Shoreline

Hey Dc, been there and done that, It really is to early to deem your fusin a succes or failure by fuzzy Xrays. Yuou had a ransforminall lumbar interbody fusion which is considerd minimally invasive discectomy and fusion with minamal access rod and screw placement. It all sounds great ss far as not having open surgery with a lamnectomy, But what's missing is crosslinking devices to support the axial plane at L5-S1, the other axial plane is L1-T12, where the ribs stop and lumbar vertabrea begin. These two points are major load bearing joints and the more excepted fusion for an axial plane levels involve crosslinking devices, meanng you need more than vertical placement and stabilization but also horiszontal stabilization with horizontal bars or crosslinking systems.

Without the horizontal bars you put the sacrum under added stress from rotation and twisting, crosslinking prevents this movement and allows the fusion to heal without excessive movement.

There are obvious advantages to TLIF where the muscle isn't completely stripped away and isn't an open surgery where a laminectomy has been performed. Using the same holes they use for a micro discectomy, "aproach from the side rather than midline" limts the types of hardware that can be placed through those small holes. The 3 systems used for TLIF are the CD Horizons sextant, the METRx system and the paramatrix plus, and none of them use crosslinking systems designed to prevent twisting and undue stress on the screws and screw holes at the crucial axial planes.

I've had back surgery 3 times, the last 2 were PLIFs , the last used cosslinking at every level and both have faled. The bones in the sacrum are much softer than the vertabrea and don't hld screws as well, the more torque you puton them the more mvement and likelyhod of crating a problem at L5_S1.

A good Xray would show screw toggling at S1 where the screw is inserted if the fusion fails. With non union the hardware is bareing all the weight, screws can toggle back and forth in the holes and the bone pulls away from the screw to the point that a good Xray will actualy show the teeth marks in the screw hole where the threads of the screws used to be. The screws in my sacrum pull in and out if I cross my legs and when I walk. I crunch and grind from non union and squeek from loose togling and broken hardware from the shiftin of the rig they built, It pretty much loks like aladder with 2 broken rungs from L1-S1.

Hardware is desingned to hold things in place while a fusion grows and provides stability. Untll that happens the hardware does the job. Unfortunately there is absolutely no test that wll tell you at 4 months if the fusion has failed or is alive and thriving or if the hardware is simply holding things in place onit's own. Docs use Xrays to determine alignment and lack of movement during flexion and extension Xrays. Unless the hardware fails imm*****ly and the fusion failed, the hardware can provide stabilty that will prvent movement and appear the fusion is doing it's job when it's all hardware doing it.

There is no test to check what's happening with the fusion materaial they placed, no way to tell if it's alive or dead and just waiting for reabsorption. The hardware may hold things in place for several years but it's not designed to do much past the fusion which sis usually deemed a success if nothing shfts durng the Xrays at the 6 month to 1 year point. The hardware becomes redundent and removable if the fusion is solid.

Because it takes 6 months to a year for a solid fusion, It is too early to tell. The only way to realy tell is very close examintion of each piece of hardware and to look for toggling in softer bone material in a high quality Xray. With a fuszzy Xray it's simply impossible to tell. ON a clean X ray, you can see the screw holes and if the bone is pulled away from the screw, or you can see if the screw head has sheared off and just sitting in place, you simply need a right angle, place it across the screw head and follow it to the tip of the screw, IF the head is offset, shearing has accured where the head of the screw breaks off leaving the tip in the bone and that screw is no longer providing stability.

The only way hardware subcomes to stress is when there isn't a fusion providing the stability. The hardware can basicaly do the work even on a failed fusion for several years, right up untill the hardware fails. I've snapped two sets, the last had crosslinks at every level but bth fusion were called a succes based on poor Xrays where alignment seemed correct and visual stability. But The hardware didn't break untill betwen the first and second year after surgery, during that time I was treated like junky because the doc couldn't explain the pain I was in, after all, he had done 1300 fusions and I was the onl one complaining acording to hime, BS . statistically impossible but with a giant ego involved geting a surgeon to accept his method failed or may not have been the best way to fuse L5-S1 is pretty tough. Surgeons learn to do techniques and tend to continue touse the same ones, It's geat he's gone less invasive, but without crosslinking, he's going to have a lower succes rate.

Harware is not designed to take the brunt of your weight and walking, flexion and extenson without a succesful fusion for an indefinite perid of time. Your frtunate he's still manageing the pain, but it may take the hardware actually snapping to prove there is a problm, if there is. But it really is too soon to do anything unless emthing is grossly abnormal or unstable and they simply don't do exploratory back surgery o see fif your fusion is solid bne or cldser to dried fish.

So it's basicaly too soon to tell, the hardware may provide and show stability and everythng may reman in proper alignment deamng the fusion a succes when the only thing holding things in place is your hardware.

But basicaly it too soon to really tell or to get a second opinion, many docs won't see you untill the 6 month mark anyway but it doesn't hurt to line those up. There really is no test at all to determine if the bone grew or died.
If your interested in crosslinking systems I can show yu a couple or at least the one actually proved for failed fusionsat L5-S1.

Hang in there and try to stay positive, your at a point where your rebulding lost muscle and strength so increased pain is very normal. You loose a lot of strenght and endurance very fast in a turtle shell.
Take care, Dave