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Old 10-30-2003, 06:26 AM   #1
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Post Post-Operative Bracing

Hello Everyone,

I have researched and read much literature on the Internet relating to Post-Operative Bracing.

It seems that each surgeon has their own protocol. Some doctor's advise that bracing is to remind the patient to avoid certain activities following surgery. Other's advise that a brace is helpful for temporarily support of the spinal repair. It can also aid in pain control by giving your spine support.

Some factors contributing to post op bracing, number of levels fused, age of the patient, quality of the patients bone, the patients physical health ie: diabetes, smoking, obesity. Some doctor's believe the titanium plate eliminates the need for the brace in most cases. Some also believe that the need for bracing depends on the immediate stability achieved at the time of the surgery. I have read doctor's state that patient's that had a 360 fusion would allow for avoiding any bracing because of it's instrumentation from both front and back. That same doctor stated that non-instrumented fusion or instrumentation in the setting of osteoporosis may require rigid bracing.

OK, I have posted what I have read not what I believe. For instance, I have written with other member's that had a 360 fusion and they had a back brace, the corset, and I think they needed it. I think we all need it. Most of you all ready know me. My surgeon had wanted me fit for a TLSO(Thoracolumbar Sacral Orthosis) back brace while I was in the hospital. Unfortunately, I had a problem with my insurance company and that is when I had originally found this board and came for help. It took several weeks for me to get an insurance approval. I have written with another member on these boards who also did not have a back brace after surgery and has had complications. I am starting this thread in hoping that other members who also did not have a brace following their surgery will share their recovery both good and bad. Even those of you that did have a brace how do you think you would have felt not having it? I remember the first several weeks not having mine and my surgeon was very angry at my insurance company. As all of you know how important it is to walk and walk and walk, I could not as my surgeon and I were more concerned about my falling and what damage that could have done. The first few months of recover are crucial to having a successful one. This is why I am having trouble comprehending what other doctor are saying about not needing a brace after the surgery. Even If you disagree with me please post as I think this is a very important issue that patient's need to discuss more so than the doctor's. I never take anything personally..lol

I will close with a statement I found online concerning Post-Operative Bracing.

[b]Spinal surgeons in general are waiting for what is known as prospective medical studies to prove or disprove the true benefit of any brace. [/b]

I hope you all have a great day!

------------------
[b]Cervical[/b] MRI 10/02
Loss of cervical lordosis with reversal of the curvature.
C4-5 and C6-7 disc bulges resulting in flattening of the ventral margin of the cord.
C5-6 there is a left foraminal herniation which results in moderate foraminal stenosis In addition, there is flattening of the ventral margin of the cord due to bulging disc.
Cervical Epidural 5/19/03

[b]Lumbar[/b] MRI 10/02
Lumbar Lordosis
L5-S1 disc herniation with moderate thecal sac deformity.
L4-5 disc desiccation with bulge which results in mild thecal sac deformity and mild bilateral foraminal stenosis.
L2-3 disc desiccation with Schmorlís nodule of L3.
Lumbar Epidural 1/30/03
Lumbar Epidural 2/12/03
Lumbar Epidural 2/26/03
Lumbar Discogram 5/23/03
Lumbar CatScan 5/23/03
[b]Posterior Fusion & Infuse with Laminectomy on L4,L5,S1 6/30/03[/b]
Instrumentation = 2 Rods 6 Screws & Disc Spacers
Lumbar X-Ray 7/24/03
Lumbar X-Ray 8/27/03
Still no pain relief....
Lumbar CT Scan 9/24/03

[This message has been edited by Tomorrow (edited 10-30-2003).]

 
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Old 10-30-2003, 07:54 AM   #2
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L5S1 HB User
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Hi Tomorrow

I thought I would post what we discussed on the other thread.

I had L5/S1 PLIF and my doctor did not prescribe a back brace because of his belief the back muscles heal quicker. At 7 months post-op, I was still having back swelling and pain and the ortho decided to perform exploratory surgery and found a loose screw. He removed the right side hardware but decided to leave the left side hardware in to help support my back and to allow the fusion to mature. I am now experiencing sciatica on my left side and the doctor is discussing removing the left side hardware. In retrospect, I feel not wearing a back brace puts all the strain on the hardware to support the back until the back is fused. In my opinion, I feel a back brace should be used for at least the first three months to allow for the body to heal and to help the fusion process.

I am interested to hear if anyone else development hardware or continued back problems possibly associated with not wearing a back brace.

Tomorrow, please note the other posters which I discussed about braces are no longer posting on this board. You might search on my logon name and find some previous discussions on back braces.

