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  • Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

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    Old 05-28-2016, 10:10 AM   #16
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Hello Teteri66,

    thanks for the reply. How do I find out if my spondylolisthesis is caused by par defects? would the X Ray flexion/extension images show that? or the MRI?

    Also you commented on my condition that I have time to try other alternatives. This week, my numbness spread to my other leg and foot, but I have limited legs pain as I restricted my activities that caused leg pain(walking, standing too long). Am I deteriorating? or maintaining my severity? please advise.

    thanks,
    glo

    thanks,
    glo

    Last edited by gabrialo; 05-28-2016 at 10:21 AM. Reason: have more questions

     
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    Old 05-28-2016, 02:48 PM   #17
    teteri66
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    I should think it would be apparent on either. Mine used to alternate legs but it would be on one side for maybe six months and then move to the other side. I remember one PT thought it was all in my head because she was treating me for right-sided symptoms; I didn't see her for awhile and when I went back she said something like "so, the pain is on the right side, correct?" and I said, "no, the left." Ultimately it has turned out that my right side is worse, but I think my numbness may be worse on the left side.

    As to "how bad" something is, since we aren't doctors we can only pay attention to the MRI reports, etc. In your case what you want to look for is the amount of nerve compression and compression or indentation of thecal sac, and foraminal stenosis.

    As I wrote today to another poster, when you have a lower lumbar spine issue, it pays to become familiar with the symptoms of Cauda Equina Syndrome as this is one of the only true medical emergencies with a lumbar spine issue. If you develop sudden problems with bowel or bladder, like incontinence, or sudden muscle weakness like foot drop, call the doctor or go to the emergency room right away. Otherwise, one just never knows what the tolerance level is for nerve compression. At what point is permanent nerve damage caused? It varies from person to person and the doctors and medical research simply do not know.

    I probably waited too long for my first surgery...and then it took almost three more years after that to find what was causing my radiculopathy even after the spondylolisthesis was addressed and corrected.

     
    Old 05-29-2016, 12:08 AM   #18
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    How long did you wait before your first surgery? Is that a fusion? Single or 2 or 3 levels?
    The radicular pain or numbness - what were the causes?
    Did PT help you at all?
    I do the pelvic tilt and bridges throughout the day, not sure if they help to strengthen the ligaments or not?
    What other exercises good for spine stability?
    Thanks for chatting with me and providing all the good advices

    Last edited by gabrialo; 05-29-2016 at 12:14 AM. Reason: Post too fast

     
    Old 05-31-2016, 05:20 AM   #19
    Voxx976
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    [q]and they look just like the ones from the corner hardware store.
    [/q]

    They ARE the same screws but at a 10 million percent markup.

    I need back work but those bolts screws and rods seem so simplistically primitive that the whole idea repulses me.

    What happened to bone on bone fusions of the 1950's? That seems so much more logical and "organic" than repairing with hardware that looks like it was lifted off a Toyota undercarriage.

    I get the impression that back surgery has not advanced one iota over the last 50 years.
    Like the old joke, "a man with a hammer sees the world as all nails", an orthopedic back specialist sees a back and thinks "fusion screws."

    It seems far too much like "one size fits all" to suit me.

    Last edited by Voxx976; 05-31-2016 at 05:42 AM.

     
    Old 05-31-2016, 06:52 AM   #20
    teteri66
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    I agree with your sentiment. After being told in 2005 that the only fix for spondylolisthesis that was unstable was fusion, I waited several years thinking there must be some wondrous new development on the horizon. After consulting with many spine surgeons and being assured that nothing was in the works, and realizing that I was becoming housebound, I finally agreed to a fusion using rods and pedicle screws. They still do the bone on bone fusion, they just now use hardware to hold one together while the bone grows together rather than putting the person in a brace for six months and restricting activity like they used to do.

