<s>[INST] L23 L34 L45 L5S1 herniations. all with nerve root contact except for L5. Disco gram showed all painful except L45. posteriolateral fusion of L23 L34 six months ago. now worsening back pain as well as worsening leg pain and extending to foot (all right sided, same as prior to surgery). repeat MRI shows L45 nerve root contact, L5-S1 bulge with no nerve root contact. However, moderate DJD to L5-S1, which is new, as well as small DJD at all other levels, and normal post op scaring at nerve root areas. treating, at this time, with pain meds for back pain and neurontin for nerve pain, however, not helping significantly. I am an otherwise healthy 45 yo female who sustained a traumatic injury resulting in this problem. what is likelihood of further surgery at this time? pre and post op we discussed probability of further surgery at some time, as no one wanted to do a 4 level fusion, which really was what I needed. We all agreed due to age, it was a poor choice to do 4 levels with initial surgery. [/INST] Dear Madam, thank you for your consultation.it seems that after a fusion operation at L23 and L34 it is still painful while maintaining your daily life. With keeping in mind your age and extent of damage done by trauma I think you should not go for a 4 level fusion. Because a second surgery like 4 level after an initial spinal fusion surgery does not necessarily yield any good result. Rather you should try some light back strengthening exercise under the supervision of a physiotherapist to get some relief from pain. This will partially overcome the apparent need of 4 level fusion surgery.my best wishes for your health in coming days. Thank you. </s>