How nice of you to ask after me. I'll have to admit this hasn't been the easiest few days. Well, here is the long of things. My doc doesn't agree with the scan reports on some aspects and thinks I may, just may have some small amount of fusion bone left in there. He dismissed the pars defects as a normal consequence of my previous surgery and says they shouldn't be creating pain so long as there is no movement. He tells me that if the pedicle screw at L4 is out of place it doesn't matter because it can't be on a nerve since I would have constant, severe pain from my bum to my foot- which I do not. He agrees that the degeneration of L3 has advanced markedly and rather alarmingly and says that level will require surgery at some point totally irregardless of the other fusion site. He asked me to undergo 2 epidural injections thinking that there may be considerable inflammation and if we could get that under control the fusion bone just might have a chance to grow. A light in the dark?
But he thinks giving it 2 months is as much as time will do for me and if the shots don't help he has nothing more to offer before going back in to see exactly what the problem is. In that case, he described 3 possible surgeries dependent upon whether I am fused at L4-5. Here is what he would NOT do: he will NOT use BMP (doesn't use it ever and marshaled some pretty stiff arguments against it), he will NOT fuse L3 to a fused L4-5, he would instead fuse L2-3 if needed and so avoid putting too much stress on L2 (this would mean 2 seperate single level fusions), and he will NOT take an anterior approach (he admits it is a great place to fuse from but feels all the risks outweigh the benefits). And here is what he will or might do: he would use hip harvest if needed but would also be using the lami bone from L3 (since he will decompress L3 no matter what else he does). He remains perplexed about my L3-4 disc and my L-5-S1 disc and hopes the epidurals will help inform him about those. But at this time he would not be planning to remove any discs. He will refuse L-4-5 if needed and will either remove the hardware or replace it with new. He will implant a bone growth stimulator. And he says he still thinks that I may be extra sensitive to weather and may begin to feel much better as spring progresses. He handed me over to schedule the epi's and BY GOSH - they called me at work this morning to up my date from April 13th (1st available) to April 4th and then called 20 minutes later to have me come in by noon.
So, I again left work in a dramatic fashion and was on the OR table by 1:15. Despite all, I felt it! It was bearable but I have been gradually experiencing a mounting pervasive ache and a funny soreness. Nothing out of the range of normal, I think, but certainly no miracle cure is evident.
And that's my story. Not the definite diagnosis I was hoping for. I would have thought the plan for the epi's would fill me with hope but there is something unsettling about all of this. I probably just need a few nights of good sleep. I am awaiting a call from the 2nd opinion - won't get that till next week. I know you know, Lorie, the toll this waiting game can take. I'll be fine tomorrow but my spirits are a little low tonight. But I have been thinking of you and wondering what your new surgery date is? Hope you are holding up. Thanks again for asking for me - Suzy-Q
Oh wow...what an ordeal. I am sorry you have had so much going on. I sure know the ups and downs of getting your hopes up and then having everything changed I hope you can just forget about everything and get some sleep. Sometimes I know I overthink things and that is no good. You have lots of time ahead of you to think...so for tonight, just sleep if you can.
You'll try the ESI's and see the 2nd opinion Dr. and then you will have the information that you need that will help you make a decision. So, for the next 2 weeks...I'd like to suggest trying not to think about your next appointment. Take the same questions you had for this Dr. and ask them at the next visit.
Some of what your Dr. told you made some sense to me and some things I will probably ask my Dr. about too. It is obvious that this particular Dr. doesn't believe in the BMP, so it will just boil down to what the 2nd opinion is and how strongly you want BMP, if you need a fusion. (If it comes down to having to make that decision down the line, perhaps you could start a thread asking for outcomes from this specific type of fusion. That way you could really see first hand if it seems to work well or not). Just a thought
But beside from that, the ESI thought isn't a bad one for now. (Obviously you don't want to have these any more than the 3 a year and if they aren't working the 1st time...you may not want to continue), but with that said, I know that a huge part of my pain comes from inflammation. The more I sit the more I swell and the longer it takes to get it back to normal. So, if the ESI helps with the inflamation, then there may be something to it and it will show the Dr. if that is the cause of the pain. If it is, you may want to ask for a TEN's unit. It works really well for my swelling.
I am interested in the l2-3 and not the 3-4. They are talking about doing my next fusion from l3-s1. I know that puts more pressure on the l2-3, but I wonder when you weigh that negative aspect with perhaps doing the l2-3 instead if there is more of a benefit...I should look into that.
Well, thanks for getting back and letting us know how things went. You are in my prayers and I will be watching for your updates.
WOW, what an ear full you had from your doc. It really did make alot of sense, his approach. There are many Dr.s out there that still feel your own bone is best. My dr. felt that way but I had to many complications to add the hip harvest to my long list. He has only had one failure with the bmp, mine, figures. But he has had the same tyoe of success with the bone graft also, so it seems they are pretty neck and neck with each other.
I will keep you and Lori in my prayers, I try to keep up with your posts to see how you both are, you have been a great help to me recently, even if I don't reply to yoru posts I do try to read them. Good luck to you also Lorie, I keep watching for your new surgery date. Good luck if I miss it.