     
    Old 06-01-2016, 10:14 AM   #21
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Hello folks,

    I went to see my neurosurgeon the 2nd time for a detailed description of the 2 levels fusion and decompression yesterday and here are the recap and questions:
    1)he is doing a PLF instead of PLIF, he said the success rate are about the same.
    But I read online PLIF has a higher fusion rate. Any opinion of that?
    2)my current complaint is mainly numbness in legs and feet but little pain if not walking.
    the success rate given by him is about 95% for a 80% recovery of mobility-such as walking.
    is that success rate given by him a bit high with 2 levels and OA and DDD?
    3)He said no/little improvement on numbness of legs & feet as they are neurogenic claudication which is permanent upon surgery
    would numbness on legs/feet get worse if no surgery?
    any experiences regarding improvement of numbness after fusion surgery?

    4)From the comments on expectation of fusion patients after surgery, most of them still have
    - pain and numbness and they will NEVER go away, just learn to live with it
    - still on pain management and pain medications long term
    - regain some mobility, but NOT total recovered
    any feedbacks and comments would be greatly appreciated.

    also how critical is if the neurosurgeon is not a fellowship trained?

    thanks for all the feedbacks and comments...it has helped tremendously!
    glo

     
    Old 06-01-2016, 12:01 PM   #22
    teteri66
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    I would never have non emergency surgery without getting several opinions, including one from a fellowship-trained orthopedic spine surgeon if the other is from a neurosurgeon.

    Your most important decision after deciding to have surgery to begin with, is the selection of the surgeon...and the hospital due to high risk of infection rates associated with spine surgery.

    Is he planning on fusion from L4 to S1?

    I am about 100% sure that nerve damage would get worse without surgery. Also the spondy could get worse and make a successful outcome less likely. Usually the longer the nerves are compressed, the greater the chance for permanent nerve damage.

    I am surprised what you were told about nerve damage recovery. Usually we are told that nerves repair very slowly, like 1mm a week (or was it a month?) and it starts from the spine and goes outward, so the last thing to recover would be the feet. They also say that if the nerve has not recovered within a year (some say 18 months), it will not get any better. However, I personally know that was not the case in my situation. I continued to be less numb for probably three years....

    Regarding recovery, and I am fused from L3 to S1, I do have nerve damage in my feet and fairly dead ankle reflexes. When I first get up after sitting awhile, I often look like I had a three martini lunch for the first several steps due to nerve damage. I do not take nor do I ohave any need for pain medication.

    By "total recovery" if you mean having the back you had years ago when you were younger, no spine surgery will never accomplish that...but I can walk again as far as I want, and I can do most things I had stopped doing due to sciatic type pain prior to surgeries.

    Everything is a trade off. I don't know how impaired you are now from the back issues. I waited until I could barely walk 50 ft. and couldn't stand long enough to chop an onion....also, in hindsight, I waited too long!

     
    Old 06-01-2016, 06:25 PM   #23
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Hello teteri66,

    thanks for your reply.
    the neurosurgeon is not a fellowship trained but he said he has doing spine/brain surgeries for over 10 years.
    He averages about 100 surgeries per year.
    Yes, he will be doing 2 levels fusion from L4-L5-S1.
    thanks for the confirmation on nerve damage will get worse without surgery. that helps me to make up my mind to go ahead with surgery before getting too late.
    he is scheduled out until august so I still have to wait for 2 more months minimum ... :-(

    if like you said the nerve damage will slowly recover, then the invasive surgery will be worth doing.
    I hope I could recover like you did. I also was told no reflexes in both ankles ... :-(
    Yes I will be happy to be able to walk couple hours a day and do some light exercises such as elliptical, cycling and core and muscles strengthening...Nothing too crazy!

    I will see a fellowship trained ortho.spine surgeon next Thursday. he has very impressive resume from Yale/Harvard/Stanford but he is very new, might be just about 5+ years experiences. so I will ask him the same set of questions I asked the neurosurgeon. but I was told his surgery schedule is more open and might have dates in july.

