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Old 01-26-2012, 03:06 PM   #1
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Fusion Surgery 2 Years Ago Needed Again

Could anyone shed some light on my issue?




I am 56 year old female.

I really cant remember a time when my back did not aggrevate me. I remember SITTING and peeling potatoes when my children were very young.

I guess about the last ten years or so, it has progressed. I have run the gammit, first chiropractic care, then pain shots, than 2 years ago I had fusion surgery on S1, L5, and L4. The dignosis was both spinal stenosis and degenerative disc disease.

The surgery was successful and I was painfree for about a year and a half when a little nagging achiness started again. This has been progressing for about 6 months.

This week I went back to my surgeon and had an x-ray. It took him about 2 seconds to say, "I see what is hurting you. Come here and look." My L3 disc is GONE! His recommendation is another fusion surgery.

My question is this: Am I going to be facing fusion surgery every 2 years and this degeneration moves up my back?

Is there any alternative treatment outside surgery? I know my disc will not reappear, but any ideas on the course of action I might take to prevent further damage?

Thanks!
Donna

 
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Old 01-27-2012, 04:17 AM   #2
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Re: Fusion Surgery 2 Years Ago Needed Again

No suggestions?

 
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Old 01-27-2012, 07:51 AM   #3
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Re: Fusion Surgery 2 Years Ago Needed Again

Welcome to the board.

I guess no one responded yet because there really isn't an answer for you. We don't know what other extenuating circumstances there may be, how the surgery was done, what else was wrong with L-3 before the first surgery, etc.

About 10 out of 100 people that have a lower lumbar fusion will then eventually need to fuse an adjacent level. Since the last two lumbar segments take the brunt of the body's spinal movement, once that area is fused into a solid block with the sacrum, the next level up, L3-L4 in your case, and the SI joints are now subjected to all that stress. So in a small number of people, a future fusion is usually necessary.

Unless there are other degenerative issues at work, it doesn't usually continue on up the spine. Once you get above L-1, you are into the thoracic area which is stabilized by the rib cage so the thoracic discs do not usually degenerate in the same way as the lumbar do.

Since you mention you've had back pain ever since you were a younger woman, it would make sense that you might have more problems with degenerative issues than the average person. You can help yourself by trying preventative issues like keeping yourself at a healthy weight, doing your core and back exercises faithfully to keep the muscles and ligaments as strong as possible, using good body mechanics and maintaining good posture, sleeping on a supportive mattress, etc. The rest of it is probably just your genetic make-up and mother nature at work.

I would suggest you get another opinion from a spine surgeon from a different practice and from the other spine specialty just to make sure a fusion is really necessary. If your first surgery was done by a neurosurgeon, try an ortho spine surgeon for the new consultation, or vice-versa....

 
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Old 01-27-2012, 10:42 AM   #4
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Re: Fusion Surgery 2 Years Ago Needed Again

Hi Donna,

I was reading your post and hoping that I'm not heading down the same path. At 35, I just had L4-L5 fused, but the lower back pain with severe spasms has been ongoing for some years now, demonstrated by a lot of scar tissue found during surgery. Fortunately, my MRIs showed good disc heights at all other levels. I'm hoping that I had an acute injury to the affected disc at some point in the past and that this fusion is going to stabilize and stop other problems.

Some people have had luck with artificial discs, but I think only one level is currently FDA-approved. Maybe this is an option to discuss with your doctors, since you have had post-fusion problems with adjacent levels? My surgeon disfavored them, because of the lack of long-term studies and my age. And, of course, knowing that you have back issues supports following all of tetonteri's advice with respect to exercise, weight maintenance, core conditionning, whether you ultimately decide to have surgery or not.

 
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Old 01-27-2012, 02:11 PM   #5
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Re: Fusion Surgery 2 Years Ago Needed Again

To answer some questions....I was not aware of anything wrong with L3 before my first surgery. I have an ortho surgeon and honestly feel very comfortable with his skill level. However, surgery is his bread and butter, so....a new Lexis is always nice for anyone.
The first diagnosis was stenosis and ddd. I have taken my new xrays to two different chiropractors (because they are my friends and I know they know how to read xrays). Both of the chiropractors say my L3 is basically gone, blown out, non-existant. Sort of handed the xrays back to me and said good luck with that.

I do have degenertive issues, I have family genetics of almost every female in the family having either back or hip issues. (That's another story.)

Both chiropractors also told me I have quite a curve in my spine...which has NOT been mentioned as what is causing my problem by my ortho dr.

