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Forum Newbie -- Advice on 2nd Fusion for Pain at 2 levels, lumbar

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:25 AM in Back Surgery and Neck Surgery
Hello, everyone. I've been lurking for a few months on here and decided to ask for advice.

I had a microdisc at L5-S1 in May 06. Nov 07 xray, MRI and CT scan revealed additional herniation at L4-L5 however discogram revealed recurring pain only L5-S1. Proceeded with ALIF fusion at L5-S1 in Jan 08--had titanium cage with bone morphogenic protein (bmp) put into place; was supposed to have two, however spine surgeon said too many blood vessels, too risky, so no second cage and no hardware. Wore monstrous brace for 5 months, then smaller brace for the summer. No therapy yet due to ongoing pain. August 08 returned with severe pain, repeated xrays, MRI and CT scan to find both levels still herniated but fusion healed well. Discogram on 10/22 revealed extreme pain L5-S1 (fused with one cage) with moderate to severe pain in L4-L5. Spine surgeon now recommending PLIF, both levels. I love my doc and believe that my situation is just as unique as anyone else's...I think a 2nd opinion would be pointless because of the amount of diagnostics tests leading up to PLIF proposal. What do you think? Anyone had similar experience, i.e., healed single fusion but still pain, so repeat double fusion?

Aside from all this, before I have surgery, I need to see Hematologist tomorrow for a blood clot that hemorrhaged in my eye the night after surgery gallbladder removal/gyn adhesions removal (these issues resolved); I have what's called a Central Retinal Vein Occlusion (CRVO) in my right eye which was supposedly precipitated by surgery but caused by inherited blook clotting disorder. Thus, consult with Hematologist for managing this condition plus clearance to proceed with PLIF. Hopefully just blood thinners for surgery and not on a regular basis.

Sorry for the lengthy intro. Would appreciate any and all commentary and/or advice--I like to hear the TRUTH!! and appreciate directness. Thx in advance.

Kathy (Mae--not last name, just my middle name)


Injury hx: mult falls in snow; most severe in Dec 05 / Microdisc in May 06 due to L5-S1 herniation, L foot drop and sciatic pain / New herniation diagnosed on MRI and CT scan at L4-L5 in Oct. 07 / Discogram in Nov 07 showed + for L5-S1 and - for L4-L5 / L5-S1 fusion in Jan 08 with enormous brace for five months, then smaller brace for summer; pain slowly resolved and fusion healed / October 08 presented with severe pain in butt, legs and hips--xrays, MRI and CT scan revealed herniations continue at both levels despite one level fusion healed / Discogram on 10/22/08 proved severe :''( pain at both levels; spine surgeon recommending PLIF at both levels ASAP (waiting for clearnance from Hematologist for blood clotting disorder)



  • For my second operation a liked the Dr and did not opt for a 2nd opinion...but I did look him up on the internet and did much research on him.

    I was on Coumadin due to heart problems and before my operation I had to get off the Coumadin. Sounds like your problem is different.

  • Hi Kathy Mae, welcome to SH. This is a great site for Spiney support. I had Plif L4-5 in August. It is a long slow recovery with its ups and downs. I am glad I did it so far as I no longer limp with hip and leg pain.

    I didn't get a second opinion either because I am a RN at the hospy where my NS practices, and did much research to discover he was really the only one worth going to locally. I was warned not to go to any others in my town. I didn't want to commute to SanFrancisco, so stayed with my original NS, who I heard all good things about. A second opinion is really a personal decision, and while in general it is probably a good idea to see if different docs confer on the tx.

    One thing I think of with your eye is for PLIF you have to be face down for surgery for many hours and I have heard of some Spineys having swelling around their eyes after. Concern would be does it increase pressure in the eye and put you at risk. Have you talked to your opthamologist about the PLIF? I wish you success in your surgery. Let us know how it goes with the hematologist and such. Take care, >:D< Cali-Sue
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  • Yes about the eye- I had 3 level PLIF with correction to scoliosis and it took just over 12 hrs. Thankfully I was warned before about the swelling but the Dr said that with a PLIF anything over 6-8 hrs can create swelling.
    I could barely recognise myself afor a week =)) and my family couldn't find me in ICU.

    Just check first as I have noticed a slight difference to my sight since surgery and you want to be sure this is going to be good for you.

    I also don't understand how you can still have herneations at L4-5 & L5-S1 if you had fusions there. To put the grafted bone in they need to remove the disc. Maybe I have read this incorrectly so please excuse me if that is so but I am interested.
    Blessings Sara O:)
  • In a typical fusion, they only remove most of the disc, not all. When they remove the ENTIRE disc, every single speck, it's called a Radical Discectomy. Generally they leave the outer edges of it, partly for extra reinforcement for the interbody devices and bone grafts, etc. And because it's extra work to scrape the entire vertebral surfaces clean... Takes extra time and extra instruments. Unless the O.R. reports specifically indicate radical discectomy as one of the procedures, there's a good chance that there is still some disc material left. The reason reherniating after a fusion is basically unheard of, is because there is no motion left at the joint where the fusion occurred... So without the motion, it's nearly impossible to push the disc material out.

    I, too, am curious as to how that happened..... I'm pretty stumped. My mind is boggled... I really have no guesses.
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