Hi Guys, I've just come from follow-up with my spine surgeon. The recent events were that I've had butt pain since about 3 months after laminectomy and fusion of my lumbar spine b/o a spinal cyst. An MRI and CT done last month showed arthritis at L5, below the fusion (new) and failure to fuse. The radiologist said I could still fuse. There was air around the screws, which he did not like, but said all was not lost; it's just not great.

Last Thursday I got steroid injections into the L5/S1 facets and joint space, which has taken some edge off the pain--I just can't sit comfortably. I can stand, lie down, but sitting hurts.

Today I saw the surgeon. He took one look at the MRI and said he is very unhappy with what he sees. It is the worst possible outcome. The three sets of screws are surrounded by air and that means, basically, they have come out. Nothing is holding them in place. There is zero fusion. No bone formed and healed where it was supposed to. He said when there's no bony fusion, there are two things which can happen. The rods can snap. Or, the screws can pull out. My screws have pulled out. And, there is now arthritis below the fusion, because, probably, there is a lot of shear force on the level.

He says nothing good will happen from here on. This is a "failed back with "pseudarthrosis". He says I do not have to worry about nerve damage---all the nerves from the lower spine have plenty of room, and nothing that will happen will hurt them. I won't get paralyzed or anything. However, over time I will have more and more back pain, as my back collapses on itself, and at some point I will decide to have a re-do. At that point, he would explore from the rear, repeat the fusion, then flip me over and do an anterior approach with hardware in the front of the spine. Since I have no risk factors for failure to fuse, whatever in my body caused me to not heal will probably still be present for the do-over.Therefore it would be prudent to do more hardware at that time, as well as extend the fusion down to S1.

He says to NOT do much exercise or physical therapy, as that will put stress on my back. (This doesn't sound right to me; I'm sure there are safe ways to exercise and stay strong). I only take oxycodone at night, because I work and need to be alert; he suggested that over vacation I allow myself to take it during the day, too, so I can sit and enjoy more. He said continue to get injections into the arthritic joint, or radio-ablation of the nerve supply to the arthritis, for some pain relief.

But, he says, there's no way I'm going to make it through life without a re-do. It's a matter of how long I can last without it and enjoy my life. He says to find a good pain doctor (I think I might have), and work with him as long as possible.

That's it. Sucks. I'm unhappy with this news. To say the least.

But pleeeze. Do not send me fuzzies. I welcome all real words, but I do not like fuzzies.

Although this outcome is not entirely unexpected--the literature and our boards are full of people who have had spinal operations and did not fuse--its still a major pain in the *** (all pun intended) when it happens to you.

I know you know how to get alternative opinions, etc.--the real question I would have is if there really is some possibility that you could still fuse (and anything you could do, body movement or supplement wise, to help that process along), and, if you do fuse, would that help your pain significantly. If not, you're looking at a lot of painkiller consumption, or another operation, neither of which is a great prospect. Moreover, given your air-surrounded screws, there's no guarantee another surgical procedure would work any better. (Wonder if there's some way to figure out why your spine is, so to speak, "rejecting" the screws and not building bone around the area--how's your calcium/mag/Vitamin D intake?)

What would your body work people think about this? Do you think there is they could do/prescribe that would lessen the discomfort so that you would need less medication?

I'm so sorry. As I read your post, the thought came to mind that Methotrexate, which you had been considering, would probably stop new bone from growing. I know that you don't take Methotrexate, but is it possible that you were taking other any other drugs that interfered with cell division and prevented new bone from forming?

My second thought is that you might have been too active postoperatively, so excess movement and torque prevented healing. If that is the case, a second surgery would have a better chance of being successful if you reduce the stress on the spine for a while.

I'm just throwing out brainstorming ideas hoping that something plausible and hopeful comes to you.

Have you asked or has the surgeon considered a bone growth stimulator? I had failure to heal from a stress fracture in the tibia until they prescribed this for me. It worked. I remember when I was being fitted for mine that there were people in the waiting room that had the same thing on their spines. Looked a little like corsets, but if it works who in the devil cares!!

I am so very sorry you are having this problem.

Love,
Billye

Did the surgeon disagree with what your Radiologist told you? No chance at all? What is causing you to not fuse? You may have already posted something on this and I missed it.

Cripes, we are all making a lot of people rich...

Sorry,
Cathie

David--I was taking dexamethasone nasal spray for my fungal sinusitis and the dose was too large. My adrenals had conked out.

Billye: I've emailed my surgeon and asked himi for the stimulator

Cathie--you didn't miss anything.

Basically, the radiologist thinks that fusing will take years---there's a big space for the bone to traverse. He wasn't worried and he's a spine radiologist. He said to get the facet injected and I'd be fine.

The pain guy said get the facet injected and then the pain nerve to the facet deadened.

A rehab doc I know says that I could get some facet injections or ablation, and feel comfortable for a couple of years, and at the end of that, I could be fused.

But the surgeon says he's never seen anybody fuse when there's so little bone at a year. He says there's no chance.

I don't think it even matters who I believe, the only choice is to get pain control and live it out and see what happens.

Well, hope and pray the Radiologist knows what he is talking about. He sure sounds more positive about your condition. Maybe you will surprise everyone.

Are you taking anything to bump your calcium absorption?

The bone growth stimulator sounds interesting. Anything would be worth trying if there is a possibility of avoiding more surgery.

Meanwhile, the Dermatologist said to cut ingrown toenails straight across. Also, if you are getting pedicures, this is a good place to get one infected, since disinfecting the spa bowl is nearly impossible. Our paper here has covered several stories on this over the last year or so.

Cathie

Perhaps a second opinion may be worth a thought.

LizaJane,

I would suggest that you do a lot of careful investigation and research, if you truly are interested in nerve ablation. I previously posted about this, in another thread, regarding your situation.

If you want to hear more, I will either post a link to my previous remarks about ablation, or can answer other questions. Just let me know if and when you want the info.

rfinney

Thanks, rfinney, I'd love the link to your post. I'm not really ready to make a plan for ablation--while the pain guy is recommending it, and my neuro thinks it would be great, it sounds pretty interventional to me. So it's going to take some more convincing before I do any permanent nerve damage ON PURPOSE!
I've enough nerve damage by accident for now, thank you very much doctors.


I don't recall ever reading anything about ablation before, so if you posted, I think I missed it. I'm thinking that I'd do another facet block before anything else. That seemed to help.