Take Care [img]http://www.healthboards.com/ubb/t_up.gif[/img]




------------------
Spondylolisthesis - level 2 L5/S1
Pars Defect
End Plate Separation
2 Nerve Root Blocks (no effect)
L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
Nerve Root Block 10/03
__________________
Spondylolisthesis - level 2 L5/S1
Pars Defect
End Plate Separation
2 Nerve Root Blocks (no effect)
L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
11/03 MRI of cervical and thorasic spine

 
Old 10-30-2003, 10:23 AM   #3
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Post

Tomorrow-
I have a 'cybertech' brace that I was fitted for a year ago, and the neuro has said he may have me wear it for a few weeks after surgery, even though I'm having the 360 fusion.

I personally think it's a good idea - if even for a 'gentle' reminder not to make certain moves. But, I'm concerned about the muscles becoming dependent on the bracing. Well, I guess I'll just have to see how it goes...

o'Girl

------------------
20 years intermittent back pain - no treatment sought
Nov 2001 - herniated disk - Right leg radiculopathy
Jan 2002 - Chiropractic care
Mar 2002 - MRI, X-Rays, Oral steroids
Apr 2002 - L4/L5 Microdiskectomy
Sept 2002 - PT, Oral steroids
Oct 2002 - MRI, Xrays - Failed Back Syndrome
Apr 2003 - TFESI, EMG, MRI
Diagnosis - DDD - foraminal narrowing, disk bulges, osteophytes, ligamentum flavum hypertrophy, active marrow edema, levoscoliosis, retrolisthesis, scar tissue encompassing L5 nerve root, disk height diminished, abnormal EMG results for left leg
Sept 2003 - Discogram with Xrays, CT Scan.
Tentative date: Nov.18 - 2 level 360 degree fusion surgery

 
Old 10-30-2003, 12:52 PM   #4
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Location: Australia
Posts: 1,339
MarianJ HB User
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Hello L5S1,

I really hope that you do not have to go through another back surgery and that the sciatic nerve does indeed heal. Your situation has sent an alarm to my brain... I am only 4 months post op and I did not wear the brace for several weeks. I do suffer with extreme swelling and posterior subcutaneous edema has also been reported on my most recent CT Scan. I had started a thread about that report and my neuro had said that my films were read incorrectly but I doubt the edema was because he did ask me if I was using Ice. Also at that bottom of that report they said the correlation with prior studies or follow up MRI would be helpful. I have searched the web but could not find the time period for a fusion patient to have an MRI. When I had gone for my first and even second follow up appointments to my surgeon he was very upset that I did not have my brace yet. He had his nurses on the phone all the time calling me, my insurance company and brace maker. So I guess he is one of the doctor's at least in my case that does believe in the benefit of the brace. Prior to my surgery I had sciatica in my right leg only. I now suffer with pain in both legs and feet. I have recently started to finally sleep on my right side (alleluia) but after a half hour I get so much pain in the right hip I have to return to my back. I get pins and needles in both feet when going to a sit down or lying position. I have left heel pain and pain in three right toes that feels as if they are twisting. I have also been seeing a podiatrist. I realize that nerves and muscles take a great deal of time to heal but I also read other posts were patients have a remarkable recovery. Gosh when I finally got my brace I even slept in it for the first week...lol I did all the walking that my back and legs would let me. Then I ran into other complications at a later time. I still have not started physical therapy.

I am sorry to hear that those members that you spoke of are no posting. I will do the search with your name and see what I come up with. Hopefully their are other members here that will come forward and share their experiences.

I forgot to ask you after the hardware was removed from your right side, did you feel any pain relief. I don't think that you would have felt it immediately as you probably needed time to recover from yet another surgery. But what I am asking did you feel any sort of a change in your pain levels and did your swelling go down. Also did you get to keep your hardware or at least see it?

Good Luck to You.

 
Old 10-30-2003, 01:07 PM   #5
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Post

Hello O'Girl,

I think I have heard of the cybertech brace. Is that the one that fairly stiff with plastic bars in the back to help prevent bending etc. Did you wear this one after your Microdiskectomy? I think that it was a very good idea that you held onto it. I will probably keep mine forever....

I really hope that your surgeon does insist that you wear it after your surgery. What I posted in the beginning of this topic about 360 fusion's was only what I read and not what I believe. I really think that you need to protect your spine and hardware for at least several weeks. I do understand you concern about the muscles becoming dependent on the bracing but that would be were the therapy would come in. You can rebuild and develop those muscles in therapy which I know can be tough. But when you think about what complication's could possible arise from the hardware as L5S1 posted, I would want all the protection I could possibly get. Also if any of us were to take a fall, and OMG I pray that we don't, I hope the brace would give us a little added protection.

