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Should I Have a CT Scan to Confirm Fusion if Surgeon Requests It?

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  • #1

    Should I Have a CT Scan to Confirm Fusion if Surgeon Requests It?

    Should I question my surgeon if he wants to check my fusions by CT if there are no problems?

    It will have been 15 months when I see Dr. Rand on March 15. He has scheduled me for a CT scan to check whether or not I am fused. I have had several CT scans and many x-rays in the past few years and need to check the amount of radiation I have already received.

    I have never questioned anything he has requested me to do.

    What has been the experience you have had with your surgeons?

    How else is there to confirm fusion if not by a CT scan?

    Please advise.

    Thanks.
    1996 x-rays (none read recently) 50 degrees thoracic, 40 degrees lumbar
    Never braced, found out I had scoliosis at age 28
    At time of surgery, multi-level disc spondylotic degeneration,
    advanced lumbar degeneration, stenosis
    65 years young and very active but no lengthy walks or standing without pain
    Now, 67. walking and standing as much as I want
    Surgery Dec. 7, 2010
    T10-S1 posterior
    Dr. Rand
    New England Baptist Hospital, Boston,
    http://s1224.photobucket.com/albums/ee369/itr1/
    Tags: None
  • #2
    That is a tough one, especially since you have had other CT's. I think healthy respect for radiation is rare and should be more common. I like to think that with radiation exposure, every image taken should count, or make a difference in treatment. For instance I do not allow my kids to have "routine" dental x-rays without a reason, other than "it is routine." I might politely tell Dr Rand you are very concerned about radiation exposure, since you have had several other CT scans. You could ask if he might explain what he would do differently based on the CT results, since you are not having problems. You could ask if he would be willing to defer the CT until such time as you had a problem, or a more concrete reason for requesting the CT. I think in general most surgeons figure the hardware will eventually tell if there is a problem such as failure to fuse. I know mine did!

    Good luck, and let us know what you decide.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

    Comment

    • #3
      Hi...

      I've never understood why Dr. Rand does this on a regular basis, and I would personally be concerned about the additional radiation. The only thing I can think of is that if he doesn't see a solid fusion, he puts patients on a bone stimulator. If you get the chance to question him about it, I would love to hear the response.

      Regards,
      Linda
      Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
      ---------------------------------------------------------------------------------------------------------------------------------------------------
      Surgery 2/10/93 A/P fusion T4-L3
      Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

      Comment

      • #4
        I agree. Unless it's absolutely necessary, you have a right to question the necessity. Last October I was diagnosed with hypertrophic cardiomyopathy and my Cardiologist wanted me to have a cardiac ct scan. I told him I'd already had 2 cts (not for scoli) in the last 10 years and he agreed that I should be concerned and ordered a MRI instead.
        Surgery March 3, 2009 at almost 58, now 63.
        Dr. Askin, Brisbane, Australia
        T4-Pelvis, Posterior only
        Osteotomies and Laminectomies
        Was 68 degrees, now 22 and pain free

        Comment

        • #5
          Dr Lenke's nurse told me yesterday that he assumes his patients are
          fused at 6-9months. He only orders a ct scan if the patient
          is experiencing problems

          Warmly
          Doreen
          44 years old at time of surgery, Atlanta GA

          Pre-Surgery Thorasic: 70 degrees, Pre-Surgery Lumbar: 68 degrees, lost 4 inches of height in 2011
          Post-Surgery curves ~10 degrees, regained 4 inches of height

          Posterior T3-sacrum & TLIF surgeries on Nov 28, 2011 with Dr. Lenke, St. Louis
          2 rods, 33 screws, 2 cages, 2 connectors, living a new life I never dreamed of!

          http://thebionicachronicles.blogspot.com/

          Comment

          • #6
            Thanks for your input.

            I will leave a message for Dr. Rand about the CT scan. I really want to add up all the radiation exposure I have had. Perhaps that will provide a good reason for him to do without it and only do it if I have a problem. I have had a spinal CT scan in January 2011 when I was having so much pain in the upper abdomen. He wanted to check to see if there was slippage from the cement at the top of the instrumentation. Ofcourse, at that time, there was no fusion.

            Can he see anything on the x-rays to show I am fused?

            I was on a bone stimulator for 9 months and went off it in September 2011.

            I'll keep you posted.

