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    Old 07-25-2012, 06:42 AM   #1
    TJdW
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    Vertebrae not repairing/growing back

    My vertebrae are not growing back. Does anyone have any history/experience with this? (Many vertebrae were cracked, broken or shattered but specifically T-8 and T-10-11-12). It has been 2 years since my accident. CT's every three months indicate very little change in vertebral repair. My nutrition is excellent, I do weight bearing and cardio exercise a minimum of 1.5 hours per day, 5Xwk, (exercise acts to assuage the pain) don't smoke or drink, hydrate well, take calcium and Vit D supplements, maintain a supremely positive and grateful attitude, low stress, 6-8hrs sleep, have an active social life/friends/family... I am wondering if the CT's themselves might be inhibiting the bone growth progress.

    I was hit by a driver under the influence in a Dodge Ram truck traveling 65mph while on my bicycle. Subsequent surgeries:

    Posterior transthoracic ORIF Spine, rods and screws from T-6 to L-2, titanium cage replaced T-11, T-10 and T-12 discectomy/T-10-12 fusion, anterior compression fracture T-8, Left ulna broken(plates and screws), Left Orbital blowout fracture, fractured pelvis, fractured acetabulum.

     
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    Old 07-25-2012, 09:01 AM   #2
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    Re: Vertebrae not repairing/growing back

    Welcome to the board. Your accident sounds horrific. I'm sure you've been told thousands of times that you are lucky to be alive...and I'm sure, some days during recovery, you must wonder if it is worth it.

    I haven't had a thoracic spine issue but I know they are very painful and can be difficult to repair. I haven't seen any evidence that indicates that having a CT scan prohibits bone growth. When I had a 3 level lumbar fusion two years ago, my surgeon had me get x-rays every month for the first eight months, and then I got to skip a couple, and went every three months and I grew bone and fused just fine.

    It certainly sounds like you are doing what you can to maximize your progress. I'm wondering if you could use a bone growth stimulator. You can get them that are worn on the outside of the body. I know these are used in lumbar fusions when the doctor thinks there may be a potential problem growing new bone cells. You might ask about it. The thing is...after two years, I don't know what the possibilities are that the cells would still grow. What are your doctors telling you?

     
    Old 07-26-2012, 05:03 AM   #3
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    Re: Vertebrae not repairing/growing back

    Thank you so much for your welcome and your reply. I have never participated in a web platform such as this and I was a little leary. As you noted, yes, Every morning when I put my feet on the floor, the gratitude I feel sometimes brings tears to my eyes, knowing, that I can still walk and move of my own volition, that I am alive at all, and have awareness to know this and more. I did indeed wear a bone stimulator for the first nine months after the accident. And, your are right in line with what the surgeon is telling me regarding bone growth after two years of waiting for bone growth: 'the possibility that the cells will still grow' is minimal.

    She had some suggestions. 1) Bone cement. It is injected into the sites, but there are no guarantees that the cement will stay where it is put; it has the potential to migrate, and does cause "stiffening" in the area injected. 2) A new drug that was released in 2009 called Teriparatide (Forteo). No adverse affects in humans (small study of only 2000) but "in laboratory tests teriparatide caused cancerous bone tumors in rats". If you please, would you let me know if you have heard anything about these alternative therapies. Your time and your experience are appreciated.

     
    Old 07-26-2012, 08:44 AM   #4
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    Re: Vertebrae not repairing/growing back

    I just managed to lose the reply I was working on. I have a new laptop and I occasionally rest my wrist on something that makes things disappear. I'll try to reconstruct what I was saying.

    I notice you are in the Dallas/Fort Worth area. There are many good spine programs in that area. By any chance are you going to someone at the Texas Back institute? I know in the case of an accident, one can get roped into using a particular doctor...and then once initially treated by said doctor, it can be hard to move on to someone else. I'll wait to hear your reply before going further with this thought.

    I personally do not know anyone that has used the products you mention. The bone cement is often used for vertebral fractures in the thoracic region in a process called vertebroplasty and kyphoplasty...and it is my understanding that it is often successful.

