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911Doctor
911Doctor, Doctor
Category: Health
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Experience:  Board Certified Emergency Physician
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We have a family member mid 30s that has S-1 to L-5 degenerative

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We have a family member mid 30s that has S-1 to L-5 degenerative spondylolisthesis, the L-5 has slipped forward 25-30%. That will require surgery because the disk is flattened and has moved forward. It seems the disk between L-5 to L-4 has turn dark gray as well, and there is a small bulge.

Should I do spinal fusion for the L-5 to L-4? Why or why not. Will doing spinal fusion for the L-5 to L-4, impact the L-4 to L-3 disc due to the L-5 to L-4 disc being so restrictive and not providing any movement due to the fusion. Or will not doing the surgery on the L-5 to L-4 PROTECT my L4 to L-3 disc down the road?

911Doctor :

I assume you have already consulted with a spine surgeon. Is this true?

911Doctor :

I have had an L4L5 fusion myself

911Doctor :

and the general rule is do as few levels as possible

911Doctor :

for

911Doctor :

as you state

911Doctor :

there is a rigidity that comes with every level fused

911Doctor :

and the more levels that are fused the more likely you are to herniate another disc above or below the fusion

911Doctor :

standing by

Customer:

Hello

911Doctor :

how are you?

Customer:

I have already consulted with a spine surgeon.

Customer:

Oh excellent, great to hear from somone with first hand experience.

911Doctor :

does the surgeon want to do two levels? I would be surprised if he did.

Customer:

I have a Dr. Odor from the Spine hospital wants to do both, and says the L-5 to L-4 is needed in order to preserve the L-4 to L-3. Dr. Parkison echoes the same opinion. Dr. Hume from a Southwest Orthopedics, favors only doing the S-1 to L-5, then lose more weight about 40 lbs and strenghten core. He says by not fusing the L-5 to L-4 I will preserve at least some minimal cushing to lengthen the preservation of the vertebrae above it.

911Doctor :

i see

911Doctor :

what do you want to do

911Doctor :

experts often disagree

911Doctor :

and i can see the point from all of your surgeons

911Doctor :

If it were me, I think I would opt for less at this point

Customer:

SO simply put if I do both the bottom fusion the the next on above it will I preserve the third one, or would it be best to only fuse the bottom one, leave the second one alone (its gray) AND THAT will preserve the third one .... It'll all about preserving the third one from the bottom.

Customer:

Okay.

911Doctor :

stand by one second

Customer:

Sure.

Customer:

Take your time.

911Doctor :

I understand

911Doctor :

The thing to remember is that once you get a fusion, if you remain active, you will likely need another at some point in the future

911Doctor :

so it is often the case that the more conservative approach is the best one

911Doctor :

in that technology and technique for spine surgery improves every year

911Doctor :

so in a sense, less is more

911Doctor :

especially at age 35

911Doctor :

I had mine at the same age for the same reasons, but one level higher

911Doctor :

and I have continued to ski and bike, but I am not allowed to run

911Doctor :

no matter what procedure you choose

911Doctor :

you SHOULD follow your restrictions

911Doctor :

standing by

911Doctor :

also,

911Doctor :

I am not in line for any surgery anytime soon and have done quite well

911Doctor :

standing by

Customer:

How old are you now?

Customer:

And how has your back held up?

911Doctor :

48

911Doctor :

I had one herniated disc at age 40 and got a microdiscetomy... was in at 8am and walked out at 11 and have had no more problems.

Customer:

How much did your pain decrease ... I do understand that I may be different.

911Doctor :

before my fusion I couldn't walk or stand more than five minutes without having to crouch to relieve pain.

911Doctor :

I was better than that 3 days after surgery

911Doctor :

the recovery is tedious

911Doctor :

but I have not had appreciable back pain since, with the exception of the one herniated disc

Customer:

How are your discs below and above your fusion?

911Doctor :

I herniated the one below

911Doctor :

but other than that they are fine... a little loss of disc height which was there previously

Customer:

Was the due in part to the spinal fusion?

911Doctor :

yes, a fusion at one level stresses the level above and below

911Doctor :

a multi level fusion

911Doctor :

stresses the levels above and below to a greater degree

911Doctor :

standing by

Customer:

How long after your spinal fusion did you herniate your disc, and did it just come out of the blue, or were you engaging in physical activities of some sort? In essence did you push it too much?

911Doctor :

four years after... it was during a long bike ride, knew it immediately

Customer:

I see .. this has been very educaitonal, I'll be sharing our chat with the Mrs., thank you very much. I have surgery tomorrow, and have to decide before I walk in.

911Doctor :

wow, does your decision also decide which surgeon is going to do it?

Customer:

I've decided on Dr. Hume, he had the most conservative ... he just answered all of my questions and took the time to answer them. The other doctors didn't make me feel that way, and seem or at least gave an impression to me that this was just a job for them. So I went with the doctor that would answer all of my crazy questions, and digging.

911Doctor :

that's a good choice

911Doctor :

personally, i like the one level and weight loss, core strengthening....

911Doctor :

either way

911Doctor :

I wish you the best result possible

Customer:

yes me too, I just wanted a reassurance

Customer:

thanks

911Doctor :

Thank you so much for your question. It was a pleasure talking with you. Should you need my assistance in the future simply start your question with ‘for 911doc only’.


Positive feedback is always appreciated.


Be Well


911Doc

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