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Spinal Fusion - Level 4

Bailey01BBailey01 Posts: 2
edited 11/19/2014 - 12:15 PM in Back Surgery and Neck Surgery
My husband and I met with his orthopedic surgeon today who is very experienced in spinal surgeries. He told my husband that he needs to fuse 4 levels - L3, L4, L5 & S1. sort of shocked us since initially we were only thinking it would be L5 & S1, but L3 and L4 need it also. No point in going through that for 2 levels and not fix the other 2 levels. I can go on many different websites and read comments about negative outcomes which of course concerns me, but then usually people tend to post more negative comments than they do positive comments, so I'm trying to keep that in mind and put this in perspective. Also many of the negative comments I've read are from many, many years ago and I'm sure that spinal fusion surgery has made great advances (I hope). I know that both neurosurgeons and some ortho surgeons who specialize in spinal surgery both do this same surgery, but which way we should go, I'm not convinced of yet. our primary care Dr. highly recommends this particular Doctor with a very good success rate, but I would like to know the real pros and cons between the two different type of Doctors. I was very impressed with him after I met him and he seems very competent, but how do you really know?


It would be very helpful if you could provide us with more details. Here are some questions that you
should answer:
  • - When did this first start?- Was it the result of an accident or trauma?- What doctors have you seen?- What Conservative treatments have you had? Which ones?- What diagnostic tests have you had? And their results- What medications are you currently using?- Has surgery been discussed as an option?- What is your doctor’s action plan for treating you?
Providing answers to questions like this will give the member community here a better understanding
of your situation and make it easier to respond.

Ron DiLauro, Spine-Health System Moderator 11/19/14 19:08


As far as doctors and which will be the best, you may never know that information. Back surgery has become so very norm today that its something that so many spinal doctors have done over and over till its almost sunk into their heads. Not like 20 years ago.

So given that, what can be even more important is the Hospital itself, the Nursing staff and the PAs and others that will follow up on the patient.
The surgeon's job is done in hours, then they move on. Once you are in recovery room, those nurses get you back to the point where you can go up to a room. Then once up in a room, those are the nurses and aids that will be watching you around the clock. Doctors dont do that, nor should they. The initial surgeon may come in once or twice, but many times, its their PA's that do the follow up. Thats not a bad thing either.

But it is very good to know your hospital, get to know the nursing staff. When I have gone in for many of my surgeries, I wanted to talk with the nursing supervisor of the floor I was going to be on. That was very important, When I felt comfortable with them, then I felt more comfortable about my surgeries.

Please dont get me wrong, the doctors play a key role, they are specifically trained to do this, so I never want to under mine them.

But always keep in mind, who is going to stay with you after the surgery is done!



  • usually people who had good outcomes move on, the ones who stay may still be in pain and more likely you hear from them. Many others had successful fusions, I am one of the lucky ones. You are aware that one of the most important component is finding a skilled and competent surgeon. It can be either a neurosurgeon or an orthopedic surgeon, what is most critical that he be a spinal specialist. As Ron pointed out, the hospital and the nursing staff ie equally important. As a patient, or a patient's advocate, you have to do your homework, you are entitled to the best. Don't let some of the stories scare you, surgeons are more skilled and techniques get refined. If you do your research and make your decision based on facts, and select a surgeon who thinks he can help your husband, in most likelihood he will have a successful surgery. Good luck!
  • To respond to the questions that Ron addressed above:
    - he's had back pain since about 2001. Along about 2002 or so he had a laminectomy i think of either L 2-3 or L 3-4 ( cant remember exactly). That has helped a lot but progressively through the years the lower back pain has gotten worse and the bulging discs and pinched nerves causes a lot of leg pain.
    - he had been living on percocet for many many years now when the pain is bad.
    -he has has two epidural injections in the past several months which seems to have helped the lower back pain but not the pinched nerve pain down his leg. Not sure how long the epidurals are going to last.
    - he's been going to physical therapy for a month and a half now a couple times a week. The last two sessions he had to cancel because the leg pain was too bad.
    - the surgeon was doubtful that the PT and epidurals were going to help so that is why he's talking spinal fusion.

