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Old 02-24-2013, 06:13 PM   #1
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Adjacent Segment Disorder

In 02/2012 I had a three level lumbar fusion done on the lower three L-3 - S1. I did fantastic in PT, finally stopping meds at 3 months. At 6 month check up, huge spine pain. Surgeon suggested numerous facet injections as x-rays showed facet arthritis. Now at one year mark, pain is incredible - Discogram shows severe degeneration L-1 & L-2 with grade 4 full thickness concentric annular tear.
It looks like I am headed back to the carving board.
Also medications are not sufficient anymore!

 
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Old 02-24-2013, 06:26 PM   #2
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Re: Adjacent Segment Disorder

Do you have to have the fusion added on to, or can you get by with a discectomy?

Were you active after the three month mark post fusion?

 
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Old 02-25-2013, 04:22 PM   #3
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Re: Adjacent Segment Disorder

[QUOTE=teteri66;5137720]Do you have to have the fusion added on to, or can you get by with a discectomy?

Were you active after the three month mark post fusion?[/QUOTE]

I have no idea whether he will add the fusion to the other hardware, these are questions to ask in March when I see the surgeon again. I was carefully active after the first fusion, with the PT doctor telling me they have never had someone so strong after an initial 3 level fusion.

 
Old 02-25-2013, 08:43 PM   #4
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Re: Adjacent Segment Disorder

Sorry to hear about the failure. I take it the three level fusion was your last resort? I was reminded today at my 7 week post-op check up that I had opted for the minimal procedure (discectomy and cleanup down L4-S1). I still have substancial pain, but i'm still healing. The risk I was explained with a multi level fusion (by more than one doctor), if I do it, it could cause a cascade effect of failure for me from L1 down. I wish the best for you

 
Old 02-25-2013, 11:09 PM   #5
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Re: Adjacent Segment Disorder

It is difficult to say how much surgery is just enough to get the job done. With your procedure there is the risk that the segments will become unstable and the pain will not be relieved...and then you end up having a fusion anyway.

Every case is different...faulty discs are not the only reason people require fusions. Many times with Adjacent segment disorder, the facet joints at the adjoining levels were already showing signs of degeneration before the surgery was performed.

I don't think egp292's fusion has failed. I believe he has fused from L3 to S1. It sounds like the original surgery was a success, but there are now additional problems that are causing pain and will need to be addressed.

 
Old 02-26-2013, 02:50 AM   #6
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Re: Adjacent Segment Disorder

My three level fusion seems to be just fine, though I have been complaining about nagging lower level pain. Yes the facets show up very white, which I am told is a very clear sign that there is arthritis in them. I have undergone three sets of injections but all three didn't do much, and I have declined anymore.

Still the pain persists but the MRI showed nothing out of the ordinary, though was blinded by the installed hardware, The CT scan showed that osteophytes or bone spurs have grown in the L-3 nerve root since surgery, one year ago. These could be taken out with laser surgery but insurance will not pay for laser surgery - only fusion. I will find out what he intends to do on March 7th , when I sit down with him to discuss options. He may take out the spurs, if he is going back in there for the upper level fusion of L-1 & L-2. I'm not in a hurry for another fusion, and have pondered disc replacement or something similar as another fusion will pretty much force me to medically retire.

 
Old 02-26-2013, 08:32 AM   #7
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Re: Adjacent Segment Disorder

Unless criteria for ADR has changed, I don't think you would qualify for an artificial disc...plus it wouldn't resolve the facet issues.

I will be interested to hear what your surgeon suggests.

 
Old 02-26-2013, 05:34 PM   #8
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Re: Adjacent Segment Disorder

Well I will certainly post when I learn his intent. You're correct in saying that I don't qualify for an artificial disc. I was simply hoping for something good to come my way; something that I can agree with. Lumbar fusion hurts - damn it is painful.

 
Old 02-26-2013, 05:59 PM   #9
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Re: Adjacent Segment Disorder

ADR can be extremely painful as well. My last fusion actually wasn't painful. I accuse my surgeon of being a magician. I cannot figure out why it was so much less painful than my one level fusion. I was off all meds on the 4th day --

 
Old 02-27-2013, 02:45 AM   #10
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Re: Adjacent Segment Disorder

My C6-7 fusion was pain free other than a sore throat from where he went in. The next day I cheerfully tossed the oxycodone that I was prescribed. This is in stark contrast to my Lumbar fusion last year. One factor could be that I was in my mid 40's when the neck was fused, and my mid 50's when I went in for the lumbar fusion; a three level lumbar fusion is much larger, and bears the weight of a large man. It took four days before I could stop the oxycodone for the lumbar fusion, declaring not one more of those evil pills will cross my tongue. Because of the crippling pain these days, I have been taking Opana ER & IR, still refusing the evil oxycodone. Florida is addicted to that drug, where addicts come from afar to get their fill.

 
Old 02-27-2013, 08:22 AM   #11
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Re: Adjacent Segment Disorder

Anecdotally, people on boards seem to report more pain with lumbar fusions than with cervical ones. I've only had lumbar fusions so have nothing to compare.

 
Old 02-27-2013, 06:11 PM   #12
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Re: Adjacent Segment Disorder

[QUOTE=egp292;5138953]My C6-7 fusion was pain free other than a sore throat from where he went in. The next day I cheerfully tossed the oxycodone that I was prescribed. This is in stark contrast to my Lumbar fusion last year. One factor could be that I was in my mid 40's when the neck was fused, and my mid 50's when I went in for the lumbar fusion; a three level lumbar fusion is much larger, and bears the weight of a large man. It took four days before I could stop the oxycodone for the lumbar fusion, declaring not one more of those evil pills will cross my tongue. Because of the crippling pain these days, I have been taking Opana ER & IR, still refusing the evil oxycodone. Florida is addicted to that drug, where addicts come from afar to get their fill.[/QUOTE]

I should say I was insensitive when writing this about the prescribing of Oxycondone, as I am sure there are many good people who really need this drug to deal with incredible pain, and I wish to say I am sorry if my post offended anyone. I have not been notified of this, but thinking back about my post on the way to work, I felt I should have kept my comments on this to myself .

Thank you

 
Old 03-10-2013, 04:14 PM   #13
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Re: Adjacent Segment Disorder

Finally, the appointment I was waiting for. My surgeon said my L-1 & L-2 discs are bad and I have a few choices. 1.) Put up with the pain and try to live out life the best I can. 2.) Hope that Blue Cross will pay for Laser surgery that will fix the two discs and as a result no fusion. 3.) He referred me to a surgeon in Tampa, for an XLIF fusion on L-1 & L-2, saying that it would be much less invasive 4.) Direct him to go back in and unzip all that he has done on the 3 level lower fusion, taking out the rods and after removing L-1 & L-2 discs, place two new full length 5 level rods for this new large PLIF fusion. He highly recommended I did not go with this as it would be nasty and so invasive.

I am told that insurance companies still will not pay for laser surgeries as they are betting that the patient will be too fearful of the fusion to go through with it. They said if I put $20K down, they would finance the remaining $12K for laser. Telling them I don't have that much money laying around, so I am going to go with option 3. and find out about the XLIF in Tampa. The pain has been unrelenting I am hoping I can get this fixed this year.

I do appreciate this Healthboard and I hope my information may help others.

egp

 
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