As always, I do wish you the best of luck as your surgery date is approaching....

 
Old 10-30-2003, 01:44 PM   #6
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Join Date: Jan 2003
Location: OK USA
Posts: 229
L5S1 HB User
Post

Hi Tomorrow

I am sorry you are still having problems. It is a very long road to recovery

I have heard from another poster she had a MRI after about 5 months post-op and the image came out well even with the hardware. Note: The radiologist should use a contrast material such as gallium to enhance the image around the hardware.

I did have immediate relief once the right side hardware was removed. After the normal post-op swelling, I have never had any more swelling in my back and began noticing a remarkable improvement on how my back felt. This is why it is so confusing why the sciatica has returned on the left side because my back feels better than it did prior to the fusion. The doctor thinks it could either be the remaining hardware; scar tissue; the bone graft growing into the nerve root canal; and the possiblity of arachnoiditis.
The hospitial did give me the hardware after surgery and it is amazing to see the size of the screws used in our backs. No wonder we are in so much pain!!! I wish there was a way to post a picture of the hardware on healthboards.

I pray you will find a treatment wish will correct your back problem.

Take Care [img]http://www.healthboards.com/ubb/t_up.gif[/img]




------------------
Spondylolisthesis - level 2 L5/S1
Pars Defect
End Plate Separation
2 Nerve Root Blocks (no effect)
L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
Nerve Root Block 10/03
__________________
Spondylolisthesis - level 2 L5/S1
Pars Defect
End Plate Separation
2 Nerve Root Blocks (no effect)
L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
11/03 MRI of cervical and thorasic spine

 
Old 10-30-2003, 02:51 PM   #7
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Location: Montana
Posts: 491
Elaine HB User
Post

Tomorrow,
I wore a TSLO after my first fusion. Two years later I had another fusion, different doctor and he had me use a corsett type brace. The TSLO felt better in that there was more support. I wore it for five months and it was real hard to wean out of it. You muscles atrophy, in other words, you become dependant on the brace. Even with the second fusion, I wore the TSLO, rather than the corsett. I did everything by the book, no bending, no lifting, etc for six months. I just found out that my first fusion did not fuse.
If you read my post "Failed Fusion" it explains what happened to me. I just found this out and it has been almost three years!!!
Elaine

 
Old 10-30-2003, 07:18 PM   #8
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Location: Australia
Posts: 1,339
MarianJ HB User
Post

Hello L5S1,

Thanks for sharing the info on the MRI at 5 months post op. I was actually pulling out my hair trying to find that out on the net. It is great to hear that you did indeed have immediate pain relief after the hardware was removed. And to be rid of the swelling must have made you real happy. As for your sciatica returning I sure can understand your frustration and fear. Especially when it can mean all sorts of things. A couple of weeks ago I started a thread concerning my findings on the disease called Arachnoiditis. This disease has worried me because many of us have agreed to many procedures and surgery's in hoping to get pain relief. And after researching and reading many articles I then became aware of this disease and it is very scary. I really hope that they do not find this to be your diagnosis as their is no cure. I am praying that they find something that they can fix and give you the pain relief that you deserve.

It is great that you got to keep you hardware. I have only seen pictures of what they look like and I have seen my films but I would love to see the actual thing. I bet your family members and friends are probably amazed when you show them.

I hope that you have a comfortable night.

 
Old 10-30-2003, 07:26 PM   #9
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Hello Elaine,

OMG, I feel so very bad for you. I can't believe that they only just told you this.
I can understand your statement about becoming dependent on the brace. But as you said you did everything by the book.
I am going to go over and read you other thread right now.

 
Old 10-31-2003, 09:34 AM   #10
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Are you guys nuts? I don't want to see anything they put in there!

Tomorrow-
I'm so sorry you are still having all those problems. The cybertech brace is a lot of plastic and velcro with adjustable 'strings' in the back (Looks like guitar strings or something). I'm sure it will be a gentle reminder, but probably not enough to keep me completely immobile. He actually prescribed it a yar ago in hopes in would help with the pain - kinda like Loulou's cast - if it worked, fusion might indeed help, also.

Elaine-
I just cannot believe your second surgeon took out the hardware without a fusion! Even all of us on here would know better than to do something like that!

L5-
I'm sorry you're still having the problems, too. I will keep you in my prayers.

