How far to fuse

[Mary Lou]

I have two questions...

1) I have heard that once my daughter has spinal fusion, she won't be able to have an epidural during child birth. She is going to be fused down to about L2. Is that true or does it depend on how low you are fused?

2) My daughter has a Grade I spondylolisthesis of L5. She has no pain or any other sypmtoms. Her doctor doesn't want to fuse her that low, because he is trying to retain as much mobility as possible, but he says he will have to watch it closely. My questions is should I ask him to fuse her that low now and lose some mobility/flexibility or watch and hope the fusion doesn't put too much stress on L5 and possibly need further fusion later.

Thank you.

Mary Lou

[LindaRacine]

Hi MaryLou....

You should get a second opinion from another scoliosis specialist in regard to your question about whether to fuse the spondylolithesis. You can find a list of specialists here:

http://www.srs.org/directory/directory.asp

Regards,
Linda

[Mary Lou]

Thanks Linda.

The doctor doing the surgery is our 5th opinion and we trust him completely. My hope is to find someone who is fused that low and ask about flexibility/mobility, things they can and cannot do, etc.

Mary Lou

[mumof5]

Mary Lou,
My daughter Amber is fused T4 to L4. I don't know what spondylolithesis is but Amber's L5 is curved and rotated. Her surgeon told us that he would stop the fusion as high as possible to retain as much mobility for her as he could.
We were told that if the curve continued to progress they may have to go back and fuse further, probably right into the tailbone. All the doctors we spoke to said the same thing. Don't fuse there if you can avoid it.
Apparently the lose of movement is major.
Amber is now 6 months post op and can do pretty much everything that she wants to. Of course there are some things that she can't do but she has found ways around her restrictions.
Her L5 is stable, it was improved a little with the surgery and not really moved since. Her last x-rays were done last week and the doc. was happy with her L5.
I haven't heard anything about not being able to have an epidural because of the surgery. But in my opinion, having had 5 children naturally, and an epidural with one of them, I wouldn't have one again. There are other ways to help the pain which give much better results.
Best wishes.
Cheryl.

[LindaRacine]

Hi MaryLou...

While flexibility should certainly be considered, you also need to find out what might happen if you don't fuse the spondy. I don't know a huge amount about this problem, but it seems to me that there's a possibility that the top vertebrae could eventually slip all the way forward, with the potential of damaging the spinal cord. If your daughter will definitely have to address the problem at some time, it might be best to get it all done at once.

Good luck with your decision.

Regards,
Linda

[Mary Lou]

Cheryl...thank you for responding. I might be wrong, but it sounds like spondylolithesis is a slipped disc. Since it isn't causing any problem, we've just been checking it on x-ray. I'm glad to hear that your daughter is doing well. Like your doctor, ours is trying to save flexibility. As for the epidural..I had two children without an epidural, but some people really push for one. It's not an issue right now, but I was just curious if it was true in case she ever needs a C-section at some point.


Linda...as always, thanks for your help. I checked out the website you suggested and three out of five of the doctors we've seen were on the list (we've seen Dr. Jose Hererra-Soto in Hershey, PA; Dr. Randal Betz in Philly, PA and currently we are seeing Dr. Lee Segal, Hershey, PA) which makes me feel even better about our choice in doctors. They all pretty much agreed with one another and were all are good doctors. I will be discussing the situation further with Dr. Segal.

Mary Lou

[LindaRacine]

Hi MaryLou...

A spondylolisthesis is more like a slipped vertebrae than a slipped disc. Here's a picture of what it looks like:

http://www.josephmaroon.com/spond1.JPG

The diagram shows an L5 slippage from the side.

Regards,
Linda