I don't know what you mean by "how the surgery was done.." but Ill try. I have incision about 6-7 inches. I did have some complications with my blood platelett count dropping seriously low but other than that I feel the surgery was completely successful. I had a fast recovery, planted flowers in my garden while I was still on medical leave and returned to a sitting job in 8 weeks.

The suggestions to go to a neurosurgeon is an excellent idea and I will do that.

I will also discuss artificial discs with my dr next week when I go for the follow up on my mri I had today.

The diet, exercise, body weight is assumed.

Thank you both so much for your responses. I guess its all about educating myself the best I can and move forward with my decision from there. You have both added valuable information. Thank you.

Donna

 
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Old 01-27-2012, 07:02 PM   #6
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Re: Fusion Surgery 2 Years Ago Needed Again

I just meant if you had a PLIF or ALIF or was it minimally invasive...done with hardware, etc.

I don't believe you will be a candidate for an artificial disc on segment that adjoins a fusion. I think it precludes the bone from being strong enough to "tie into" with what they need to anchor the artificial disc...but I may be wrong. I wasn't a candidate so never spent a lot of time researching the topic.

That's interesting that you planted your garden and went back to work at 8 weeks. My surgeon would not allow me to use a shovel for ages -- I had my surgery in June and I wasn't allowed to garden that first summer or fall, and then in the spring, I was allowed to do "gentle" gardening as long as I promised to only use a shovel very sparingly! It was my third lumbar surgery and 2nd fusion and my surgeon was very cautious with me. Not all his patients would have these restrictions.

It could be that your surgeon doesn't feel the curve is causing your issues or your pain, so he doesn't talk about it. Has he commented in the past that your disc between L3 and L4 was beginning to degenerate? I doubt this all happened in the last 18 months.

 
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Old 01-28-2012, 04:58 AM   #7
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Re: Fusion Surgery 2 Years Ago Needed Again

I dont know what those letters stand for but I do know it was invasive surgery! I do have hardware in my back, 2 rods and 6 screws and a nice little 6 or 7 inch scar in my back.

He didn't really allow me to do gardening. I just did. I did not dig a new garden. I planted a few flowers in a bed that was already done. I guess I misstated...I was actually a little proud I was able to put in my flower bed. It was done fast, a little at a time. I did actually have a recovery but my point i intended to make was that I had a very smooth recovery.

You sound very knowledgeable. I was thinking maybe you were a participating physician until you mentioned your own surgeries.

How is your life now?

Thanks again,
Donna

 
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Old 01-28-2012, 09:24 AM   #8
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Re: Fusion Surgery 2 Years Ago Needed Again

plif alif I dont know what these initials stand for....I had invasive surgery, 6-7 inch incision on my back, and he installed 2 rods and 6 screws.

You are very knowledgeable. I so appreciate your input. I thought maybe you were a participating physicain on the message board!

I really didn't have permission to garden per se. I didnt dig with a shovel but did get down on the ground and put some flowers in. I guess my point was that I had a very smooth recovery.

It concerns me that this was possibly going on before my previous surgery and it wasnt discussed. Actually at the time he was considering doing only one fusion and I told him if he got in there and I needed two to do it because I didnt want to come back and do this again anytime in the near future.

Again, I so appreciate your feedback.

Donna

 
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Old 01-28-2012, 09:25 AM   #9
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Re: Fusion Surgery 2 Years Ago Needed Again

plif alif I dont know what these initials stand for....I had invasive surgery, 6-7 inch incision on my back, and he installed 2 rods and 6 screws.

You are very knowledgeable. I so appreciate your input. I thought maybe you were a participating physicain on the message board!

I really didn't have permission to garden per se. I didnt dig with a shovel but did get down on the ground and put some flowers in. I guess my point was that I had a very smooth recovery.

It concerns me that this was possibly going on before my previous surgery and it wasnt discussed. Actually at the time he was considering doing only one fusion and I told him if he got in there and I needed two to do it because I didnt want to come back and do this again anytime in the near future.

Again, I so appreciate your feedback.

Donna

 
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Old 01-28-2012, 10:35 AM   #10
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Re: Fusion Surgery 2 Years Ago Needed Again

No medical training for me...I am just curious by nature, and tend to throw myself into a new topic that is occupying my thoughts at the moment. For the past 6 years that has been the spine! I've also been really lucky to have had some caring and generous doctors, PTs and a couple "alternative" medicine people who have been great about answer all my many questions, teaching me what to look for on imaging, and sharing a great deal of information. Plus with all the resources now available on the internet, and the trend in medicine to educate the patient, it is now so easy to access medical journals, textbooks, articles, etc. that were formerly only available to doctors, etc.

