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Alif at L5-S1 and Plif at L3-4 same surgery

Wendy WhittWWendy Whitt Posts: 7
edited 02/18/2017 - 5:12 PM in Spinal Stenosis
So I have a most incredible neurosurgeon at .[EDIT}. He is the assistant professor at around 35 years old. Smart guy to say the least! He says most neuros would think he's nuts for doing my surgery without fusing the middle segment (L4-5) but thinks that he can save mobility this way. Question is have any other spineys have both surgeries done at once at different levels? I cannot find anything anywhere about it! 
Surgery scheduled for 10 days from now... 

Comment edited by Liz, Spine-health Moderator removed name of medical facility



  • hvillshhvills Suzhou, ChinaPosts: 971
    edited 02/19/2017 - 9:28 AM


    What your surgeon has proposed seems a bit odd... and maybe even a bit dangerous. Not fusing the L4-L5 segment isn't really the issue.   The L5-S1 segment is the largest and hardest disc segment to fuse in your spine and the idea of not installing any hardware to stabilize that segment during the long bone growth fusion process sounds very risky.  If I was in your shoes I would get a second opinion or at least ask more questions.  Once you go through the fusion surgery there is no turning back... and if it turns out that you don't properly fuse at L5-S1 due to the lack of stabilization hardware then you will likely have to a second fusion surgery.

    I'm fused from L4-L5-S1 and there is some reduced flexibility but it's not really that dramatic... and if I was in your shoes I would want the added peace of mind and security offered by having PLIF hardware at L5-S1 so that the bone fusion could take place under fully stable conditions.  Recovery from fusion is a tough road... you don't want to make it worse by adding unnecessary risks.  I would ask your surgeon how many procedures he has preformed this way and what was the outcome.  This surgery is something you have to live with for the rest of your life...

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
  • Wendy WhittWWendy Whitt Posts: 7
    edited 02/21/2017 - 7:05 AM
    Thanks for responding, Harry. He assured me that the stand alone cage is extremely strong, screws to each vertebrae.. I have read about the stand alone cage, and as far as my surgeon, he is actually a very sought after young neurosurgeon , with fellowship training in minimally invasive techniques  and is assistant professor of Neurosurgery at ... He was my second opinion! The first guy wasn't even going to deal with my L5-S1... Just the spondylolisthesis at L3-4. 
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  • I think Harry is spot on!  Even though it's more surgery, the extra stabilization would make me feel better.  I had a 360 ALIF L4-S1.  My surgeon did everything (both sides) at the same time. 

    Just be comfortable with the decision you make because fusion can be a life altering procedure.  Many people have turned out great from fusions!  Some, not so lucky.  My recommendation to you is follow your surgeons orders and don't over do it!  No BLT (Bending, Lifting, Twisting)! 


    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Thanks Keith... Much appreciated advice. I have done a little more research and the stand alone cage has a four screw plate that that is incorporated into the device. So it isn't like they are just throwing a cage with some bone in there...  :) can't wait for Tuesday! After 2+ years of this and jumping (oh so figuratively) through all of the  hoops it's surgery time! 
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