I had a TLIF @ L4/5 w/screws, rods etc. done Sept. 25, 2007. The fusion appears to have failed. Doc has no explanation as to why it may have failed but did have a fancy name for it: "Pseudarthrosis".
I do have to mention though that immediately after the surgery the back, leg, hip pain that I was experiencing was totally 100% GONE! Now, there is significant sharp pain when I do any type of bending, twisting, extended walking, extended sitting, getting up from a chair (especially my favorite adirondack chair) or the couch etc. If I mow our 3/4 acre on the riding mower I can barely walk the next day. The past couple of weeks I have actually lost my balance and fell twice.
At 10 months out I went to my Ortho Surgeon for a follow up. Doc took x-rays and declared the fusion was finally starting to show signs of some positive progress. According to him the experience he's had in his practice is that at 10 months, the fusion is supposed to be nearly complete, we shake hands, no more follow ups with him should be required and we both live happily ever after. But, this is not to be in my case. To verify his observations w/x-rays, he sent me for a CT scan and MRI (I didn't realize how claustrophobic I was until I went for my 1st MRI. Valium is a wonderful thing.) I went in earlier this week for his interpretation of the scans. He told me that while the x-rays appeared to show something was finally happening, the CT and MRI clearly showed very little if any progress had taken place.
From here he said I had a couple of options.
First - I could wait... see what happens... and hope for the best. He said at the rate of things so far that it could very well be years before the fusion was complete if at all. (not my favorite)
Second - I should seriously consider a "360-degree", "Global" or "Circumferential Fusion" (all 3 terms meaning the same). He favors the 360 as the best option as in his opinion it has proven to have a better success rate than a TLIF alone. I assume this is because the problem is approached both anterior and posterior. (the extent of my knowledge of the 360 fusion procedure.)
If possible, I would like to hear from others that have had the 360-degree fusion surgery. Including post op level of pain, recovery time, overall success etc. as well as pointing me to other sources of on-line information on this procedure. I'm hungry for information, not looking forward to another surgery but do want to get back to a somewhat normal life with minimal pain.
I had a 360 done on Sept 25, 2006 and subsequent hardware removal (just one piece) exactly a year later, Sept 25, 2007, the same day you had your fusion. It's a harder surgery to recover from, as you have two incisions and two huge areas of irritation to heal. But it does have a better success rate. I also had a bone growth stimulator, which I wore 24/7 except in the shower. I received a mix of cadaver bone and BMP for my fusion. The BMP has proven to help stimulate bone growth, too. I have to add that there were also a lot of people praying for me! And I was showing bone growth after only 6 weeks, which is just about unheard of. My doctor had a giant grin as he popped my x-rays up to show me. He was just as ecstatic as I was, and he certainly deserves a lot of credit. He did a great job! I had a lot of levels done, 8 this time around, which also increases the risk of non-fusion. But there I was at 6 weeks showing bone growth!
If you decide to go this route, you might want to ask your doctor about the bone growth stimulator and whether he would use BMP. Both would probably increase your chances of fusion.
I'm not a good gauge for pain, as my problem is different from yours. I'm still on pain meds and will be forever. But lots of people have this surgery and are able to get completely off pain meds and get their lives back. It's a long recovery, as you already know, but I would make the same decision again if I had to do it all over again. I know it was the right thing for me. I was quickly heading for a wheelchair. The goal never was for me to be pain-free, but rather to stop the progression of my escalating spine problem and get the pain to a manageable level. That was accomplished, and I will be forever grateful to my doctor, who didn't give up on me when other spine specialists did! A wheelchair is not in my foreseeable future anymore!
Only you know how bad your pain is and whether it's time to go for further surgery. You're doing the best thing you can for yourself: educating yourself and asking questions! I wish you the best as you make your decision. If you have other questions, we'll do our best to help you from our own experiences.
Kevin welcome to the board but I am sorry about your problems because I know that must be very discouraging. You have already received some great advice from Emily and I am sure several will comment too but like Emily said you are the only one that knows how you feel and IF you think you can put it off for awhile.
I had my 360 done this past January and March and my doctor warned me that this was going to be a tough surgery and he didn't lie. I did have some problems with an infection when they did the abdominal entry on January 29, 2008 which caused additional pain and a delay in the posterior portion. Finally had it done in March and again had a slight infection but had a terrible time with reactions to nerve medication (Neurontin and Lyrica). Thankfully I had home health nurses and therapist coming by my house to help me the first 3 weeks. I am still on my pain medication and muscle relaxers and will be for awhile if not permanent because I also had permanent nerve damage from my cervical spine surgery. I still cannot stand or walk for very long without my back still hurting and still have sharp stabbing pains at times but I do not regret having the surgery at all because I was very limited before also. I still use a cane and sometimes if I am having a bad day I get out my walker. I had a small amount of fusion at my 3 month checkup so I was happy about that but I do not go back until December. I had had several MRI's done before my surgery and they did not pick up on the 4 bone spurs that I had at the L5/S1 level so I may have permanent damage there but only time will tell.