            Regards, Irene
            1996 x-rays (none read recently) 50 degrees thoracic, 40 degrees lumbar
            Never braced, found out I had scoliosis at age 28
            At time of surgery, multi-level disc spondylotic degeneration,
            advanced lumbar degeneration, stenosis
            65 years young and very active but no lengthy walks or standing without pain
            Now, 67. walking and standing as much as I want
            Surgery Dec. 7, 2010
            T10-S1 posterior
            Dr. Rand
            New England Baptist Hospital, Boston,
            http://s1224.photobucket.com/albums/ee369/itr1/

            Comment

            • #7
              You can usually see some bone, but there's no way to know if the fusion is solid. (There's also no way of knowing it for certain from a CT scan either.)
              Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
              ---------------------------------------------------------------------------------------------------------------------------------------------------
              Surgery 2/10/93 A/P fusion T4-L3
              Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

              Comment

              • #8
                I just returned from vacation and called Dr. Rand's office today and asked about the necessity of the CT scan. His liaison said they wouldn't force me to have one but that this is the only way to be sure of the status of the fusion, such as any places that haven't fused. If there is ever a problem, they would have the CT scan to refer to. I asked if I could have an x-ray instead and she said I could do that but it wouldn't be as definitive as the CT scan. He really can't see much on an x-ray. Also, if they don't do the CT scan now and I have a problem, they would have to do it in the future.

                From all that I have read and heard, I think I will go with the latter of having the x-ray now and defer a CT scan. Tomorrow, I'll call the office back with my decision.

                I would like to know for sure about whether or not I am fused but think I would have problems if I wasn't. From your input, it seems there really is no certain way to know about whether the fusion is really solid.
                Irene
                1996 x-rays (none read recently) 50 degrees thoracic, 40 degrees lumbar
                Never braced, found out I had scoliosis at age 28
                At time of surgery, multi-level disc spondylotic degeneration,
                advanced lumbar degeneration, stenosis
                65 years young and very active but no lengthy walks or standing without pain
                Now, 67. walking and standing as much as I want
                Surgery Dec. 7, 2010
                T10-S1 posterior
                Dr. Rand
                New England Baptist Hospital, Boston,
                http://s1224.photobucket.com/albums/ee369/itr1/

                Comment

                • #9
                  Originally posted by backissues View Post
                  I just returned from vacation and called Dr. Rand's office today and asked about the necessity of the CT scan. His liaison said they wouldn't force me to have one but that this is the only way to be sure of the status of the fusion, such as any places that haven't fused. If there is ever a problem, they would have the CT scan to refer to. I asked if I could have an x-ray instead and she said I could do that but it wouldn't be as definitive as the CT scan. He really can't see much on an x-ray. Also, if they don't do the CT scan now and I have a problem, they would have to do it in the future.

                  From all that I have read and heard, I think I will go with the latter of having the x-ray now and defer a CT scan. Tomorrow, I'll call the office back with my decision.

                  I would like to know for sure about whether or not I am fused but think I would have problems if I wasn't. From your input, it seems there really is no certain way to know about whether the fusion is really solid.
                  Irene
                  Hi Irene...

                  Hope you had a great vacation.

                  I just don't get this reasoning. First, I've known of several cases where CT scans were not definitive in terms of finding pseudarthroses. I've heard of post false positives and false negatives. Second, I can't imagine that there's any benefit of having a CT now as opposed to having a CT if/when one becomes symptomatic.

                  I'm actually surprised that insurance companies continue to pay for CTs in non-symptomatic individuals. It's definitely not a standard of care I've ever heard about at other centers.

                  Do they typically suggest you have the CT scan at a specific business? I hate to be a real skeptic, but it hasn't been unheard of that physicians steer patients to facilities in which they have a financial interest.

                  http://www.newyorker.com/reporting/2...a_fact_gawande

                  Regards,
                  Linda
                  Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                  ---------------------------------------------------------------------------------------------------------------------------------------------------
                  Surgery 2/10/93 A/P fusion T4-L3
                  Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                  Comment

                  • #10
                    The CT scan is done at New England Baptist Hospital in their radiology dept. Hopefully, this isn't a business decision to order the scan. I can't imagine that it is. But, you bring up a good point.
                    1996 x-rays (none read recently) 50 degrees thoracic, 40 degrees lumbar
                    Never braced, found out I had scoliosis at age 28
                    At time of surgery, multi-level disc spondylotic degeneration,
                    advanced lumbar degeneration, stenosis
                    65 years young and very active but no lengthy walks or standing without pain
                    Now, 67. walking and standing as much as I want
                    Surgery Dec. 7, 2010
                    T10-S1 posterior
                    Dr. Rand
                    New England Baptist Hospital, Boston,
                    http://s1224.photobucket.com/albums/ee369/itr1/

                    Comment

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