    I'm not too bad but can't walk more than 5 minute without support. I tried not to take any pain med, just ibuprofen before bedroom to help with the leg pain. But I sure don't want to wait too long and risk having more nerve damage.

    thanks for sharing your experiences with me....

    glo

    Last edited by gabrialo; 06-01-2016 at 06:27 PM. Reason: forgot something

     
    Old 06-10-2016, 04:50 PM   #24
    Anj75
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    [QUOTE=gabrielalo;5420375]Hello folks,

    I went to see my neurosurgeon the 2nd time for a detailed description of the 2 levels fusion and decompression yesterday and here are the recap and questions:
    1)he is doing a PLF instead of PLIF, he said the success rate are about the same.
    But I read online PLIF has a higher fusion rate. Any opinion of that?
    2)my current complaint is mainly numbness in legs and feet but little pain if not walking.
    the success rate given by him is about 95% for a 80% recovery of mobility-such as walking.
    is that success rate given by him a bit high with 2 levels and OA and DDD?
    3)He said no/little improvement on numbness of legs & feet as they are neurogenic claudication which is permanent upon surgery
    would numbness on legs/feet get worse if no surgery?
    any experiences regarding improvement of numbness after fusion surgery?

    4)From the comments on expectation of fusion patients after surgery, most of them still have
    - pain and numbness and they will NEVER go away, just learn to live with it
    - still on pain management and pain medications long term
    - regain some mobility, but NOT total recovered
    any feedbacks and comments would be greatly appreciated.

    also how critical is if the neurosurgeon is not a fellowship trained?

    thanks for all the feedbacks and comments...it has helped tremendously!
    glo[/QUOTE]

    When I finally got my MRI with contrast before my L5 S1 PLIF, lamidectomy. It said L5 S1 grade 1 anterolisthesis with bilateral L5 spondylosis. There is severe left/moderate right neural foraminal stenosis with compression of the left L5 nerve root and contact of the right L5 nerve.
    L4-L5 mild neural foraminal stenosis.
    I know that the surgery helped my nerve that was being crushed. I don't regret the surgery because it truly did help. I still have back pain and now I have been diagnosed with failed back surgical syndrome...Arachnoditis..and sacroliitis. My surgeon was worried that the nerve damage was permanent because I waited so long.

     
    Old 06-12-2016, 01:47 AM   #25
    teg01
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Since you will be seeing a surgeon at Yale maybe you could consider seeing another physician there. He is one of the most progressive surgeons in the U. S. and has been trained by the spine surgeons in Europe who perform ADR. I have seen him and was happy with the visit. I plan on using this surgeon for my neck surgery. I am just holding on until I can no longer avoid surgery. I had a fusion in 2006 at c6-c7 and have issues with the discs above and below the fusion. He does a hybrid procedure that includes fusion and ADR.

    Hang in there.

    Last edited by mod85; 06-12-2016 at 05:08 PM.

     
    Old 06-29-2016, 05:33 AM   #26
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    I had a anterior posterior L3-L4 double fusion Feb 3. I had done everything prior to control the pain. I went back to my neurologist after I had trouble lifting my big toe. I will be honest, the surgery is not a cake walk. It will take at least six months before you can return to normal activities. The good news is that my back pain is getting much better and I feel it was a success. The longer you wait the more risk you have of foot drop etc.

     
    Old 07-13-2016, 06:14 PM   #27
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Hello
    I would like to post new updates to my condition.
    I went to see 2nd surgeon(fellowship trained spine ortho) early July and was told I only need L4-l5 fusion and decompression. He thought I can try PT before considering fusion, he referred me to another round of PT.
    Compared to the first surgeon(NS) who recommended 2 levels fusion(l4-s1) plus decompression and urged me to not wait too long.
    I am at a loss as they called for different levels of fusion.
    so I asked for a recommendation from the NS and my appointment is 8/8/16.
    The NS can do the 2 levels fusion in august.

    then I asked for an updated MRI from my PCP and just got the report.
    here is the impression:
    Degenerative spondylolisthesis at L4-5 has progressed when compared to the previous examination. Marrow edema involving the posterior elements of L4 and L5 most likely represents stress reaction.
    Focal right foraminal disc protrusion at L3-4 does not result in nerve root compression.
    Left paracentral disc protrusion at T12-L1 without resulting in spinal stenosis.

    first it looked like my spondy is getting worse and now it has marrow edema at L4-L5.
    not sure what it is but sounds scary!