You probably had a PLIF, which is a posterior lumbar interbody fusion. Alif is the same, but the surgeon goes in from the front, and the surgery is done from the front side of the spine.

Now -- to your concerns. I can assure you that most spine surgeons have to make a decision regarding how many levels they will operate on. Usually if one disc is "bad," chances are most of the others are showing some signs of the same disease process (assuming it wasn't an injury caused by a bad accident, impact, etc.) even if it is just at a very beginning stage. Also, the levels most stressed are L3 to S1.

The surgeon will want to do the least amount of surgery he can get away with. But he is also balancing this with the knowledge that he doesn't want the patient having to return soon because he didn't do "enough." It is a judgment call. I imagine your L3 showed signs of degeneration, but not enough to warrant surgery.

Despite what one would think from reading these boards and others, doctors do not discuss their decision making process with the patient! They don't tell us every single thing that looks a bit out of the ordinary on the MRI or X-ray. There aren't enough minutes in the appointment for that. So we learn about our conditions on a "need-to-know" basis.

It could be that your L3 disc was shot at the time he did surgery and the surgeon screwed up. But somehow I doubt that is the case. More likely is that there were small issues. The surgeon made the call that he would do the two levels, which apparently was one more than he wanted to do. Keep in mind that with each additional level that is operated on, the chances for the success of the surgery diminish. So there is real impetus to do as little as the doctor feels he can get away with.

Also, in the US, most insurance carriers are loathe to cover a multi-level fusion. Part of the reason for this is because the rate of success is not very high.

This is my guess about your situation...and you can ask your surgeon why when you next see him.

Last edited by teteri66; 01-28-2012 at 10:44 AM.

 
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Old 02-01-2012, 09:54 AM   #11
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Re: Fusion Surgery 2 Years Ago Needed Again

Today I had my follow up appt with my doctor following my MRI.

I took a list of questions and discussed options and also the fact that I can't sit to work. I went out to eat on Sunday nite and had to leave the table before I finished my meal.

He would not give me a doctor's excuse not to work...because I have a desk job and sit at a computer for my work. Huh? I cannot sit one hour! Much less and 8 hour work day. I am in tears after about 2 hours.

I wake up at night...at 3...at 4...at 5....with radiating pain.

I agree to do the surgery. I agree to do whatever I need to do so that I can get fixed...but what the heck do I do now?

I cannot work and he says I can.

**Have a feeling I know what the answer is going to be.**

Donna

 
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Old 02-01-2012, 10:55 AM   #12
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Re: Fusion Surgery 2 Years Ago Needed Again

Also, could anyone explain why my doctor said I have DDD when looking at my xray, and today when he was viewing my MRI he said I have stonosis?

 
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Old 02-01-2012, 02:36 PM   #13
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Re: Fusion Surgery 2 Years Ago Needed Again

As to the recent question, DDD and stenosis are not mutually exclusive. In fact DDD can cause stenosis, whether it's foraminal or spinal. Likely, the presence of osteophytes or the proximity of the vertabrae on the X-rays led him to the conclusion that you have disc damage. The MRI allowed him to see that the soft tissues were narrowing other soft tissue areas -- possibly disc matter pushing into or against either the foramen or spine.

As to your question about what you should do next, it sounds like your doctor is unwilling to listen to your needs. You might be able to ask your workplace for modifications to allow you to work without constantly sitting, but you will probably need medical documentation. For example, I have a normal chair, a saddle chair, and a tabletop that moves up and down. This allows me to sit, saddle-sit or stand throughout the day.

Maybe your doctor isn't aware that your desk job requires you to sit only for eight hours and would be willing to provide you the documentation to get additional resources at work? If not, it seems inconsistent that he thinks your clinical findings are severe enough for surgery, yet he is ratifying your sitting for eight hours per day, increasing the stress on your spine. If that's the case, you might want to find another doctor.

 
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Old 02-01-2012, 05:10 PM   #14
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Re: Fusion Surgery 2 Years Ago Needed Again

...off to another doctor....

 
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Old 02-01-2012, 06:13 PM   #15
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Re: Fusion Surgery 2 Years Ago Needed Again

I have some good recommendations, if you are in the San Francisco Bay area. You could also ask any of the physical therapists you may have had contact with before for a referral. Since you are a previous surgery patient, your best option may be a teaching hospital. You can specify that you don't want anyone but your surgeon touching you (no residents or fellows). I hope you find the right doctor!

 
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