I have been not well this past week or two, nerve damage symptoms getting lil worse, so I stopped doing everything, still waiting for improvement. My son will be going to Irag on the 21st, so stress is a big factor too right now.
May God Bless and watch over you both.
"Thru every dark corner is a door to a new light"
Sounds like you went through the mill and then some. Sorry you are having to endure so much.
Must ask though, as your doc does not use BMP, is he general ortho or neuro surgeon? Certainly cannot imagine a true spine specialist being that far off the more advanced techniques, especially since BMP fusion is much stronger than bone alone. Would you share what his specific arguments against it are? After all, the failure rate with BMP is less than 2 percent and even most of that is when allograft or donor bone is used. Also, as BMP uses in about 5-7 months instead of 12-24 months with bone on bone, there is a lot less time for things to go wrong before a fusion takes place. As I've had both types of fusion, and have seen so many spine specialists before choosing mine, I'm really interested in medical arguments against BMP, and I think it might be useful for others on the board as well.
You may recall that my first fusion of 3 levels was bone to bone. It was successful but also broke when I was in a wreck, even though the hit was only something like 30 MPH or less. It took a full 12 months before it fused. Thank goodness when my car was struck from the rear at 70 MPH in Nov, less than a year after my 10 level fusion with BMP the fusion held up, even though I had severe internal bruising around all the hardware. I was fully fused with that one in just under 6 months.
As for having two separate fusions, I had two separate 3 level fusions prior to the 10 level fusion. It worked and I still had some flexibility at that point, but of course that did not keep me from needing the total fusion but I cannot say that having the individual fusions versus a solid 6 levels played any role in the continued degeneration. As I've said before, I have a number of health factors that had an impact, so cannot pin point the "why" for all the deterioration.
What would concern me is that he wants to go in to see exactly what is going on. As a spine specialist and with the extreme details that can be had from the various tests, he should know exactly what is going on and exactly what is causing your pain and why, before getting in there.
Look forward to learning why your doc is against BMP. Hope you will get relief from the injections.
Greeeting To All and many thanks for 'chatting' -
Believe you me, no one is more surprised by my doc never using BMP than me! He is a spine specialist and did a muti-year spine surgery fellowship at Mt. Saini (? spelling). He has more than 1500 spine surgeries under his belt. His argument is that 1) the material causes bone cell growth - artificial bone cell growth that he feels could potentially become uncontrolled cell growth (cancer). He feels the current studies fail to demonstrate that this may not become a problem for people as time progresses. As you have pointed out, QCook, there were intial problems when this material got loose and those problem were severe. In a simialr way, my doc isn't sure that a disease process may not promote or contribute to these cells going off on a growth frenzy. Also, he says he has become jaded since BMP is simply the latest in a long line of artificial products promoted heavily by the producers and marketed to the heavens only to loose favor 6 or 8 years down the line. Then there are all the 'studies'. He said the producers always design studies that show miraculous results despite the reality that the products fail miserably in practice. Finally, he said he would gladly use BMP when efficacy studies conducted by non-industry appear and/or those with BMP pass the test of time. He cited ADR as an example of a product that was supposed to be nothing short of a miracle but a few years ago and still is highly sought but for which increasing numbers of surgeons have already abandoned due to complications and failures that the short -term studies could not reveal.
I think that was all of it. I haven't begun my check of these allegations as yet. Similarly, he went into enormous detail to tell how the ban on Ibuprofen developed., A certain rare condition exists with a real humdinger of a name that results in bone growing in the incision. I kid you NOT! It is a bone growth process but not the same one as happens with bone fusions. Well, it was discoved that this rare complication can be successfully treated or prevented by use of a certain NSAID. Also, studies conducted on the healing of fracturs in Rats showed NSAID could inhibit fusion. From these it has become assumed or it has been inferred that all bone growth can be inhibited with all NSAIDs. But the evidence is just not there, so saith my surgeon. Thus he says a ton of folks have made a leap of faith and just prefer to prohibit NSAID use - either believing what they've heard or deciding to err on the side of caution.
Is he wrong? Could be. I won't defend him. I will only say that, considering my own scientific background, he speaks my language. I'll check his sources, not to worry. But his arguments are compelling.
As far as the mulit-level fusions go, I am assumming he will do a 3 level or so on if he has no choice. But I'll ask to be sure. And I'm not sure how I feel about the fact that he isn't sure exactly what is causing my pain. I've read enough on this board to think that it is indeed possible to be a little surprised at what you might find when you finally go back in. I know I'd rather be told ABSOLUTELY what is wrong. I thought my scan results did just that. So the beat goes on. How do you like them apples? I am in no position to tell anyone what is the truth in these matters. I'm very grateful to have you all to talk with. Thanks, Suzy-Q
It sounds like you have a lot to sort through, huh? It is all very interesting, what you Dr. says. Keep us posted on any new studies you may come across. I hope you can get a good night sleep tonight, as I do for everyone who is up reading this post.