    The Teriparatide (Forteo) I had not heard of, but did some cursory reading. It sounds like a great possibility, but not without risk. It is a bit like the use of BMP in fusion surgeries. It works great, allows the average person to fuse faster while avoiding the pain of bone harvesting for the graft, but, it is not without its problems. But with most medications, the consumer has to weigh the positive benefits vs. the potential risks, both known and unknown.

    You didn't say anything about how this lack of bone growth is affecting you. Has the surgeon indicated what options you have? Hardware isn't really designed to hold the spine together indefinitely.....

     
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    Old 07-27-2012, 06:50 AM   #5
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    Re: Vertebrae not repairing/growing back

    Oh dear, how frustrating to lose your response -- for which I thank you again as they are well composed, perceptive, helpful and supporting in more ways than you know.

    You are correct again -- 'one can get roped into using a particular doctor' (the one who happens to be on call at the time of the accident). I do feel fortunate though. I am working with a surgeon at North Texas Neurosurgical and Spine. I believe that she made the best possible decisions at the time about my surgery and follow-up treatments and I believe her to be an artist as well as a master at her craft; My scar is barely noticeable and I have seen a few horrendous scars. She continues to show concern about my pain, and she is focused and attentive during my office visits, and, I do not feel rushed. I also know that every single case is unique, and that makes me an experiment. A second opinion never hurts and I have heard of the Texas Back Institute.... wait a minute... if this is where I think it is located, I used a PT in the adjacent office at the beginning of this year.

    Thank you for your info on the bone cement use and teriparatide -- I need to do more research on both, for certain.

    Yikes. The hardware is (italicized for emphasis supposed to come out? Really? I thought I understood that to be optional/my choice/removed if healing went as expected. Originally, my surgeon said (optimistically)that "in a year or maybe a little longer depending on how the fusion went, we could take the rods out, if I wanted to" . Hmmmm.....

    Ok. since you asked (smile) I'll complain. I don't honestly know whether it is the lack of bone growth, all the hardware, the extent of the original trauma to anterior abdominal muscles opposing the site of impact or what but yes, I am in pain. typically, on a day that I do not exercise, in the morning it is most often a delightful 2-3 (on a scale of 1-10). By 10AM it is easily a 4 and the pain increases throughout the day. By 1pm it is impossible not to think about, and by 4pm I need to be off my feet, preferably on my back. I try not to take anything for pain if I can avoid it, but sometimes I just get tired of being in pain and take something. The pain is erratic and unpredictable in its onset and intensity; I never know when or what will cause it to intensify. But I DO know without a doubt that exercises postpones the pain for a good two hours. I am seeing a pain management doctor for pain meds. (Whew! that felt kind o' good! you are kind to ask)

     
    Old 07-27-2012, 10:20 AM   #6
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    Re: Vertebrae not repairing/growing back

    As i mentioned, at least by reputation, you are in a good area for spine surgeons. Your surgeon sounds good. You just never know when you enter through the emergency room what you'll end up with. I've been on the board long enough to know that some people never think to move beyond the doctor they were first "assigned" to...and sometimes, it is to their detriment.
    But it sounds like you are in good hands.

    Does she work with the bone cement? This is something i have no personal experience with, nor have I ever discussed it with any of the surgeons I have worked with, since I do not have thoracic issues.

    I'm a big believer in doing what you can to get the problem resolved when possible, rather than resorting to pain relief as the #1 plan of treatment.

    My first fusion was "successful" (medically speaking) but after six months, it was beginning to occur to me that my pain was no different than it had been prior to surgery. But because everything looked good on new MRIs and there were no signs of nerve compression, no one knew what to do with me, other than to recommend a spinal cord stimulator (neurostimulator). Due to the type of pain I had, I felt my pain was of a mechanical nature and there was still something that they could at least attempt to fix...and the neurostimulator was always there as a last resort.

