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Old 01-06-2011, 02:38 AM   #1
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Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

After 2 back surgeries in the last 2 1/2 years including July 2010 TLIF failed lumbar fusions L4-5, L5 S1, with severe back pain and acute achy legs. After drug eluting coronary stent 3 months ago, I have been cleared for a redo. Orthopedist wants to do 2 phase surgeries, anterior/posterior ALIF and decompression of L3-4. Is this overkill, and I first have to detox from Oxycodone 2 weeks pre surgery.
2 part operation Tues/Thursday, Feb 8 & 10.
All those narcotics caused low testosterone levels, and addiction, and I am scared to death. Is it worth front/back surgery to achieve fusion. Using cadaver and synthetic and my bone this time. Zero fusion last time, is there an easier fusion surgery? I stop Plavix and aspirin 7 days pre surgery.
Bedridden since Aug 2009, even tho I walked, PT, strengthening exercises. Even bone growth stimulator failed to fuse me. How long to recover? Should I insist on only one surgery? I have 5 coronary stents, and am 60 yr old man. I have caregivers and wife to take care of me and provide meds. Is this the best fusion surgery?
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Last edited by Larryheadhunter; 01-06-2011 at 02:40 AM.

 
Old 01-09-2011, 03:15 AM   #2
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Re: Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

The latest news is that my MRI showed failed back syndrome after July 1, 2010 fusion surgery and I will be undergoing either a one stage or 2 stage, L-3-4 decompression, and A/P fusion of L-4-5, and L-5S1. Since I am in Southern CA, I have seen Dr. Watkins, and now will be seeing Dr. Robert Pashman for another opinion, as I hear that this surgery is quite barbaric, and I am scared out of my mind. I have lower back pain, and achy legs, which leave me mostly bedridden. I was told that I needed to be narcotic free for 2 weeks before surgery, so I will be detoxing in patient next Friday for 10 days, then 2 weeks later undergo this double fusion from one of these 2 docs. Anyone have any ideas, or opinions on pre and post surgery. The one thing the first fusion accomplished was it stopped the shooting pains down my legs, instead they just ache. Help! 2 years bedridden is long enough. The first surgery was a lumbar decompression with excision of a large synovial cyst that returned. Then TLIF fusion, and now the possibility of A/P surgery. Anyone have it done in one surgery, or like Dr. Watkins wants, on a Tues and Thurs. 2 stage surgery.
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Old 01-09-2011, 08:27 AM   #3
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Re: Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

First, welcome to the board. I hope you will find a group of caring people who will attempt to support you and answer your questions.

I searched for the two surgeons you mentioned. Is the Watkins the group with the father and son Roberts? That's who I looked up and who I am basing my comments on....in either case, with either group it would certainly appear that they are well-credentialed and very experienced. At least on paper, it would be hard to find too many better-qualified surgeons. Now you have to go with your personal experiences with them -- who you feel most comfortable with --. We all have certain things we look for in a doctor and I cannot say what is important to you. But, figure that out, and then use those criteria to guide you in your decision. It is always a good idea to gather several opinions. (I consider myself the Queen of second opinions....I perhaps overdo it a bit!!) But to the best of your ability, you want to find the right doctor for the job and you want to be sure your are getting the "right" surgery for your issues. Those two things are the magic combo for the best chances of a successful fusion. As you well know, there are no guarantees when it comes to spine surgery.

Now, pertaining to what is commonly called a 360 fusion, I would not consider it barbaric. It is the gold standard to guarantee the best chance for a complete fusion. It is used for revision when someone has not fused from a less invasive procedure, but it is also used in many first-time surgeries. It is, in large part, a preference of the surgeon....Oddly enough, recovery time doesn't seem to take much longer than from the standard open posterior interbody fusion.

Keep in mind that when you are consulting with a surgeon that offers a variety of types of fusion, including all the new, current ones like TLIF and minimally invasive, when this surgeon recommends to you a 360, he feels that this surgery stands the best chance of providing you with a successful fusion.

Sometimes the 360 is performed all at one time. They start out on the front, complete that surgery, then flip the patient over and operate from the back. Probably due to your other health problems, the surgeon is electing to give your body a little break in between so you are not under anesthetic for such a long time.

I can imagine how you are reacting to the possibility of what is in reality, two surgeries. I was offered a 360 for my first one level fusion, and I was stunned. At that point I wasn't even convinced I needed any surgery, so this struck me as over-kill. It did seem primitive with all the new advances in spine surgery that are out there. But, keep in mind, this surgery has years and years of statistics behind it, with a proven track record. The same cannot be said for the TLIF, XLIF, etc. You need the surgery that is most appropriate for your specific health issues, spinal problems, etc. regardless of what may be en vogue at the time.