O'Girl


------------------
20 years intermittent back pain - no treatment sought
Nov 2001 - herniated disk - Right leg radiculopathy
Jan 2002 - Chiropractic care
Mar 2002 - MRI, X-Rays, Oral steroids
Apr 2002 - L4/L5 Microdiskectomy
Sept 2002 - PT, Oral steroids
Oct 2002 - MRI, Xrays - Failed Back Syndrome
Apr 2003 - TFESI, EMG, MRI
Diagnosis - DDD - foraminal narrowing, disk bulges, osteophytes, ligamentum flavum hypertrophy, active marrow edema, levoscoliosis, retrolisthesis, scar tissue encompassing L5 nerve root, disk height diminished, abnormal EMG results for left leg
Sept 2003 - Discogram with Xrays, CT Scan.
Tentative date: Nov.18 - 2 level 360 degree fusion surgery

 
Old 10-31-2003, 01:21 PM   #11
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Join Date: Jul 2003
Location: Australia
Posts: 1,339
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Hello O'Girl,

Any brace is better than no brace at all. Even if it works as a reminder like you said. That raises another issue because as a patient starts to feel better as they recover I think that the slightest incorrect twist or bend could damage or even delay the fusion. But then again you have patients such as Elaine, that have done everything by the book and still have had a failed fusion. When I was researching I did read that the rigid braces such as the TLSO were known as the better quality braces. The first week I was wearing mine the screw fell out but thank God I found it.

O'girl, I just wanted to say that I do admire the fact that you do have an upcoming fusion surgery and you still do participate in all topic's. I do know that it is important for you to have a positive state of mind for your surgery. Just because some of us are not so lucky and have more difficult recovery's does not mean this will happen to you and I am sure you already know this. It just that I don't want you to think that I get so wrapped up in my own problems, that I don't care about other's. Gosh, when you go into surgery I will probably be counting the days till you will be able to post to let us know how you are doing. Speaking of which, do you think it would be possible to have someone post for you. I am also a member of another board and my daughter did this for me. Just a suggestion...

Well, have a Happy Halloween.

 
Old 10-31-2003, 02:48 PM   #12
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Awww, Tomorrow-
You have been extremely supportive. I know it's hard for you to encourage those of us with upcoming surgery when you're having so many continued problems. But, you do an excellent job of that! I, like you, just try to be there for people and all we can do is share our experiences - good or bad. Each of us is different, and we should all expect different doctors' advice and outcomes.

I went to the dr yesterday (the neuro who is going to do the hardware). I swear, there used to be a time when all my doctors were older than me, but this one is a young'un. He's just out of medical school, but sometimes I think that's an advantage. He told me it would take about 2 hours for what he will be doing, and another 2 for the front surgery. Doesn't that sound overly optimistic?

I can try to have my daughter post for me, but she is away at school and will not be home until Friday (after my Tuesday surgery). And, that is her 21st birthday! I don't think my hubby would be able to do it - he's just not computer literate. Forget my son - he's never around, anyway....

I think I speak for a lot of people on this board when I say just how glad we are that you're around. You always seem to dig up good advice and information.

Take care - you are always in my prayers.

O'Girl



------------------
20 years intermittent back pain - no treatment sought
Nov 2001 - herniated disk - Right leg radiculopathy
Jan 2002 - Chiropractic care
Mar 2002 - MRI, X-Rays, Oral steroids
Apr 2002 - L4/L5 Microdiskectomy
Sept 2002 - PT, Oral steroids
Oct 2002 - MRI, Xrays - Failed Back Syndrome
Apr 2003 - TFESI, EMG, MRI
Diagnosis - DDD - foraminal narrowing, disk bulges, osteophytes, ligamentum flavum hypertrophy, active marrow edema, levoscoliosis, retrolisthesis, scar tissue encompassing L5 nerve root, disk height diminished, abnormal EMG results for left leg
Sept 2003 - Discogram with Xrays, CT Scan.
Tentative date: Nov.18 - 2 level 360 degree fusion surgery

 
Old 11-03-2003, 01:29 PM   #13
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Join Date: Jul 2003
Location: Australia
Posts: 1,339
MarianJ HB User
[COLOR=Purple][B][CENTER]Hello O'Girl,[/CENTER][/B]
[INDENT]Well, it took me a couple of day to finally get back on these boards and they did a wonderful job with them. Yes, I also remember when all my doctor's were older then me and my neuro surgeon was actually born the same year as me. This just makes me feel older, lol... [/INDENT][INDENT]Thank you for trying to get your daughter to post on your behalf. My husband is just like yours, he doesn't even know how to turn the computer on. Thank you so very much for the compliment. It sure does mean a lot to me, probably more than you know. [/INDENT][INDENT]So do you have everything all set for your surgery? I hope that you have some plans on enjoying yourself as well. I also hope that you find your way to the new boards as I had a hard time.[/INDENT]
[B][CENTER]Take Care[/COLOR][/CENTER][/B]

 
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