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

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    Old 09-27-2016, 09:48 AM   #46
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Yes, I have RA and Lupus and bad OA for many years. would you think that is the reasons why the last neuro wants to do a 360 fusion? But the other 3 surgeons didn't mention and when I asked them, they just said it will have to work and said I worried too much! LOL

     
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    Old 09-27-2016, 10:22 AM   #47
    teteri66
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Just to be clear, you specifically asked about difficulty in fusing with your health history?

    Also, was there any mention of the sacralized vertebra?

    Last edited by teteri66; 09-27-2016 at 10:23 AM.

     
    Old 09-27-2016, 10:29 AM   #48
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    If you feel comfortable talking to the female neurosurgeon, I would ask if you could have the two level fusion done from the posterior side, and, what would be the reasons for needing the 360 fusion.

     
    Old 09-27-2016, 10:36 AM   #49
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    [QUOTE]Just to be clear, you specifically asked about difficulty in fusing with your health history?
    Also, was there any mention of the sacralized vertebra?
    [/QUOTE]

    Not sure if I understood your question about difficulty in fusing. This will be my first fusion surgery and I don't know how much risks in fusion with lupus and RA and OA. Would these chronic diseases reduce the fusion rate by 20% or 50%?? I did ask the surgeons and the ortho. don't see as a risk but the neuro. said it will reduce my fusion rate.

    I asked all of them about sacralized vertebra and most just brushed me again, saying it has no bearing on the fusion surgery. When I asked more, they get upset!! Hard to be an informed patient with spine surgeons.

     
    Old 09-27-2016, 03:02 PM   #50
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Wow. I'm glad I don't live where you do when it comes to spine surgeons. I had some that were short on time, but no one ever suggested I should not be asking questions or reading information about spine surgeries online!

    I would think the surgeon would want to monitor you carefully to see how the bone cells are growing. You could wear a bone growth stimulator if they were concerned you might have some trouble fusing.

     
    Old 09-27-2016, 03:24 PM   #51
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Thanks for the reply.

    Both neuro will prescribe brace and bone simulator to improve my fusion rate. But the ortho do not.
    What is your opinion on neuro and ortho. surgeons.
    Who would or did you pick to do your surgeries?

    What do you think of the 360 on L4-L5 and PLF on L5-S1. Do I need to fuse from the front on L4-L5 in addition of fusing the back? I found the success rate of 360 fusion(50-60%) is low compared to PLF or PLIF(80-90%).

    Do you I need 360 fusion because I have RA and lupus? I thought PLF with instrumentation is as good as PLIF.

    Also is TLIF same as ALIF+PLIF which allows the surgeon to access both front and back with 1 incision from side?

    please advise.

    thanks,
    glo

     
    Old 09-27-2016, 06:03 PM   #52
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    I understand your angst about this decision. I have both lupus and RA and have had 3 spinal surgeries, the last two being fusions, one posterior, one extreme lateral of two levels. I don't think the lupus/RA issue is too critical, although I would make sure your Vitamin D levels are good (many lupus patients are deficient) as that affects calcium absorption and could affect fusion. The real issue is how bad the L5-S1 disc is. It is interesting that 2 surgeons only want to fuse one level, and 2 want to fuse 2. I question why an anterior/posterior fusion is recommended by one when 2 others recommend only 1 level fusion. Anterior/posterior surgery is double the incisions, and IMO, riskier than 1 approach. However, I do not like that the 3 male surgeons said you asked too many questions. I do think that neurological monitoring to make sure nerves are free of impingement are important. Would you consider a 5th opinion to break the tie? I have had good results from my fusions, and would be a mess if I had not had them. No complications, disease progressed upwards requiring fusion of L2-3 and L3-4 eventually, but my lupus/RA didn't interfere with healing or outcome. Good luck with what you decide and have done!

     
    Old 09-27-2016, 06:18 PM   #53
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    It seems a lateral (side) approach would not be possible to fuse L5-S1, as it is so low, they may not be able to access that disc space from the side because of the height of the iliac crest. I would ask about that. The neuro's are more likely to use neuro monitoring, which I think is valuable. If both discs are bad, and you have only one fixed, you are looking at another possible surgery sooner. A fusion puts extra stress on the disc above it over time. I don't think that is true for the disc below it.

     
    Old 09-27-2016, 08:23 PM   #54
    gabrialo
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Hello Ladybud,

    thanks for your post and advices.
    I am taking Vit-D3 daily and magnesium for nerve health so hopefully it will help in bone growth.
    My spondy is on L4/L5 with severe facet antropathy. L5-S1 has some disc bulging and L5 is sacralized to S1. At first I thought I don't need L5-S1 fused as it's partially fused, but teteri66 advised me to have it fused too.

    I really do not like the 360 with 2 cuts and extended pain and recovery. If I were to have 2 levels, PLF is my preferred choice, but again I'm no doctor.
    I actually question my first neuro and he got upset when I asked him why 2 levels when an ortho. recommended 1 level. It's hard to deal with these surgeons.

    I ran out of surgeons to see within my IPA group for HMO. It seems to me that both ortho. recommended 1 level and both neuro recommended 2 levels may be due to their training and specialty???
    would you prefer a neuro over an ortho. surgeon?
    were your 3 spinal surgeries all fusion? were they successful?

    My current options are 1 level with an ortho or 360 2 levels with a neuro.
    I am leaning over the 1 level as I think the 360 is an overkill, even though I believe I need a 2 levels to cover all the ground.

    thanks for sharing your experience and appreciate your advices.

     
    Old 09-28-2016, 05:21 AM   #55
    lilac100
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    Re: Grade 1 Spondylolisthesis L4-L5 doctor suggests 2 level fusion

    Honestly I would do the 360 because doing it all again in 5 years doesn't sound like it would be fun.

     
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    bulging disc, ddd, fusion, herniated, spondylolisthesis



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