Join Date: Dec 2004
Re: Fusion Surgery Advice Needed from the Experienced - how long to wait?
I've had 8 spine surgeries, been temporarily paralyzed, and four of my surgeries were fusions. Three were 3 levels because after one of the 3 levels, was in a wreck which broke a solid fusion, then more levels collapsed and finally, the last fusion was a 10 level fusion 9 months ago.
When the pain became unbearable, I gave in to the first fusion. But it has to be a combination of what your medical provider says and when you are ready to get relief.
A couple of other things I really want to stress though. First, please, if you are to the point of having fusion, have a true spine specialist and not a general ortho surgeon or general neuro surgeon. The difference? The spine specialist will noit only have completed a lengthy spine fellowship (I prefer a 2 year, but no less than a one year), PLUS and a must with me, that they must truly specialize in that 75 to 100 percent of their patients are spine patients. If they are neurosurgeons and doing brain surgery and other nerve related surgeries, they are not true spine specialists, but general neuro surgeons. If they are orthos and treating knees, elbows, shoulders, etc. they are not true spine specialist as they spend maybe 25% or so of their time on the spine.
So what, you say? Well, a true spine specialist is going to already be up and going on the newest technqiues approved by FDA as well as the clinical trials. The general ortho or general neurosurgeons may get around to the BMP fusions several years after it was approved; still won't be doing any Artifical disc replacements and certainly won't be doing the Dynesys flexible fusions. In fact, although they do fusions, by doing the older method, you wind up suffering with the bone from the hip which will hurt worse than the fusion and it will take you up to 2 years to fuse plus failure rate is considerably higher than with BMP which will take a few months. (My 10 levels were fused solid in 7 months, but looked good earlier). BMP fusion can use ground bone from the laminectomies done at the time of fusion, so no hip bone being drilled out, or they may prefer donor or autograph bone which increases your risk for non-fusion. BUT, the biggest difference here is that a general ortho surgeon or general neuro surgeon is only going to offer the fusion as your only option. Artifical disc replacement on one level with fusion on 1-2 levels is now approved by FDA, so a true spine specialist may, depending on your condition offer you that which allows you to remain more flexible, OR they may be able to do a Dynesys flexible fusion instead of the hard hardware rigid rusion. Lots of variables, but mainly your condition and your doctor's skills and this is why a true spine specialist is so doggone important.
You have only one back and one life. Once you are solidly fused, yes it can be taken apart, as they had to do that to the 6 levels I already had fused, in order to totally realign the spine in the 10 level job. However, once fused there's virtually little if any chance you can go back for an artifical disc even after insurance companies don't try to fight the costs, because with that time it has been fused, your muscles, tendons, etc have all atrophied and can no longer support you once again having a moving flexible back.
Finally, the second thing I wanted to address was your question regarding timing or when to have the surgery. Having tried conservative treatment is of course the thing to do. But also what I found out too late after dealing first with ortho/neuro surgeons was that because they are NOT spine specialist per se, they didn't bother or else just are not in tune to the fact that while I wanted to do all I could to avoid surgery, they did not inform me that the longer I pushed on in severe pain, trying NOT to have surgery, the more I was reducing my chances for a full recovery. On my first visit with my spine specialist, I had already been stuck, bent over at the waist for 10 months and living with horrific pain, when I learned that if a nerve which is being severely compressed is repaired/released within 6 months there is excellent chance for full recovery. That drops to 75 percent chance at 9 months and only 50 percent at a year or more. Not exact - because the amount/severity of compression, our general health, etc plays into that. I was lucky and got rid of the pain, but was left with permanent numbness in toes. Far better than not getting rid of the pain and having to deal with increasing amts and strengths of pain meds for the rest of my life while trying to mask the pain but coming immune to medications!
When I became paralyzed and then left on the virtual limb waiting to fall further into the trap so many general orthos and general neuros leave us in by saying there is nothing that can be done, it took being on that limb to realize that what they are really saying is that there is nothing more that they can do because that is the limit of their skills. They are human and cannot specialize in every area of the body, but why not admit that it's really that there is no more that THEY themselves can do, but there are others even more skilled who may help? Once I realized that and then did my research of credentials and started seeing spine specialists, then the whole world changed for the positive.
There are good and mediocre in every field AND in specialized fields. You have to find the one that is right for you, but back to the subject - you must not keep waiting while the nerves become more and more and perhaps permanently damaged. Then, no matter how skilled the surgeon, you may be out of luck and that nerve may never stop hurting, or that numbness may never leave.
So, I encourage you to be sure you have a true spine specialist who can offer you more than a hard fusion if your body and condition will allow that, and to do so quickly so as to not reduce your chances for successful recovery.
If you don't know how to search for a spine specialist I do have a post "how to find a spine specialist in your area" which you can find with the search.
Best wishes and do let us know how you are doing.