    The very frightening part is reading all of the forums and studies and articles about spinal fusions and the high percentage of people reporting that after the fusion they were still in pain, some worse ( some better) and some saying it wasnt worth going through. However our surgeon says he has had a lot of success and is optimistic. We dont know what to believe.

    So is the option of not doing the surgery that my husband will just keep living on percocet and get progressively worse or do we take our chances on surgery?

    And yes he has had MRI's showing the bulging and herniated discs, and an EMG to show nerve damage.
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  • ADRJenAADRJen Posts: 211
    edited 11/20/2014 - 1:03 AM
    I'm a success case and I've had my entire lumbar done except one level (L1). I'm not 100% by any means, but I live a normal life now, instead of constantly looking for a seat when on my feet. Or having to stand up 3 or more times during a meal out. I can even sit through a movie now. His life may never be "normal", but the new normal will most likely be a lot better than the old. Just make sure his surgeon does nothing but backs and check his credentials. Good luck!
    Artificial disc at L5S1 for 10 years. Had 3 Level lumbar fusion and Laminectomy on Sept 27, 2013. It was an OLIF (Oblique Lumbar Interbody Fusion) with cages, BMP, rods & screws. Norco, Plaquenil
  • Hi!. I hope I am also a success story, although I am only about 2 months out from my single-level fusion. I can definitely say that the horrid sciatic pain down my leg that rendered me unable to sit upright or walk for more than a couple of minutes has disappeared. The jury is still out on whether or not my nerve is permanently damaged. It's definitely a possibility as it was damaged for about a year. When I woke up from the fusion, my left foot still had a lot of nerve pain and that has not really relented (without medication, that is). Lyrica is doing a decent job of controlling that nerve pain now, but we just don't know if it will ever be completely gone.

    You mentioned that some nerve damage was found with the EMG. If that's the case, the fusion will likely not change that, but it can help prevent further nerve damage if things are structurally problematic, if that makes sense.

    I will say that I had a minimally invasive fusion with a one-night stay (other than being admitted the night before surgery) and the recovery wasn't a ton of fun. That being said, around the 6 week mark, I started to sleep better (that was the biggest challenge as nothing was comfy) and feel more normal. I am currently only taking Lyrica for nerve pain and Tylenol as needed. I don't know if my fusion was a true success yet, but in general I feel better and have less pain. I do still have some interesting challenges with my left foot not quite working right, but I'm hoping that as the nerve heals, it will get better.

    Best wishes!
    Left leg radiculopathy/sciatic pain
    L5/S1 microdiscectomy - May 30, 2014
    L5/S1 microdiscectomy - Aug 14, 2014
    L5/S1 TLIF - Sept. 24, 2014
    Left-side screws/rod removed along with bone fragment Dec. 29, 2014
  • I'm 34 I've been dealing with back pain since I was 16 (no wreck or injuries) no idea why nor does the drs. I had my first surgery in 2012 also my first MRI in 2012. Went to consult with 8 different orthopedic surgeons and only 1 would operate due to the curvage in my spine. First it was only my right side hip leg. I had anterior posterior spinal fusions. Hospital 9 days I felt ok went back to work 3 weeks after. Then my left side started my surgeron said it was common to move to other side. I've tried pt, epidurals, steroids. Everything prior to surgeries. So had another spinal surgey in April of 2014. After first surgery I woke up in recovery and I had feeling back in my right leg instantly. Now second surgery not so lucky. I woke up to my leg still numb. My surgeon said it could take some time for it to work. Since then I go to pain clinic twice a month for injections. Now I'm experiencing pain going down both legs from my hips and numbness off and on in both legs. Now I know many people who have had surgery and haven't had any issues since. I feel it depends on the person and their body and their condition Best of luck
    Jolynn varrati
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