    It took me almost two more years to determine what else could be wrong and then to convince my surgeon of it. After I finally did that and he agreed I needed a three level fusion, and I was within 24 hours of the surgery date, my insurance carrier decided the surgery was not "medically necessary." So I waited a bit longer...but finally had the surgery and all my efforts were rewarded.

    Long way of saying that in your case, I think there are still things to try before deciding that you're not going to get that thoracic injury to heal. If it is possible for you to consult with a couple other experts in reconstructive spinal surgery, I think it would be a very good thing for you to do.

    I didn't mean to suggest that hardware needed to come out. No, it is left in unless there is a very good reason to remove it. (like allergy to the materials, a breakage of a screw, etc.) If everything is properly installed and stays in place, bone grows around it or at least part of it, and the patient doesn't know it is there, in most cases. I think really thin people are at a disadvantage in this regard, because, especially with lower lumbar fusion, they sometimes can feel the hardware...I don't happen to have that problem.

    There is good information on the Forteo on the manufacturer's website. Rules prohibit posting links to products, etc. but it is OK to quote from a government website...so here's a link to the FDA's review sheet on the drug...http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088604.pdf.

    It sounds like it could be a wonder drug in the right situations but does carry some risk with it. This is another reason to have a consultation with a specialist who is really up to date on the latest treatments and who works in a spine clinic that is involved in research, etc.

    It sounds like you are on top of things and are doing what you can to aid your recovery. It doesn't hurt to take whatever medication you can find that helps with your pain. For some injuries there just isn't a whole lot that helps...but it is certainly worth pursuing while at the same time trying to find something that will help those vertebrae....

     
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    Old 07-27-2012, 06:52 PM   #7
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    Re: Vertebrae not repairing/growing back

    I was going to ask you about your surgery. It is wonderful to hear stories about other successful fusions and back surgeries where the patient really does have no pain ... it does give me hope. And of course, I loved reading about your persistence with your own surgeon regarding your three level fusion. Would you consider your own surgeon an "expert in reconstructive spinal surgery"? your encouragements and suggestions to seek another opinion do indeed give me even more hope. Thank you very much for the link. I will have to catch up with you on researching those options :-)

    I offer you sincere gratitude for your taking the time to listen, to reply and for your thorough and thoughtful answers.

     
    Old 07-27-2012, 08:55 PM   #8
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    Re: Vertebrae not repairing/growing back

    I met my surgeon 17 years ago when my husband ruptured a disc. Then we didn't need anyone until 2005 when my problems developed. Since that time I've had three surgeries, two lumbar fusions with a smaller surgery in between. But before I had the first surgery, I consulted with eight different spine surgeons. I think altogether I have seen a total of 17 spine surgeons. It sounds pretty crazy when I write it out...but the first go round I couldn't believe the only way to resolve my problem was by fusion. I don't feel I was "that bad." And the third surgery no one could agree what was wrong...so I just kept going to people who did a unique procedure or had different training, etc. But I realized that my guy was as talented and experienced as any of the surgeons with the big reputations and he ran his practice much more in keeping with the way I like to be treated...and I trust him to be completely honest.

    He did have to do a bit of reconstructive surgery on me as the facet joints at L3 were worn down to little nubs...and it was not anything that had shown up on x-rays. He began his career as a trauma surgeon and then a number of years later, went back and did a spine fellowship in Toronto. I think that early training helps him to make quick decisions in the OR when something doesn't go as planned. Some spine surgeons operate very much
    "by the book" and are not comfortable improvising.

    At some point in the future, if you want to look for another spine specialist in your area, I can give you some tips on how to proceed, if you aren't sure how to go about it.

     
    Old 07-28-2012, 03:16 AM   #9
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    Re: Vertebrae not repairing/growing back

    Very interesting story. Sounds like you did lots and lots of research and I would LOVE to hear your hints and tips for seeking out another specialist for my specific needs.

     
    Old 07-28-2012, 08:26 AM   #10
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    Re: Vertebrae not repairing/growing back

    You were either up very early or didn't go to bed at all. I'll do some research for your area and see what I come up with and will post later with some tips.

