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Old 12-10-2003, 03:41 AM   #1
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Paula 3 HB User
interbody fusion and spondylolisthesis

I have beginning Grade III spondylolisthesis, and the general feeling from doctors is to perform a fusion before attempting to become pregnant, as the pain will increase dramatically.

The orthopaedic surgeon recommends a two-level posterior fusion. However, I just went to a neurosurgeon, and he recommends an interbody fusion. He would perform 2 operations. One from the anterior where he would place a prosthetic disk (Bak), then 3 weeks later he would do a posterior fusion. He even said that my spine would be brought back into alignment.

Can any shed some light on this procedure? I've heard it has greater risks. I'm debating as to whether or not I should just stick with the orthopaedic's recommendations for a posterior fusion.

Thanks.

 
Old 12-10-2003, 04:43 AM   #2
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ltedeschi HB User
Re: interbody fusion and spondylolisthesis

[QUOTE=Paula 3]I have beginning Grade III spondylolisthesis, and the general feeling from doctors is to perform a fusion before attempting to become pregnant, as the pain will increase dramatically.

The orthopaedic surgeon recommends a two-level posterior fusion. However, I just went to a neurosurgeon, and he recommends an interbody fusion. He would perform 2 operations. One from the anterior where he would place a prosthetic disk (Bak), then 3 weeks later he would do a posterior fusion. He even said that my spine would be brought back into alignment.

Can any shed some light on this procedure? I've heard it has greater risks. I'm debating as to whether or not I should just stick with the orthopaedic's recommendations for a posterior fusion.

Thanks.[/QUOTE]

I would definately try to fix the problem before getting pregnant since that in itself causes back strain and pain medication at that time is risky.
However I had a fusion and a cage for the disk both performed from the back at the same time. This requires a very efficient skilled surgeon but it is worth it. The other option a 360 which requires you to be cut front and back or two surgeries I wasn't willing to do. I couldn't imagine the recovery from that. I have a hard time being still anyway. Make sure you check out all of your options before proceeding.

Good luck
Lisa

 
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Old 12-10-2003, 07:09 PM   #3
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Brooke79 HB User
Re: interbody fusion and spondylolisthesis

Dear Paula,

Hmm, this is tricky though if i were you i would speak to both surgeons about the others proposal and see what they think, at least that way you can weight up the pros and cons straight from the horses mouth so to speak.

I am assuming that your options are
a) a 2 level (L4/5 L5/s1)?
b) a one level and a laminectomy and insertion of artifical disc?

Is this for a spondy? I would have thought that a fusion is the only way really to stop a spondy. The 360 fusion is a risky op. This is because they cut from the front and then have to move aside major organs and arteries and this is where the risk is. If they were to rupture your aorta on moving it or any other major artery or organ the concequences could be fatal. You would be required to donate a significant amount of blood to protect against significant blood loss if a rupture were to occur but who is to say this would even help. I dont mean to scare you but this is what everyone talks of when they discuss the risk of 360 fusion. On the plus side for a 360 fusion, no muscles are cut at all, everything is moved aside. It is from the posterior that the back muscles are cut and srtipped off the spine to get to the vertebrae, this is what i had but it was the only option and the safest according to my surgeon. This is a 6 month recovery but i am sure it will be worth it.

Really you need to research this, have you damaged nerves? It is very important that the nerves are cared for correctly and that is why i would go with a neurosurgeon over ortho.

My gyno also told me that when the time comes to have children i would have to be under anesthetic for the birth once a fusion has occurred.


Keep me posted about your situation.

Brooke

 
Old 12-10-2003, 08:27 PM   #4
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Paula 3 HB User
Re: interbody fusion and spondylolisthesis

Hi Brooke,

I appreciate the thoughtful response. I always enjoy reading your threads. It sounds like the procedure this neurologist is discussing on me is rather radical. Once the anterior procedure of disk insertion is completed. 3-4 weeks later they would perform a posterior fusion. The neuro also talked about how this procedure allows them to re-align my vertebrae and fix the slippage.

