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Old 12-21-2011, 12:01 PM   #1
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new herniation 1 year after lumbar fusion

New toback forum and wouldI like someto help. I had lumbar fusion surgery one year ago after two discectomy/laminectomy for degenerative disk and stenosis. I now have herniation in the same area. After two epidurals in the last month my doc recommendations another discectomy. How is this possible?

 
Old 12-21-2011, 04:43 PM   #2
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Re: new herniation 1 year after lumbar fusion

Where are you fused (what level)? What type of fusion did you have?

Have you consulted with another spine surgeon to see if there is agreement?

Do you know if you have fused?

Sorry for all the questions, but with a few more details, more people will be able to offer some suggestions.

 
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Old 12-22-2011, 05:38 AM   #3
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Re: new herniation 1 year after lumbar fusion

Thanks for the advice. I'll post with more specific info. The fusion took place.at the l4-5 area.and the doc used. a cage (I believe.this is the correct term 4.screws and donor bone). after the two recent epidural blocks failed and surgery was the next step, I saw a neurologist who independently told.me.that I should have the disectomy asap to get out of pain. I thought that the fusion was going to stop.these problems, but the pain now is worse than before the fusion.

Please let me know if this is "common" with fusions and will it progress to where additional levels of fusion are necessary. thanks

 
Old 12-22-2011, 06:55 AM   #4
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Re: new herniation 1 year after lumbar fusion

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.

 
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