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Old 01-09-2012, 09:58 AM   #1
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Drop Foot Risk from fusion

It's become clear to me that drop foot is a much greater risk from lumbar fusion than neurosurgeons let on. It also seems to be common practice among them to tell you that things will get better -- just wait a few months.
Well, I've yet to find a person who recovered from drop foot that occurred as a result of spinal fusion. If drop foot is not somethig you're willing to take a significant chance on having post-fusion, don't have it done. It is a nightmare.

 
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Old 01-09-2012, 11:32 AM   #2
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Re: Drop Foot Risk from fusion

Hey bracer...I'm thrilled to see your post. I was wondering how things were going, as you haven't been on the board in ages. When you last posted, there was some indication that you might have loose hardware and might be going back for revision. Whatever happened with that?

I can assume things are no better with your foot, judging by your post....but are there plans to fix the screw?

Please don't be a stranger. We have missed you on the board.

 
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Old 01-11-2012, 06:42 AM   #3
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Re: Drop Foot Risk from fusion

[QUOTE=bracer;4907364]It's become clear to me that drop foot is a much greater risk from lumbar fusion than neurosurgeons let on. It also seems to be common practice among them to tell you that things will get better -- just wait a few months.
Well, I've yet to find a person who recovered from drop foot that occurred as a result of spinal fusion. If drop foot is not somethig you're willing to take a significant chance on having post-fusion, don't have it done. It is a nightmare.[/QUOTE]

Well said, Bracer. My husband's drop foot is not one bit better 8 1/2 months after surgery. His neurologist thinks there's a possibility that scar tissue is causing pressure on the L5 nerve and wants him to see a neurosurgeon. So, that will be the next step we take.

Nice to see you Bracer.

 
Old 01-11-2012, 09:54 AM   #4
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Re: Drop Foot Risk from fusion

linjack --nice to see you on the board again. I'd been wondering if your husband's drop foot was improving. I'm so sorry to hear it has not. How is he doing otherwise?

Not to be contrarian, but it doesn't make sense to me that this would be caused by scar tissue since it occurred immediately following surgery. Scar tissue doesn't begin to fill in until the third week post surgery and optimal period of formation is week 3 to week 12...perhaps scar tissue is now pressing on the L5 nerve and contributing to the problem, but I doubt that was the cause of the drop foot.

 
Old 01-11-2012, 11:31 AM   #5
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Re: Drop Foot Risk from fusion

Hi tetonteri,

My husband asked the neuro how it could be scar tissue when the drop foot was present immediately after surgery. His answer was the drop foot after surgery could have been from post-surgery swelling and, just like your response to me Teri, the scar tissue could be adding to the problem now.

We are getting the surgical notes from the orthopedic surgeon and having them sent to the neurosurgeon along with his two post surgery MRIs. The neurosurgeon will then review them and let us know if he thinks he can help.

My husband's back fusion has not progressed as well as the orthopedic surgeon had hoped, so he ordered a bone growth stimulator. My husband uses that for 30 minutes per day, and then the ortho wants to evaulate him in 6 more months.

My husband still has some pain and swelling in his foot. The longer he's on it, the worse it gets. But, we walk every night and he's determined not to let this get him down too much.

He said if another surgery will help with the drop foot, he will have it. As for me, I have some serious reservations about him having more surgery. I would hate to think he would end up with more serious complications.

We are open to any suggestions or comments from any and all.

Thanks for replying, Teri

 
Old 01-11-2012, 01:24 PM   #6
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Re: Drop Foot Risk from fusion

I don't recall all the particulars of your husband's case, but I do remember that it struck me as not the typical foot drop that I see on forums like this. My recollection is that there was a lot of swelling first. I should go back and read through your old posts -- you don't need to write it all over again.

Be sure to tell the neurosurgeon exactly when you noticed the drop foot, and any circumstances surrounding it because I think your husband's is a bit unique. Be sure to mention how swollen the foot got, etc. because I think that is fairly unusual to have swelling with foot drop.

I had surgery with a plastic surgeon yesterday to repair a hole in my septum. It was a two hour surgery, as long as my first fusion. When I was in recovery, the nurse asked about my pain...you know the drill: "On a scale of 1 to 10..." I interrupted her and said "Honey, I've had 3 lumbar spine surgeries. This isn't even on the same scale." She thought that was amusing...but she said she needed to write something down, so we settled on .5.

I'm glad you're walking with your husband and keeping him going. Does he need a walker or a cane in order to walk?

Last edited by teteri66; 01-11-2012 at 01:27 PM.

 
Old 01-11-2012, 02:07 PM   #7
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Re: Drop Foot Risk from fusion

I'm in the process of reading through the old posts -- which is something you should do too before your appointment with the new doctor...and take notes, because I bet you've forgotten much of the detail. I'm replying as things pop into my head as I'm rereading old posts, so excuse me if things are somewhat disorganized!

