What does 'Pre Testing' for fusion surgery entail?

Brooke79

Dear FRACBACK2

Hi nice to meet you. Thanks so much for your input. I also forgot to ask when i posted, but do you or anyone know if the site of bone grafting hurts? Does bone hurt? or is it just the incision? Is this incision small?

Cheers guys
[img]http://www.healthboards.com/ubb/heart.gif[/img]
Brooke

__________________
October 2003 PLIF for L5S1 Spondy
May 2004 PLIF revision RHBMP2

MarianJ

Hello Shg,

I live in Suffolk County and most of the hospitals here work through the blood services center. My insurance is United Health Care and I really am not happy with them whatsoever. But at the blood service center they did tell me that most insurance companies do not cover this service but I can try and submit the bill. It sounds as if you already have a good insurance company.

I think that you are doing great with your walking. Keep up the good work...

Take Care.

MarianJ

Hello Camelia,

I am sorry to hear of your burning sensation in your feet. That must be awful, as I had experienced it only once but in my buttock area. Sometimes it just take longer for it to work and the doctor's also said that some people need two of them before they get any pain relief. Trying the epidural's first to see if they do give you any relief is standard procedure before considering surgery. The nurse at my neuro surgeon's office told me that in order for them to get authorization for surgery from insurance companies, they must show that other methods have been tried.
Sorry but I can't tell you to cancel the second epidural as only you can make that decision. I would discuss this with your doctor. I really hope that the steroid injection starts to work for you.

I also had fusion on the same disc's that you may need fusion. They have three different ways of performing this surgery. I had (PLIF), posterior lumbar interbody fusion. This method is done through the back. Then you also have (ALIF), anterior lumbar interbody fusion. This technique is done through the stomach. And then of course the (360) which is done through stomach and back.

Your doctor will also decide whether titanium metal screws would be beneficial. These are typically placed through the "pedicle" bone of the spine and thereby allow purchase of the back, middle and front parts of your vertebral bones. These screws are attached to a rod or plate that is contoured to your spine. This type of spinal "instrumentation" provides immediate strength to your spine during the process of bone fusion.

In other situations, a titanium metal "cage" or bone cylinder may be screwed into your disc space. This is called an interbody fusion because it is between the "bodies" of the vertebral bones and is across the diseased disc space. This can be done from the front (anterior) or from the backside (posterior). An approach through the abdomen (anterior) may be done "laparoscopically" with several small incisions or "open" through a single incision. Your surgeon can discuss the advantages and disadvantages of both techniques as well as what has worked best in their own surgical experience. Typically, these bone or metal "cages" or cylinders are packed with bone graft taken from either your pelvis (ileum) or tailbone (spinous processes and laminar bone). Bone graft serves as the source of bone cells to help initiate the fusion process at the surgery site. In some circumstances, cages may be used in conjunction with pedicle screws. Other techniques involve placement of bone marrow or "graft" along the sides of your spine (with or without screws). This is called a "posterolateral" lumbar fusion and is another effective way to fuse a level of the lumbar spine. The source of the bone graft material in your pelvis (ileum) can remain painful for weeks or months following surgery but gets better in the majority of patients.

I hope this info helps you understand the terms just a little bit better.

Take Care.

Some doctor's are also using a newer technique called infuse. I had infuse with my fusion.
INFUSE Bone Graft contains recombinant human bone morphogenetic protein (rhBMP-2), the genetically engineered version of a naturally occurring protein that is capable of initiating bone growth, or bone regeneration, in specific, targeted areas in the spine. Approved for use with the LT-CAGE Lumbar Tapered Fusion Device, INFUSE Bone Graft is indicated to treat certain types of spinal degenerative disc disease, a common cause of low back pain. Using INFUSE Bone Graft with the LT-CAGE Device in spine surgery reduces the pain and complications associated with treating degenerative disc disease by eliminating the second surgery required to harvest bone from a patient's hip, as is done in traditional spinal fusion procedures.
I did have infuse with the BMP but I do not have the cages. My infuse is experimental and is not FDA approved.

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[b]Cervical[/b] MRI 10/02
Loss of cervical lordosis with reversal of the curvature.
C4-5 and C6-7 disc bulges resulting in flattening of the ventral margin of the cord.
C5-6 there is a left foraminal herniation which results in moderate foraminal stenosis In addition, there is flattening of the ventral margin of the cord due to bulging disc.
Cervical Epidural 5/19/03

[b]Lumbar[/b] MRI 10/02
Lumbar Lordosis
L5-S1 disc herniation with moderate thecal sac deformity.
L4-5 disc desiccation with bulge which results in mild thecal sac deformity and mild bilateral foraminal stenosis.
L2-3 disc desiccation with Schmorl’s nodule of L3.
Lumbar Epidural 1/30/03
Lumbar Epidural 2/12/03
Lumbar Epidural 2/26/03
Lumbar Discogram 5/23/03
Lumbar CatScan 5/23/03
[b]Posterior Fusion & Infuse on L4,L5,S1 6/30/03[/b]
Lumbar X-Ray 7/24/03
Lumbar X-Ray 8/27/03
Still no pain relief....