I'm postponing my surgery with the ortho, scheduled for Jan. 20, and getting other neurosurgeons opinions. By performing a anterior and posterior, it sounds like my risks are doubled.

I'm also going for nerve testing for the first time to determine what nerves are being compressed.

It sounds like you are having a good recovery.

Paula

 
Old 12-10-2003, 10:38 PM   #5
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Brooke79 HB User
Re: interbody fusion and spondylolisthesis

Dear Paula,

Thank you and i'm glad my posts can be of assistance to you. Im glad you're going for opinions from other neuros, it cant hurt right? My surgeons could tell from a detailed MRI exactly what nerves were damaged just from the vertebral narrowing that showed up on the scans, that and my symptoms seemed to be enough but certainly by having the nerves tested they can see 100% what the issue is.

There's one thing i am confused about. The ortho wants to put the artifical disc in betweeb L3 AND L4? And then which are level does he want to fuse? What are the reasons he gave instead of just doing a 2 level fusion? Was it simply to try and get away without having to fuse 2 levels because of the mobility you would lose in the lumbar region? If this is so i wonder why he wont do 2 artificial disks and no fusion?


My surgery was posterior and that was where the slippage is best corrected from. Your are having rods and screws as well?

My recovery is going well. The only time i hear from my back is when i move in bed, i wake up each time i move but its only until i settle then i go back to sleep. I started working again today only 3 hours but i was quite uncomfortable when i got home so slept for a few hours. Any time i may have pushed myself a bit too much i always sleep for a few hours and im ok.

Brooke

 
Old 12-11-2003, 03:47 AM   #6
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Paula 3 HB User
Re: interbody fusion and spondylolisthesis

Hi Brook,

I agree about getting nerve testing. I'm actually thinking a neurosurgeon is the best route. The Neurosurgeon wants to use the Bak cage in between L4-L5 where the slip is. There is no disk space there currently. It's fused bone on bone. I assume that putting a space in between the L4-L5 allows them to manipulate the spine. 3-4 weeks later, he would then go in from my posterior and re-align the spine and fuse the vertebrae in the back and use a bone graft. The purpose of this operation is to attempt to re-align the spine. Otherwise with only a posterior fusion, I will still be dealing with a spine that is out of alignment which eventually puts stress on other bones. Yes, rods and screws will be used. I'm not sure if I've explained it completely accurately, but I'm just beginning to understand this procedure.

Paula


Brooke[/QUOTE]

 
Old 12-11-2003, 12:44 PM   #7
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Brooke79 HB User
Re: interbody fusion and spondylolisthesis

Dear Paula,

Hmm, it does sound confusing. Perhaps the L4/5 fused out of alignment? is that why they want to correct it? That would make more sence to me. I am assuming your L4/5 disc dissappeared on its own and then naturally fused. My NS said that can happen.

Perhaps you are correct in that by putting a space it will create a better opportunity for them to work with the spine.

I go for my 6 week post op check up today, but he wont be doing an x ray for another 6 weeks. I hope he can tell if its going ok.

Brooke

 
Old 12-11-2003, 01:07 PM   #8
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Paula 3 HB User
Re: interbody fusion and spondylolisthesis

Right, Brooke

Due to years of stress and pressure, the disk has worn away. There is bone on bone which tends to naturally fuse. I'm just concerned because this sounds like a radical operation.

Good Luck with your check-up. How are you feeling overall?

Paula

Hmm, it does sound confusing. Perhaps the L4/5 fused out of alignment? is that why they want to correct it? That would make more sence to me. I am assuming your L4/5 disc dissappeared on its own and then naturally fused. My NS said that can happen.

Perhaps you are correct in that by putting a space it will create a better opportunity for them to work with the spine.

I go for my 6 week post op check up today, but he wont be doing an x ray for another 6 weeks. I hope he can tell if its going ok.

Brooke[/QUOTE]

 
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