Many people on the board have had fusions, including the 360 and can share tips and advice with you. Please ask if you have specific questions.

Good luck getting off your pain meds. Your doctor is insuring that your body will be able to respond to pain medication during and after surgery...so I guess it will be rough on the front end, but you should have excellent relief post surgery.

 
Old 01-09-2011, 09:28 AM   #4
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Re: Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

I had the 360 fusion a few years ago and it was one of the easiest recoveries I have had. I am a veteran of 8 lumbar surgeries and have had cages, rods, screws, spacers, etc. so I have a variety of experiences with the different types. My 360 was a one-step surgery....I cant think of anyone who has had this done in two steps. I would urge you to do some research and find out how common it is as I would think it is better to go under anesthesia once. I also don't quite understand why you need to go into the hospital for detox unless you are on some very heavy medication, so perhaps you could detail that for us a bit.

I just urge you to research as much as you are able and to ask lots of questions of your doctor. It might also be a good thing to get yet another opinion, perhaps from an orthopedic spine specialist just so you are clear in your mind as to what this entails and which method might be best for you.

Please do stay in touch and let us know how you are doing and ask whatever other questions you might have.

Carol

 
Old 01-29-2011, 06:58 PM   #5
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Re: Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

I really must take exception to your comments. An orthopedic spine surgeon is NOT an orthopedic generalist and is not involved in "setting bones" unless there is a pars defect or something like that. An orthopedic surgeon completes his training in orthopedics and then applies for a spine fellowship where the curriculum is comparable to what a neurosurgeon learns, minus the study of the brain.

I'm sure there may be some general orthopedic surgeons out there who do a little of everything, including spine surgery, but the trend the last thirty years or so has been to specialize after the orthopedic surgery residency. They choose joint replacement, hand surgery, foot and ankle surgery, sports medicine or a spine fellowship.

Some of the larger spine clinics that offer fellowship training are combining the neurosurgery program and the spine surgery program because there is so much overlap and the doctors from both groups come out with similar skills and training.

Many med students going into neurosurgery plan on becoming brain surgeons, but the fact is, there hasn't been enough work to go around, so many of them end up doing spine surgery. But often, it is not their preference.

If you were to take a poll, I think you'd find just as many people who preferred an ortho spine specialist over a neurosurgeon. Unfortunately both specialties have a certain percentage of less than successful outcomes. I think it is really unfair to make a blanket statement that a neurosurgeon is better qualified than an orthopedic spine surgeon.

 
Old 01-29-2011, 07:19 PM   #6
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Re: Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

Thanks for all the comments. Interestingly, my first decompression surgery was performed by the Dir. Of Orthopedics from Scripps. After that failed I went to a distinguished Yale and Stanford trained Neurosurgeon at Hoag Hospital in Newport Beach, CA and the fusion using plastic discs and TLIF procedure was an abject failure, but he released impinged nerves. On Tue and Thu I'm going to have a redo by a famous Orthopedist, Dr. Robert Watkins, Marina Spine Center. As he explained to me, and I understand, that he is concerned about me being under anesthesia for 10-12 hours straight, as well as the team standing on their feet for that long, isn't in my best interests. He does these front/back surgeries all the time in 2 stages.
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Old 01-30-2011, 02:33 PM   #7
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Re: Anterior/Posterior L4-5, L5 S1 Fusion from failed fusion

Larry,
I wish you luck,sounds like your plate is full before even getting the surgery...but it seems as though you have good Drs. looking after your case. I had the posterior surgery in 2008,S1 to L3. My surgeon was going to do the 360 but changed his mind feeling that he could accomplish stabilization posterely alone. I fused really good except at L3 L4 so revision surgery was in order....this was done this past May and it was a 360. Recovery has not been to bad but I would'int mislead anyone and say it was a breeze either,its a slow process and you just have to be patient and follow Drs orders...the pain gets better,kinda in baby steps
As far ortho vs neuro,the most important aspect of choosing is the Dr you feel the most comfortable with. I had all three of my surguries done by a fellowship trained orthopedic surgeon who splcializes in back surguries, there are other Drs in his practice that specialize in knee joint replacements,foot/ankle surgery,ect. I had a second opinoin with a neurosurgeon who siad he would do the reconstruct but he would be teamed up with his partner who is an orthopedic surgeon who would do the majority of the hardware placement and fusion procedure while he (the neuro) would do the nerve decompression. Any way, I stuck with my original Ortho Dr, its stressful enough getting surgery without changing Docs mid stream. Just my 2 cents...hope everything works out well and keep us all informed and...its good to ask questions!! Lots of great people here.

Rich

 
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