MarianJ

Hello Joe,

I just wanted to say hi and wish you well with your pre-op testing. You did post very important information as other's may not be aware that certain health issue's may require further pre-op testing in order to get medical clearance.

When is your thorascopic discectomy surgery scheduled for? I am also wishing you the best success with your surgery.

Take Care.

MarianJ

Hello Brooke,

Good Morning. I did not have the bone graphing with my surgery, I only had bone marrow taking from my hip and that was slightly painful. I did post a reply to Camelia about medical terms and different procedure's of surgery. I have read of some stating that the area hurt and some that said it was minimal pain. I believe Sean had bone taking from his hip, and he seems to be doing great..

Have a great day.

MarianJ

Hello again Brooke,

I forgot to include your incision question in previous post. That is the one thing that really didn't hurt me to much. My husband kept telling me that I will feel better once the staples are taking out. I only felt pinching when they took them out and my incision area still felt the same. So I then told my husband the pain was not coming from the incision. I am told that my scar is about 6 inches long and I had a two level. I still can't look at it, but that is because I have a mental problem as it grosses me out to much...lol

Take Care.

shg

Brooke,

I work in financial sales. I use my brain every day and am mentally drained at night…no matter how hard I work my brain my body is still ready to run a marathon. I like the thought though and if you have more, PLEASE KEEP ‘EM COMING!!! So how are you today?

Tomorrow,

What hospital are you going to? Stony Brook? I’m so sorry about the blood situation. I can’t see how it’s not medically necessary. Most surgeons do this, but ask yours if he uses a “cell saver?” If so, ask if you still need 2 units. Don’t question him if he says yes, he knows best but hey, if says no b/c they do use the cell saver, it may help.

SHG

oakleygirl

Hey all-
This looks like a thread (along with Good Fusion Outcomes...) that I can relate to! Although I don't have the date for my fusion, he's hoping to get it scheduled in the next couple weeks. Looks like there may be several of us in around the same time.

Some questions you all touched on earlier - Can someone explain what a BAK cage is? The neuro showed me a plastic ring-like thing with serated edges that he says will be filled with BMP and inserted into the disk spaces. What's this? And, what is INFUSE? Although he explained the procedure well, he didn't use technical terms.

Oh, one more question. The neuro gave me Ambien yesterday, I took one last night and bounced off the walls all night. I haven't slept for 31 hours now. Anyone had that experience? Could it be that I take Celexa, Neurontin and Zanaflex at night, also?

Take Care all

O'Girl




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20 years intermittent back pain - no treatment sought
Nov 2001 - herniated disk - Right leg radiculopathy
Jan 2002 - Chiropractic care
Mar 2002 - MRI, X-Rays, Oral steroids
Apr 2002 - L4/L5 Microdiskectomy
Sept 2002 - PT, Oral steroids
Oct 2002 - MRI, Xrays - Failed Back Syndrome
Apr 2003 - TFESI, EMG, MRI
Diagnosis - DDD - foraminal narrowing, disk bulges, osteophytes, ligamentum flavum hypertrophy, active marrow edema, levoscoliosis, retrolisthesis, scar tissue encompassing L5 nerve root, disk height diminished, abnormal EMG results for left leg
Sept 2003 - Discogram with Xrays, CT Scan.
Oct 2003 - 2 level 360 degree fusion to be scheduled

isillyme

Hi Everyone
I just saw a surgeon today, who will be in the operating room with my ORTHO, and now the realization is actually there. I did my blood donation so now I am set with that. I have my pre testing on Monday, and since My family doc did most of that, I won't be at the hospital all that long My surgery is in 2 weeks, and I am hoping I have everything in place. Like you Brooke I will be home alone 90% of the time, so I am trying to figure out if I will be needing someone at home with me. I spoke to the surgeon and he suggested I talk with the case worker of the hospital so I will most likely take care of that on Monday as well. All of your comments are greatly appreciated and it helps to know that I am not going thru this stuff alone. It helps not being so scared for the surgery. I am having a PRODISC surgery done, and I am starting to look forward on recovering, and having some kind of normal in my life. My family doctor says I will pull thru this surgery with flying colors, that made me feel some relief . I hope you all are having a less painful day today.