    If your insurance allows it, and you are up to getting a second opinion, I would suggest it be with an orthopedic spine surgeon who mentions reconstructive surgery as a specialty or special interest.

    Last edited by teteri66; 07-28-2012 at 08:33 AM.

     
    Old 08-03-2012, 05:27 AM   #11
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    Re: Vertebrae not repairing/growing back

    My apologies! for the tardiness of this response. Somehow, I missed this post in my in box. My hours are sort of ... different, 4a-8p. The sooner I start my workout, the less pain i am in. ..."ortho spine surgeon who mentions reconstructive surgery..." Well, if you are willing, you might have to hold my hand through this: When you went for your consultations, did you just wait until they mention their philosophy/experience or something... to sort of feel out where they stood, or did you ask specific questions regarding their experience with this type of reconstructive surgery

     
    Old 08-03-2012, 08:35 AM   #12
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    Re: Vertebrae not repairing/growing back

    I try to respond fairly quickly, but on occasion I miss something too. The nice thing about the internet is that most doctors have something online...most practices will have a summary of the doctor's particular interests, and often it will just say "reconstructive" surgery or something similar. Otherwise, just call the front desk and ask if the doctor performs revision surgeries.

    I don't recall ever asking a surgeon specifically about his experience. I was usually able to find enough through various online resources to figure it out on my own. Then when I went for a consultation, from the way the appointment moved along, I could tell from the surgeon's approach to me whether he was one who thinks out of the box, or one who you can just tell doesn't want to work on someone else's patient.

    From my experience, and I have had a number of doctors confirm my feelings, as a generality, neurosurgeons are more "fussy" about this. They tend to want a fresh canvas for their work...not be trying to resolve another surgeon's attempt to fix you. But maybe this was just my experience. I know ortho spine surgeons are more willing to be a little more experimental -- not that you want to be an experiment, but if no one else will take you on, and I had a guy saying...I'm pretty confidant this will work...and if not, we'll do this...I was willing to take a chance.

    I need to go back and read through your details and I'll look around and see if I can find someone you could call...can you go anywhere in the Dallas/Fort Worth area?

     
    Old 08-05-2012, 10:20 AM   #13
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    Re: Vertebrae not repairing/growing back

    Thank you again for taking time to reply. I had an appointment with my pain managment doctor on Friday. So I now have a revised picture of my situation. First we went over my expectations. Then, looking at my x-rays, He explained a little more about how my surgery might have gone, that with this type of extensive surgery, I was lucky to not have a scar in front or on my side as well as the long one in the back. That most of his patients have 2 or possibly 3 level fusions and that mine was 8,yet, I still have the will and capability to do all the exercise that I do (triathlete). He explained that with this kind of injury, usually, there is chronic pain associated with it, and me being able to move independently, at will, with my choice of activity is pretty amazing. He asked again about my expectations. I sat there, realizing that vertebrae or no vertebrae, I am doing almost as much as I was before my accident, usually with minimal pain meds and reminded myself again of how I am very lucky to even be alive. I will definitely make an appointment with one of the surgeons at the clinic (you previously mentioned) adjacent to where I had my physical therapy in January 2012, to get a second opinion on past treatment and future options. But all in all, the most important thing I can do for my healing is 1)be grateful daily 2)accept what is 3)change my perspective 4)stay educated about this type of injury and treatment and 5)do my back and core exercises every day (smile). Thank you, thank you!

     
    Old 08-05-2012, 02:06 PM   #14
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    Re: Vertebrae not repairing/growing back

    It is so important to keep the back and core strong and to keep the muscles in balance. It sounds like you received sufficient information from your doctor that you are now comfortable doing what you can and remembering that time is your friend when it comes to recovery.

    I am two years out from my last fusion and I am still noticing some changes in the nerves in my feet...when I thought at a year I must be fully recovered.

    I hope you'll stay in touch and let us know how you are progressing.

     
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