Be sure to mention that early on your ortho brought up the possibility of the BMP being a cause of the swelling your husband was experiencing. Why is this important, you wonder? Within the last six months, more information has been released about the side-effects of BMP. There is a chance that the BMP may be causing your husband's problem...and maybe what's keeping it from getting better. It may be that if it was removed, the nerve might recover. It certainly bears mentioning to the new surgeon....

This is the conclusion from the article published in Spine Journal" " This risk of adverse events associated with rhBMP-2 is 10 to 50 times the original estimates reported in the industry-sponsored peer-reviewed publications."

Last edited by teteri66; 01-11-2012 at 02:19 PM.

 
Old 01-11-2012, 02:21 PM   #8
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Re: Drop Foot Risk from fusion

One more question --does your husband have a cage or what type of spacer was used in his surgery, if any? I remember being surprised at the time that your husband had such a big surgery as "day surgery" and went home the same day.

 
Old 01-12-2012, 09:57 AM   #9
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Re: Drop Foot Risk from fusion

I do not recall EVER hearing the term in my pre-op process.

 
Old 01-12-2012, 10:15 AM   #10
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Re: Drop Foot Risk from fusion

Do you mean you weren't told it is a possible unwanted side-effect of lumbar surgery?

 
Old 01-12-2012, 11:00 AM   #11
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Re: Drop Foot Risk from fusion

My husband has a cage with four screws at the L5 S1. Out-patient surgery at 10 a.m. and we were home by 4 p.m.

I will be sure to mention the BMP to the new doctor. According to the ortho, the BMP is only in your system for a couple of weeks. I will try to find the Spine Journal article.

Our primary dr. diagnosed the swelling and extreme pain in his foot, as RSD and had him in PT right away.

I hope you are doing o.k. after your septum surgery. Take care of yourself.

As always, I appreciate all of your help.

 
Old 01-12-2012, 11:02 AM   #12
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Re: Drop Foot Risk from fusion

[QUOTE=cheryl1213;4909469]I do not recall EVER hearing the term in my pre-op process.[/QUOTE]

Cheryl,

Are you referring to drop foot?

 
Old 01-12-2012, 02:00 PM   #13
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Re: Drop Foot Risk from fusion

I think what you are remembering about the BMP is that it is only supposed to be biologically active for a short while...but they are discovering that many doctors were using it off-label...and some of their patients developed problems with overgrowth. Do bring it up, because it doesn't sound like they know what is causing your husband's foot drop...and they may as well have as much information as possible, right?

RSD would explain the feeling of heat, pain and swelling, but it would not explain the foot drop...unless there was just so much swelling inside that it squished the nerve somehow...but I think that is highly unlikely. I'll be eager to hear what the new doctor thinks.

I am doing very well after my Tuesday surgery. It took as long as my first fusion as it was very delicate surgery, but there must not be any nerve endings in the nose as I have had NO pain. I don't even have a mark on my arm from the IV insertion. I thought for sure I would be black and blue under my eyes, but so far, so good. Other than just wanting terribly much to blow my nose, which I cannot do for two weeks, you'd never know I'd had anything done!

Last edited by teteri66; 01-12-2012 at 02:03 PM.

 
Old 01-12-2012, 09:18 PM   #14
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Re: Drop Foot Risk from fusion

Hi,
I had an ALIF L4-S1 and woke up with drop foot. It is NOT common to have this happen and have it occur for any length of time. My brother is a surgeon and he was horrified by my failed procedure.

PEEK stalif was used instead of titanium without my knowledge. I was one of the orthopedic surgeon's trial patients for PEEK surgery. Pedicle screws were found in my muscle tissue during my revision surgery. The PEEK was either never placed properly or it slipped, impinging 3 nerve roots. I had to undergo a 10 hour revision and fusion. I endured 2 years of rehab. I walk with a limp. My drop foot comes and goes. I now (6 years later) have permanent nerve damage-no reflexes in my leg, chronic pain, numbness, intermittent swelling. But I was able to dx the problem by getting very good second and third opinions. You need to do that as soon as possible.

It is very important to find out what kind of cage your husband's physician used. There is not as much stability with the PEEK (plastic) as with the titanium. Also, if titanium was used, a nerve root could be impinged and may not be viewed on CT scan because it may be hidden behind the metal on the scan. The pedicle screws could also be causing your husband a problem. Like referred to in another entry, a myleogram may help with this. Unfortunately, a MRI would be much less painful but not an option due to the titanium.

Don't be afraid to advocate for your husband. He is a lucky man to have you love him so much.

Best wishes. No matter what happens, it does get better, I promise!

 
Old 01-13-2012, 07:14 AM   #15
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Re: Drop Foot Risk from fusion

[QUOTE=linjack;4909510]Cheryl,

Are you referring to drop foot?[/QUOTE]

Yes. And, Teri, I assume it is in some of the documents but don't recall the doc saying anything about drop foot.

 
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