    I think fusion surgery is in my path but unsure about the levels : 1 or 2?
    I'd heard people with SJ joints dysfunction will worsen after l5-s1 fusion.
    I have SJ joints dysfunction so I am very worry about fusiing l5-s1 might cause worsening of the SI joints.

    I like to find out what is marrow edema in relationship to my current medical conditions.
    would it be fixed with a fusion surgery?

    any helps and advices would be greatly appreciated.

    thanks,
    glo

     
    Old 07-14-2016, 05:59 AM   #28
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Sorry, you are having so much trouble. I went thru a year of PT etc. and after I experienced I could not raise my big toe, my neurosurgeon advised a L3-L4 posterior anterior double fusion. Even though this is a vary major operation, the fusion rate is 95%. I had the operation Feb 3rd and I am now almost pain free. If you decide to have fusion, ask your doctor about this option. Keep in mind the recovery process is painful at first and takes a long time to recover. I had the operation only after all other options were exhausted.

    I wish you luck 😊

     
    Old 07-23-2016, 04:10 PM   #29
    John5167
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Not sure how old you are, but it sounds like yout low back is worn out! I had the same surgery using alif and plif day one then two. It is a very big surgery and it takes a long time to recover and get off narco pain meds. First 100 days are pretty awful and you wont be very mobile. Important to do stretching and pt when advised. I had a complicating element in that my left hip was severely arthritic and was not discovered by three spine surgeons, although it is a common morbidity. So after 12 months and numerous post surgery dr visits, i was convinced that something was wrong. I thought it had to do with the surgery, but turned out to be my hip, which i had re placed six weeks ago and have been doing pt for three weeks for my leg and back. Hope i solve my pain problems which are similar to what i hade before back surgery. Drs advise three more months of hip recovery and pt before chasing various possibilities. Just make sure you have a hip xray to confirm condition before back surgey, and yes get several surgeon opinions re your potential fusion. You may get different opinions and solutions proposed.

     
    Old 07-24-2016, 08:37 AM   #30
    teteri66
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Sorry I didn't see your update until now. To answer your question about fusion, edema is something that can come about as part of the degenerative process. When a disc and facet joint are in the process of degeneration, the vertebra is affected too and this change is sometimes reflected in marrow edema.

    A fusion doesn't really "fix" anything but it is done to prevent further deterioration, to stabilize an area that is slipping, to hopefully keep stenosis from reforming.

    In your case a fusion would stop the spondylolisthesis from getting worse and the surgeon might choose to correct the amount of slippage and realign the vertebrae...this realignment is not always done...it just depends on factors like the degree of slippage, etc.

    Once the segment is stabilized it will keep the vertebrae and adjoining areas from rubbing together which should stop further marrow edema from forming and stop degeneration.

    Now you hear a lot about the "domino effect" or "adjacent disc disease" and people use it as a reason why not to have a fusion...in reality this is not as common as one is led to believe. It is true that more burden is put on the segment that adjoins the fused section of the spine because it has to absorb movement from the fused area that is immobile. With a one level fusion, it isn't too much of an issue. However with multiple level fusions there is quite a bit of stress put on the first segment that is able to move. Since I am fused from L3 to S1, I am careful in what activities I choose to do and careful how I do them. I follow my weight restrictions, which for me is not lifting more than 35 pounds. I am pleased with my results and I do not have further degeneration in adjoining segments and no further nerve damage according to recent EMG. If anyone should have developed adjacent disc disease, I was a prime candidate...but I have avoided it.

    If you already have SIJ dysfunction, fusing L5-S1 shouldn't make it worse. That segment has very little movement to begin with, so when fused, it shouldn't make the SIJ situation worse. If there is a lot of instability in the sacroiliac joints already, the fusion surgery will not change that or affect it.

     
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