Question
Male, 63, Spondylolisthesis L4-L5. Spinal stenosis & degenerative disc disease L5-S1 Stenosis L4-L5-S1, Spondylosisthesis L4-L5:     
9-2003 L4-L5-S1 laminectomy/bilateral segmental pedicle screw instrumentation/bilateral fusion/Posterior lumbar interbody fusion L4-L5/ application of VG2 prosthetic device L4-L5 disc space. Q: 16 months post surgery told non-union of fusion. still in mild to mid pain, when standing sitting walking (limits my ability to perform most activities for over 5-15 minuets.When failed fusion MUST IT BE CORRECTED?If not corrected may spine be weaker? Is there a chance that fusion still may occur? What is "normal" to be done for failed back surgery? I am concerened if I do not redo surgery that I will need this done when I get even older. I am debating what my opinons are to be able to live a active life style again. Thank you for any input you may give me. I acknowledge that any information you may provide is just for reference and not a recommendation of any kind peter Smithuysen

Answer
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Dear Peter,

If I understand correctly, you have underwent a decompression and fusion of the L4-5 space. It is not clear from your description what still bothers you. Is it the back pain or leg pain/numbness/both ?
It is very difficult to assess fusion after a PLIF procedure. It is normally done by doing a spiral 16-slice CT scan with reconstructions, and then trying to figure if what you see is bone union or an artifact.
As a generalization, if you still have back pain ?the problem might be the non-union. If you still have leg problems, your decompression might be inadequate. What I would do after carefully trying to understand your exact complaint, is a CT-myelogram to see if there is any residual spinal stenosis in case you have leg problems. If your main complaint is backache, I would try and see if there is any sign of infection. If that is ruled out, I would do a discography on adjacent levels to see if they are not the source of your pain. Only then would I consider revision surgery.

Sincerely,

Dr. N. Rahamimov