[Jellyhall]

#25649

Dr Corenman, I am hoping that you will explain to me what extending an existing fusion of L4/5 would entail.

I had L4/5 fused with an interbody cage 7 years ago. The adjoining levels of L3/4 andL2/3 have now herniated and are compressing nerves and causing me pain.

I saw a surgeon a week ago but the appointment was very short. He said that if he did surgery, he would need to fuse both the levels and extend the existing fusion. He said it would be a very invasive surgery.

Having got home and discussed what he said with my husband who was at the appointment with me, we are wondering if he meant that extending the fusion would make the surgery more invasive than the original fusion surgery. Would he have to drill out the previous hardware at L4 in order to place new hardware at that level?

Could you please describe how you would usually approach this type of surgery to me?

Many thanks

[Donald Corenman, MD, DC]

#25774

If you have a fusion at L4-5 as a solitary fusion with disc herniations at the two levels above (without any instability or malalignment), and your pain is radicular (nerve compression type pain), I would recommend only microdiscectomies and avoid further fusion.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Jellyhall]

#25784

Thank you Dr Corenman, for your reply.
It is reassuring to hear that you would only recommend microdiscectomies, which is what I wished I had asked the neurosurgeon about during the appointment, but it was rather rushed.
I wonder if the reason he said that he would have to fuse both the new levels and extend the existing L4/5 fusion to include them could be because my spine is not quite in the normal position.
The fusion of L4/5 was done for a spondylolisthesis although the surgeon has managed to pull the L4 vertebra back somewhat in relation to the L5.

Also there are whitish marks on the endplates of the three vertebrae either side of these new disc herniations. I am wondering what is causing this, and am hoping that you will be able to enlighten me. It is most obvious on the T2 images.

I appreciate so much being able to ask you these questions.

[Jellyhall]

#25785

I also meant to tell you that the neurosurgeon did say he was worried that if he fused more levels of my spine, it would cause other levels to also need attention. He said that because the whole of my spine is very degenerated, fusing other levels would put more strain on aleady weakened levels and cause a domino effect throughout my spine. This sounds horrendous and very worrying.

[Donald Corenman, MD, DC]

#25804

The T2 image highlights both water and fat as “white”. If the white margins are at the endplates, it could be tears of the discs or simply fat at the edges of the disc space.

It is true that longer fusions will put discs above and below at a higher stress level. There are occasions however that progressive deformity (advancing asymmetric disc collapse or “the curve is getting bigger”) or instability causing significant lower back pain needs to be fused. The trick is to know when conservative measures will do or when surgery is necessary.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Jellyhall]

#25806

Thank you Dr Corenman,
The ‘white’ is actually in the bone of the vertebrae, but at/near the endplates. Any other ideas? Would there be fat in the bone?

My lower back pain is not as bad as when it led to my fusion. I intend to try to hang on for as long as possible.
I have been offered steroid injections in all three levels of my spine, but I have read that they can cause damage/degeneration to the spine so I am not keen to have them. I already have enough degeneration throughout my spine.

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