Now... 3 months after... its still pretty shitty.  The surgery resulted in sciatica in my left buttock, knee and ankle, and my toes are numb.  My left hip feels like I've been shot. I can walk and sit just fine... but sleeping is a huge problem. I go to bed... then... when my body goes to naturally change positions, I wake up from the pain of trying to turn... and thats pretty much it for the nights sleep, so its 4 hrs maximum a night.  Man... I look 5 years older.

    Also, lying on my back both my legs go numb.  I am guessing lying on my back, because the l4 and l5 have no spacer keeping them from closing... move closer together like a peg closing and this compresses the nerve causing me problems.  At least... that's my guess.

    I am not financially, physically or mentally up for a revision... though I am thinking to go back to my surgeon and demand some answers as to why he didn't just add the spacers at both levels?  Pretty  annoyed.  Am starting to think it was a cost/surgery time cutting measure so he made more money... and if it fails?  Well.... chance he will also get to do the revision surgery.

    Edited by Sandra for foul language

  • Yes, I would try and get some answers as to why your surgeon made the decision he made. I had a full lumbar fusion L1-S1 and a TLIF. I have immense faith in my surgeon, which made this whole surgery ordeal a bit easier.

    I can understand your frustration~ I hope you get some answers and reassurance.

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  • My surgeon made the decision BEFORE he operated on me, based on his position the outcomes are the same either way.  Maybe they are for an 80 year old, but i used to run 100miles a month and rock climb 3 times a week..  pissed off i don't have a solid result.. he KNEW my physicla history too, and my desire to return to it..

  • Sorry to hear that he didn't consult or listen to you! 

    I was a long-time runner and have had to give it up~too much pounding on the spine. I miss it, but don't want to go through surgery again (if I can help it).

  • Hi, sorry you're having such a hard time. Do you know if your surgeon packed bone around the screws at L4-5? I have a cage and screws at L5-S1, but at L4-L5 - my surgeon just diid screws and added bone grafting, My surgeon's theory is that cages can cause complications, so if he doesn't have to use one, he won't. However, my screws are now loose and I'm only partially fused. If he packed bone on the sides of L4-5, I believe it would be a PLF - posterior lateral fusion, just no interbody (cage). I know others have had successful fusions with this method, even though mine isn't. So don't freak out! Get some more info. If you aren't confident with this surgeon, you could get a second opinion. 3 months is still very early. Good luck & hope your symptoms improve! Let me know if you have any questions.

  • Hmm.. by "added bone grafting" do you mean.... he harvested bone from somewhere?  Like from your hip?  No harvesting done on me.

    I have to admit... week by week... I continue to improve.  Its just that directly afterwards I had a whole host of new symptoms which i didn't have before.  

    I have to have a catch up with him in 6 weeks, will ask then.

  • Sometimes the bone comes from the hip. My surgeon used BMP, which is artificial bone, as well as some of my bone. My bone didn't come from the hip - but was part of what he removed in the surgery.

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