I wish you the best of luck whatever you decide to do. I know how frustrated I was when I had my first cervical spine fusion on two levels then just a few years later the disc above that went out and actually the one below is showing problems now also. I really took a long time to decide on my lumbar but then I really didn't have a life because of all the pain and limitations that I had. You will know when it is the right time.
I had a two level 360 done in Plano Texas two years ago. They opend the front-removed what was left of the damaged discs-inserted the cages betweeen my vertebrae and sewed me back up, flipped me over and entered thru the back. There they PACKED the cages with BMP mixed with all the bone spurs I had ground up (this kept them from having to go into my pelvic bone for some of my oen bone) -they then secured only the right side with instumentation and sewed me back up.
My fron incision healed fast and beautifully. My back had a problem at the top probably because I was on it so much. It took much longer to heal and I actually have a little "dent" in my back where the scar ends at the top -LOL.
I was walking outside at 2 weeks and in PT at 5 weeks. My Ortho is fellowship trained and wins all kinds of awards in research so when he said "get moving and keep moving" I believe he was right. I am on pain killers and will be FOREVER till they come up with something for scar tissue-I also waited too long for the surgery and my sciatic nerve was compressed too long-
I would do it again in a NEW YORK second. I am better than I was before surgery and I am glad they worked from all angles to make sure noe bone went unturned LOL.
Hey Kevin and welcome
I had my 360 surgery in march of this year. And that is also what we decided that it would be better going in both ways than rather just one. I had a PLIF in 2002 where the fusion did not take causing the screws to break. The first time i just had L-5 S-1 and beings the screw londged into the upper disc L-4 to S-1 was done this time. And it is a big surgery as you know not easy to heal from but a positive attitude is the only thing that helps knowing you always want to be better and let that be your motive to push to get better. I still have pain as well but am off all pain meds and take toradol occasionally. The front incision is what is getting me its still REALLY tender and i hate it that i am still wearing sstretch pants.
This surgery was not all that bad but i say i would not have another surgery and i only say that cause i dont want to go through all the pain and missing out on the things with my kids. And i might think about it i guess if things get really bad i dont know.
Just ask if you have more questions im sure someone will know. Good luck.
Last edited by Administrator; 04-06-2012 at 03:07 AM.
BMP is currently the "gold standard" for our kind of surgery. It grows better, faster and harder than our bone so when they mix it there is less chance of our body rejecting it because our own cells are mixed in. My surgeon said he thought there was very little chance of me not fusing because in his words he"packed that baby full". LOL
I WILL be praying for you. Have you had a discogram yet? If not try and get one. There may be some surprises and you want to know before the cut you open. Sometimes the pain is referred and another disc can be the culprit. Some docs, like mine, won't operate without one.
Last edited by Administrator; 04-06-2012 at 03:07 AM.
I went to Dr. Steven Courtney at Plano Orthopedic Sports Medicine in West Plano. I was given the option of Baylor Plano or Presbytarian for my surgery and chose Baylor Plano. Really inportant-opt for surgery early in the week if you can. Weekend staff in the hospital I was were not good at all. I went forever waiting for pain meds,help rolling over, anything. Come Monday morning it was a whole new world.
I had a successful surgery-it was two years later I developed scar tissue. That was not the doctor's fault-it is how my body healed. I am in pain mgmt and live my life at about 85% of what it used to be.
Last edited by Administrator; 04-06-2012 at 03:08 AM.
My surgery was the very 1st scheduled for Tuesday morning at Texas Orthopedic Hospital in the Houston Medical Center. A doctor owned and operated hospital. Definitely a 1st class orthopedic health care center. I am very pleased with my surgeon (Dr. Jeffrey Kozak) and entire hospital staff. I was there for 3 days after surgery (went home Fri. AM). The nurses and aids put up with a lot of "stuff" from us patients all the while being professional and courteous. I would have lost my temper on a few of them and pushed 'em down the stairs.
Last edited by Administrator; 04-06-2012 at 03:08 AM.
Thanks for your info. I am scheduled with Dr. Hostin (baylor scoliosis) at Baylor plano, I guess where you had it done. He only had one day left and it was Friday. Let's hope for good nurses. I've heard your complaint several times about nurses not being there to provide meds, help rolling over, etc. How many levels were fused and how long were you in the hospital? I'm 39 and in good shape other than my back. Hoping the healing process goes quickly.