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canadate for the prodisc surgery. have herniated disc at L4-5 also have tears in L3-4,and
L5-S1. Had the IDET in January 2000 at
L4-5 level. Have nerve blocks under sedation at C5-6 and C6-7 also have swelling in the nerve that supplies down both arms and hands. May have 3 buldging discs in the cervical region as well. due to have the prodisc surgery for the lumbar in October. Have tried everything for lumbar nothing has worked, including significant weight loss.

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I had the prodisc surgery at level L4-5 on October 9,2003. I have L3-4 and L5S1 starting to go bad... but will look into that in the future. Epideral blocks are helping.

shg

O'girl,

Welcome aboard...glad you came by. You will soon receive the info you need. I'll help in anyway I can.

Isillyme,

You're on your way, congrats to you. Your having "Prodisc" surgery ha? Are you going for a 1 or 2 level? I think for a 2 level it's randomized. Wow, I wasn't eligible for ADR which meant a 2-level fusion which I had 3 weeks ago. Interestingly enough, I was willing to go to Germany and have an ADR procedure over the fusion until I met with a Dr. here in NYC who's in the Prodisc study and he said I wasn't eligible b/c of a Pars Defect. Oh well, I was initially heart broken but thanks to the people here, the great surgeons I met, etc, I went with the fusion and I have ZERO regrets as of now.

Anyway, do me a favor, come to, "good fusion outcomes wanted" and go through the 6 pages there. While you're not having a fusion, I think you'll find benefit in the things that were posted there on preparing for the procedure. Things along the lines of, how to prepare your home, friends, in hospital pain care, etc.

If I may, where is "Clay?" I could look it up but I'd rather jsut hear it from you. Also, where is your operation taking place?

I wish you luck , I'm sure you'll be GREA AND KNOW YOU ARE NOW PART OF OUR FAMILY AND WE'LL BE HERE FOR YOU EACH DAY.

SHG

Brooke79

Hi Everyone

I have to go to uni now but of course by the time i get home it will be the middle of the night in the states so I wanted to say I hope you are all doing well, and have a lovely evening.
I'll post later but you'll all be tucked in bed.

Seam, you're a machine, but i'll keep my mind on it for you.

[img]http://www.healthboards.com/ubb/heart.gif[/img]
Brooke

__________________
October 2003 PLIF for L5S1 Spondy
May 2004 PLIF revision RHBMP2

camelia

tomorrow - another question - if you had fusion at L4 L5 &S1 what pain were you having ? & what pain do you still have
Is it the same pain?
You dont have 'spondy' right?
thats what makes me nervous too - what are chances of going through the whole procedure & not experiencing any pain relief - definitely a question to add to my surgeon's list I guess
C

__________________
Spondylolisthesis at L5S1 = nerve impingement = pain in legs & feet
Laminectomy April 21, 2004

shg

Brooke,

Your a machine as well. Can't wait to hear from you.

C,

I wanted to chime in for a second. I want you to think of some stats. Last year over 125,000 fusions were performed. Of that, only a small percentage of people didn't receive relief. In fact, answer this to yourself, if the procedure really had such a high level of failure, why would doctors still be performing it? Why would the AMA, States, the FDA or even insurance companies (don't forget, they hate paying for anything) still acknowledge this procedure?

Yes, one person not receving relief is too many but if it's 1 in 1000 who doesn't, the odds are pretty good. Those odds apply to many procedures. My doctor made a great point when I was afraid to have my operation b/c of some of the people I met here, he (and other professionals) said, support sites are good however, people who are unhappy tend to spend all their time there complaining, etc and try to bring others down...which may be why some people with good outcomes don't come back. Another point is there is a mental test that can show within about 98% accuracy what a patients outcome will be after a major operation. The test is based 100% off of your mental capacity, etc. Negative people who complain, blame others, etc who fail the test are the one's who have bad outcomes. More doctors need to give the test. In fact, some of the doctors I saw required me to take the test before I met with them...good for them, that's why they're considered some of the best in this country.

Be positive and don't worry about things until they happen and even then, put it in perspective and lets work through it on a positive level and if you can't, than you have issues you have to deal with on your own (that's directed to all, not you in particular).

Just my 8 cents.

SHG

camelia

I love that! thank you thank you sean - great to hear those statistics - gives me ammo for some of my friends
You are so right - the mind effects the body both ways - up & down - & the optimists among us just happen to live longer as has been proved time & again
have good evenings everyone
C

__________________
Spondylolisthesis at L5S1 = nerve impingement = pain in legs & feet
Laminectomy April 21, 2004