teteri66

Welcome to the board. I'm sorry about the reason you find yourself here, particularly after you assumed your "issues" were taken care of.

I must say that I am a bit confused by your new herniation. In some types of fusions, the disc is left in place. Sometimes a portion of it will be removed, or it will be trimmed. But I was under the impression that when a cage was implanted, the disc at that level was removed and the disc inserted in its place. If that were the case, I don't see how you would have a new herniation. I think this is something you need to have clarified by your surgeon.

In my lumbar spine, I have both types. I first had a PLIF at L4-L5 -- this is the posterior lumbar interbody fusion, where the disc is removed and bone is placed between the two vertebrae. I have a PEEK cage with rods and pedicle screws holding everything in place.

Then two years later, and since the original surgery never resolved my pain issues, I had additional surgery one segment above (L3-L4) and one segment below (L5-S1). In this surgery, it was a posterolateral gutter fusion where the disc is left in place, trimmed, if necessary, and the graft is laid in along the "gutters", on either side of the central canal.

In both cases, bone graft is laid between the joints and when new cells grow, the joint grows together and fusion occurs, creating stability. If for some reason, fusion does not occur, this segment can become unstable and there can be movement between the joints which can cause nerve irritation and/or compression, resulting in lower back pain or radicular (radiating) pain.

Perhaps you have herniated a disc one segment up or down from L4-L5.

There is more stress on the discs one level up and down from the area where the surgery took place. Where the immovable segment joins to the first segment that has motion, it puts additional stress on that first segment that can move. This used to be considered a major problem with fusion surgeries, but statistics indicate that it isn't as big a problem as thought previously.

You mention a neurologist telling you to have surgery, but have you been back to your surgeon and has he told you that you need a discectomy and at what level?

Fusion is not performed because a disc has ruptured or herniated. It is done when there is instability or movement that is causing pain or nerve compression.

This is a long way of saying I cannot answer your question as it doesn't make sense to me! I would suggest you call your surgeon or get a second opinion from a different spine specialist. Neurologists are not the best choice on making the call on whether surgery is needed.