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  #1  
Old 02-06-2014, 02:37 PM
LBK LBK is offline
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Default Fusion surgery

Hi! I have spondylolisthesis L4/5 that has ruined my disc at that level. It is caused by a crack in my L5 vertebrae (a birth defect). I had a consult with Dr. Bierstedt hoping to get an artificial disc. He said because of the instability of L5 vertibrae my only option is a fusion. He also said that my discs above and below are healthy so he doesn't think I should have a problem with them degenerating after surgery with the extra stress put on them.a So now....Does ANYONE have a good fusion Dr. to recommend in the US?! Dr. Bierstedt says he will be glad to do the surgery. The way he explains it all and how they will do the surgery there just makes sense. Also their attention to detail and physical therapy is amazing. So far I haven't found anyone here that will operate from the back & the front. An important thing Dr. Bierstedt said is that the screws need to be long enough. He has seen too short of screws used and pretty soon it starts moving again and then you're back to square 1. I have insurance that would pay in US but if I get a crummy job done what then? Does anyone know of any successful, long lasting fusion stories?
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Spondylolisthesis L4/5

Last edited by LBK; 02-06-2014 at 05:34 PM.
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  #2  
Old 02-06-2014, 02:49 PM
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jss jss is offline
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LBK,

Condolences on the problem and on not being an ADR candidate.

I have two cervical fusions done two years apart. If you're in the Dallas area I highly recommend the neurosurgeon that did those; Richard Naftalis at Neurosurgery Associates in the Baylor complex in downtown Dallas. Also Jack Zigler at Texas Back in Plano.

Good luck, Jeff
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C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #3  
Old 02-06-2014, 04:18 PM
bwink23 bwink23 is offline
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Hi LBK..

I'm a bit confused....you are saying you have DDD at L4/L5....Has your L5 vertebra slipped to cause your spondy? I also have DDD at L4/L5. My slip is at the L5 vertebra....How bad is your slip ? Did Bierstadt recommend fusion both front and back to you?
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2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.

Last edited by bwink23; 02-06-2014 at 05:25 PM. Reason: misunderstood the problem
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Old 02-06-2014, 05:33 PM
LBK LBK is offline
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My disc between L4/5 is basically gone. The spondy "slip" has affected my hip, caused numbness and tingling in my legs and foot. I have had a orthopedic spine surgeon tell me here in US that he doesn't know for sure if he can get everything aligned properly. Dr. Bierstedt says the only way to get everything back to where it should be is to go in from the front, clean out disc, pull L5 back into alignment, put in "cage" where old dics was, then flip you over and put the screws in from the back. You can't get long enough screws in from front alone and you can't get the L5 vertibrae pulled back where it should be from back alone. He says it's really important in my case that the screws be long enough to completely immobilize. (He says they've seen a lot of failed fusions because of too short of screws.) None of my other discs have degenerated so they would feel fairly confident that a 1 level fusion should fix me up seeing as it is a birth defect that has caused the degeneration between L4/5. They feel like the post surgery care and PT also plays a big part in your total recovery. Sounds like here in US I wouldn't get PT til 6 wks. out. I've fought this for 6 yrs now and am about done with living with the pain and not having any energy left after work for my wife and kids. I'm in construction and love it and want to get back to enjoying my job and recreation.
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Old 02-06-2014, 06:52 PM
bwink23 bwink23 is offline
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Quote:
Originally Posted by LBK View Post
My disc between L4/5 is basically gone. The spondy "slip" has affected my hip, caused numbness and tingling in my legs and foot. I have had a orthopedic spine surgeon tell me here in US that he doesn't know for sure if he can get everything aligned properly. Dr. Bierstedt says the only way to get everything back to where it should be is to go in from the front, clean out disc, pull L5 back into alignment, put in "cage" where old dics was, then flip you over and put the screws in from the back. You can't get long enough screws in from front alone and you can't get the L5 vertibrae pulled back where it should be from back alone. He says it's really important in my case that the screws be long enough to completely immobilize. (He says they've seen a lot of failed fusions because of too short of screws.) None of my other discs have degenerated so they would feel fairly confident that a 1 level fusion should fix me up seeing as it is a birth defect that has caused the degeneration between L4/5. They feel like the post surgery care and PT also plays a big part in your total recovery. Sounds like here in US I wouldn't get PT til 6 wks. out. I've fought this for 6 yrs now and am about done with living with the pain and not having any energy left after work for my wife and kids. I'm in construction and love it and want to get back to enjoying my job and recreation.

Do you know what grade of slippage you have or how many mm's it is? Unless your slip is real bad, i wouldn't automatically assume it's that is what's causing the pain. The fact that your disc is GONE, tells me you probably have nerve compression, sciatica affecting your hips and legs...I have the same problems with my hip, leg and groin pain...and my spondy is small at 2mm. My L4/L5 disc is there, but it's degenerated and bulging. Do you have your MRI report ? Post it's findings so we can get a better understanding of what is going on with you.
__________________
2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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  #6  
Old 02-07-2014, 01:40 AM
WNB175 WNB175 is offline
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I had a fusion of L4/L5 - L5/S1 from both the front and the back in 2001. I would say mostly successful. Some lumbar pain still but nothing like it was. I have developed some thoracic pain problems in the last few years but all accounts say they are unrelated. No domino effect. I swim and hike every week.
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  #7  
Old 02-07-2014, 12:52 PM
LBK LBK is offline
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My MRI report reads: Grade 1 Spondylolisthesis. A portion of the disc at L4-L5 appears to be displaced posteriorly and posterior to the lower portion of the L4 vertebral body. This has minimal impression on the thecal sac. There are facet degeneration changes. (Impression) says: Grade 1 Spondylolisthesis at L4-L5 with broad based disc bulge. No significant stenosis.
This report is from a small town hospital that has had trouble acurately reading MRIs and Xrays. (They never have talked about the crack in my vertebrae (obviously to eye on images) and missed my sons broken ankle...but?!
I've had several opinions including meeting with Dr. Bierstedt in person and feel like they would all agree. I should clarify that my disc isn't "gone" like I had written in previous post, but badly degenerated(thinned way out and black on MRI.) You read such awful horror stories out there about after fusion. I'm mid 30's and don't feel like messing anything up any worse than what it is..I really appreciate this site..There's LOTS of info here..
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Spondylolisthesis L4/5
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  #8  
Old 02-07-2014, 02:13 PM
bwink23 bwink23 is offline
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So it's your L5 vertebra that has slipped ?? Discs don't slip, vertebra do. As far as the fusion goes...it sounds like you would just be getting the cage, but with longer screws inserted through the back? Or is he wanting to fuse a portion from the posterior as well?

I say this becuase i have spondy at L5 with 2mm of slip...i've not had a doctor recommend an anterior and posterior fusion together. It sounds like that's what was recommended for you....i don't know if that's due to the fracture in the vertebra or not....Grade 1 spondies from what i've read don't typically need an anterior and posterior fusion in conjunction with one another.

Does the doctor feel the slip is large enough that an anterior/posterior combo would be necessary?
__________________
2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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