Shoreline

Hey Shawley, How long has it been since the fusion. The first thing that comes to my mind after breaking two sets of hardware from non union is that if the fusion was solid, How was so much stress still being put on on a pedicle screw to snap it. Second thought is fusion at LL4-L5 is bound to add a lot of extra pressure on the disc beteeen L5-S1. That's what they call an axial plain, the greatest motion and stress in your spine occurs at these planes or junctions. Another major junction is T12-L1 where your go from rib bearing vertabrea to no rib bearing, you have more movement and it';s apoint of greater stress. I assume they have done flexion and extension Xrays and still call your fusion solid. There really is no test they can do to determine if you have a solid fusion or the fusion material is dead and just sitting in lace and only the harware is providing the observed stability in Xrays. It takes several years for all that bone to reabsorb and vanish if it completely failed. Although docs act like you can't break hardware we both know it's BS.


Actually watching you flex and extend under flouroscopy would probably be worth while. You would see movement if the fusion has failed enough and that screw gave up enough fixation to allow movement. If you have movement, likely the fusion failed, or it may take another year to actually see it, or you may have to break another screw for it to really be visable. They don't go in to do exploratory back surgery to check fusions. They didn't nknow mine had failed untill 2 broken screws and a bent rod.

The doc said he had to flake the fusion material out of my spine and what was left was like dry fish. But in some places that material would return a lighter signal than vertabrea but still look fused.

A disco gram would tell you if you had problems with the disc below but I wouldn't wish a disco on anyone. It's not that uncommon for a fusion to create added stress on the disc above and below and when it's adding stress on that major juncture at L5-S1, it's not uncommon to have to lengthen the fusion, but replacing the disc with an ADR may be an option. The thing is if the OSS you see doesn't do ADR's, you won't be offered one or even get to talk about the posibility of one.

Becuase the L5-S1 joint takes such a beating with fusions above , and the bone in the sacrum is softer , and I have had two fail and create the most problems at that level, If I were in the position of needing a fusion extended, if an ADR was an option, I would want an anterior aproach done. They remove the disc completely and place two cylinders with wholes in them to restore disc height and stuff with fusioion material. They are called cages. But they are just cylinders that they plce bone material "marrow and BMP "biomorphic proteins to grow bone. Posterior fusion to the sacrum have inherant problems with the hardware they use and lack of overlapping bone.

If you look at the little model of the spine most spine docs keep. Where do they have a good place to fuse bone to bone at L5-S1 other than the large flat areas after removing the disc from the front. It's like fusing a wing tip to a wing tip, so you have minimal bone overlap to actually fuse with a posterior aproach. The sacrum simply doesn't hold a screw as well. The screws in my sacrum toggle back and forth and pull in and out of some very large holes they wore down bcause the the attempt to refuse me failed.

I have hardware from L1-S1 and it's my second set I have sheared screw heads off, bent rods and broken screws. You also need horizontal stabilization "Horizontal bars" when you fuse to the sacrum or twisting motion pulls screws out, so you would likely end up with cages and some screws and rods called cross linmks. They want to run a bar from my hip to hip and attach it to my scarum to prevent all twisting which pulls the screws out and breaks them.

There is still alot to research, and I would start with the flouroscopy of flexion and extension, because they can obseve the hardware and bone and look for shifting of either and check for spondylotheshis whilke you moving versus static Xrays, L5 being off set from S1, or the same above.

I would hold off on berve blocks unlesss they are going to due medial banch blocks first to see if you would benefit from them. MBB's aren't as invasive as nerve blocks.
Also remember this is just one docs opinion, If he only does posterior aproach fusions, he probably wouldn't recomend an anterior aproach. Every docs different, so get several opninions.
Take care, Dave