Can anything be done?

[mgs]

I haven't read anyone's mentioning of my particular problem.

I was fused T-3 to L-3 a year ago (the 25th will be my one year anniv!!!)

I don't know quite how to describe my "discomfort" - the best I can do is to say that my back is very "tight" at the upper part of my fusion. It definitely limits my desire to be more active. I constatly feel like I want to roll my shoulders forward and inward to relieve it, but (of course) that doesn't help in the least. The only time that I don't feel this sensation is when I'm lying down. I kept thinking that this would resolve itself w/time, but - so far - no improvement.

I have noticed that the small of my back is. . . gone. Flatback?

Between the upper thoracic tightness and the lack of a small of my back, my posture is off.

I have another post-op appt on 9/2.

Any thoughts??

[Back-out]

I haven't read anyone's mentioning of my particular problem.

I was fused T-3 to L-3 a year ago (the 25th will be my one year anniv!!!)

I don't know quite how to describe my "discomfort" - the best I can do is to say that my back is very "tight" at the upper part of my fusion. It definitely limits my desire to be more active. I constatly feel like I want to roll my shoulders forward and inward to relieve it, but (of course) that doesn't help in the least. The only time that I don't feel this sensation is when I'm lying down. I kept thinking that this would resolve itself w/time, but - so far - no improvement.

I have noticed that the small of my back is. . . gone. Flatback?

Between the upper thoracic tightness and the lack of a small of my back, my posture is off.

I have another post-op appt on 9/2.

Any thoughts??

It would be very presumptuous to attempt a diagnosis from what you've said, but I'll just make a few observations.

As you probably know, most often surgeons take a patient lacking proper lordosis ("small of back" is one indicator) and try to create one to help the patient stand comfortably erect.

I've noticed that when doctors don't "get this" right (most patients seem to notice right off the bat), the patients suffer from typical postural accommodations to compensate: (some combination of) tilting forward, difficulty lifting the head, bending knees and a wide stance. "Fixed sagittal imbalance" - sideways imbalance - is another name for it, AFAIK.

I'm especially sensitive to this since I have congenital flat back - what for most, is "iatrogenic" (= the result of a treatment error, the treatment here being surgery). I hope surgery will succeed in giving me what Nature didn't (In fact, if I have surgery - and I think I'll have to - it will be primarily for this reason rather than to fix the scoliotic Cobb angle. This FWIW is the fruit of LOADS of thinking and confusion!).

All this is a prelude to my offering the only contribution I have to make to your quandary - my own experience. I guess everyone's condition/curves and deformities are different. That said, however, to the extent I have flat back, I don't feel anything like what you're describing about your shoulders. Likewise, you haven't mentioned any of those typical compensations I listed above. Maybe they're there but you didn't highlight them. They're more the usual w/ "flat back".

Not having a "small of back" does mean SOMETHING, tho - but what, I don't know. Possibly it this is fairly new, you haven't had time to develop the compensations.

Maybe if you describe yourself more - your age, your curves (pre and post-op), someone else will have more of an "aha!" identifying a common experience with you. I am sorry you have this worry and certainly hope you find it can be resolved and understood without more surgery! Lest it not be crystal clear, though, OF COURSE, all this must be presented to your surgeon in stark relief!

I have noticed that when patients come in with post surgical posture problems, many surgeons "defend themselves" and their work (it sure sounds like defensiveness, anyhow), by pointing out how great the patient's Xrays look. This is NOT much consolation for a patient in distress.

To get the most out of your upcoming appointment, it might be worth your while to send your new Xrays (maybe your pre-op films too) to "espines" (Dr. Robt. Pashman) for a second opinion. It will cost a few hundred bucks but OTOH you will have something more than your "feelings" to bring to your own surgeon when you return. It will also give you another take on your diagnosis.

If you felt able to mention your surgeon's name, and something abt your distance from him, your prior relationship (have you complained about this to him before?), it would help us get a greater sense of what this upcoming appointmt means to you, too. Best of luck!!

[JenM]

Hi MGS-

I am only 9 weeks post-op. I am doing so much better this week. Just wanted to let you know that I can totally relate to you when you say upper back tightness. Ever since I was released from the hospital back in mid June, I had shoulder spasms (never had them in my back post-op). I am still having them now and the dr has me on valium since the flexeril didn't work. The spasms in my shoulders has led to neck problems (after a few hours of activity, my neck leans totally forward and at night my chin rests on my chest). I never feel the hardware in my lower back or mid back. All my problems seem to arise at the top of the fusion. I was giving myself a year to recover, but after reading your post and others, this looks like it seems to be a problem for a long time, and may never go away. The part of my upper back/shoulder that has the most discomfort is strangely the side where I didn't have my "rib hump." So this is a new pain to me, but I only seem to get it when I do too much activity. My problem is I have a 5 and 3 year old, so every day I am doing way too much activity!

Anyway, I wish you luck at your doctor appointment on 9/2. Please keep us posted and let us know what your doctor says.

Take care,
JenM

[LindaRacine]

I haven't read anyone's mentioning of my particular problem.

I was fused T-3 to L-3 a year ago (the 25th will be my one year anniv!!!)

I don't know quite how to describe my "discomfort" - the best I can do is to say that my back is very "tight" at the upper part of my fusion. It definitely limits my desire to be more active. I constatly feel like I want to roll my shoulders forward and inward to relieve it, but (of course) that doesn't help in the least. The only time that I don't feel this sensation is when I'm lying down. I kept thinking that this would resolve itself w/time, but - so far - no improvement.

I have noticed that the small of my back is. . . gone. Flatback?

Between the upper thoracic tightness and the lack of a small of my back, my posture is off.

I have another post-op appt on 9/2.

Any thoughts??

Hi...

That really sucks. Have you discussed it with Dr. Tribus yet?

--Linda

[mgs]

Not yet. Even before my surgery, he did tell me that I might very well need more surgery in the future, if the significant arthritis in my lumbar spine starts to bother me (I do notice it, but the tightness across my upper back is what really gets my attention). These, along with the ?flatback . .I guess we'll have something to talk about when I see him next month.

I am grateful that I have a surgeon whom I have complete trust in, and - whether some of this "live with it" or can be helped with further surgery - I have never regretted for a nanosecond having had the surgery.

[mgs]

I had my 1 yr follow-up appt. yesterday. I did my best to describe my discomfort. His guess is that either it's a non-union problem, or a hardware problem, though more likely the former. I am having a CT scan on Thurs, then seeing him on 10/4 (he had told the resident to have my appt to follow the CT, but w/his double-booked days, that wasn't to be). I am fused from T-3 to L-3, so the CT will be T-2 to L-4. If the CT isn't difinitive, that doesn't mean there isn't a problem, it just means it didn't show. No matter which of the 3 possible approaches to the possible problem he chooses, they all do involve surgery. As he said, "it's a Pandora's box" - I guess this is where the art of what he does meets the science, and I am grateful to have a surgeon in whom I have faith.