PDA

View Full Version : Fusion Possible More than I yr Post Op



GOE
07-31-2012, 11:20 AM
Hello Everyone -

I had my one year post op appointment yesterday and left there very dissapointed and literally in tears.

First of all my curves seem to have changed since the last visit by like 6-8 degrees and also the rotation increased from 5-10 degrees as well. My doctor described this as "settling" that is normal and expected. He said some people lose some correction in the first six months to 1 year but that is not expected to continue except there is a possible non union.

Also based on the leg pain I have had in my right leg since after surgery, he got a CT scan of my lumbar spine at this visit. He said that L1-L2 and L2-3 seemed to have fused but L3-L4 is still open at the facet joint and did not show fusion as yet. I was very distraught at this information and asked if it was possible to expect fusion past the first year and he said it is different for each patient.

In terms of next steps, he said to come back in six months so we cold take new xrays and take all the measurements again to make sure that there is no more shifting in the correction and then for the lumbar to wait until two years to see if the fusion completes before we make any further decisions.

This is where I need your guidance on the forum. Was your doctor able to tell if you were fully fused at your first year appt and is it possible for fusion to continue in the second year. Everything I have read out there seems to suggest that fusion is complete in the first year after surgery. Also given these signs at my one year appt I am not very comfortable about the wait and see approach that my doctor has decided to adopt. Please any into your own experiences will be helpful. I literally did not get any sleep last night just worrying about all this.

Thanks is advance for your responses.

leahdragonfly
07-31-2012, 11:58 AM
Hi there,

Did your surgeon mention anything about wearing a bone growth stimulator to try and heal this area? I think it is out of the ordinary that it is not at least starting to fuse.

I broke my rods at 15 months post-op due to pseudoarthrosis at two levels (faulire to fuse). My X-rays looked fine at one year post-op, and it was even hard to tell from the CT after I broke the rods whether or not there were any pseudoarthroses. However, my surgeon was able to identify two levels with pseudoarthrosis once he was in doing the revision surgery.

I personally would not be happy either with the wait and see approach with the info you describe. Have you considered another opinion? I would be really curious what Linda Racine has to say about your situation.

Doreen1
07-31-2012, 12:00 PM
Sorry to hear about your unexpected outcome; however, one thing I've learned from this group is that everyone heals at much different rates. My surgeon said that fusion begins between the 6-9 month mark so I imagine fusion, according to Lenke's timeline, fusion will continue throughout the 1 year postop mark. When I saw Lenke at 6 months post op he said he didn't see any fusion on the xrays but that was normal.

What levels are you fused? Keep up posted.

Warmly,
Doreen

LindaRacine
07-31-2012, 01:02 PM
Hi...

There is NO way of knowing if a fusion is solid. Various radiology tests can tell if it's obvious, but not if it's not obvious. I know dozens of patients who were told their fusions were solid, but who had curves return after having their implants removed. My point here is that no one should ever be surprised to find out that there is a non-union.

The good news, GOE, is that you have a potential reason for your leg pain. While none of us wants more surgery, it could be good news. Every week, I meet patients who have to have more surgery, and I can tell you they're almost universally happy after their revisions.

Regards,
Linda

By the way, Doreen, I think fusion actually starts immediately. I'm told that bone becomes "tacky" within weeks, and we saw evidence of fusion at my 3 months follow-up visit. I suspect what Dr. Lenke was referring to is that fusion is usually relatively solid in adults at 6-9 months. From what I've read, I think fusion continues in adults for at least a year or two.

Irina
07-31-2012, 01:16 PM
Hi...

My point here is that no one should ever be surprised to find out that there is a non-union.



Hi Linda,

How high is the chance of non-union (in %) and what one can do to reduce this risk? Or these things just happen for no reason?

GOE
07-31-2012, 06:34 PM
Thanks everyone for your responses. Doreen I am fused T3-L4.

Linda to be clear, I asked Dr Boachie point blank and he categorically said the fact that I am not yet fused at the L3-L4 facet joint is not the cause of the leg pain. He said the L3, L4 vertebrae would cause pain in the lower back and not in the legs. He said the only thing he thinks can be causing the pain in the legs at this point is inflammation around nerves which would not show up on a CT so I guess that is a seperate issue.

On the other hand I asked for the radiologists report today and the report says that I show fusion biltaerally from T11-L4 as it was a CT of my lumbar spine only. The report was not yet ready at the time I saw my doctor yesterday as he pulled the images fresh off the press online. I have put in a call to his office and will follow up if I don't hear back. Not sure why I am getting conflicting information esp on something this sensitive and important.

Thanks anyways for all the responses. I do appreciate your sharing your experiences with me. Will keep you posted when I hear back.

GOE
08-07-2012, 01:07 PM
On the other hand I asked for the radiologists report today and the report says that I show fusion biltaerally from T11-L4 as it was a CT of my lumbar spine only. The report was not yet ready at the time I saw my doctor yesterday as he pulled the images fresh off the press online. I have put in a call to his office and will follow up if I don't hear back. Not sure why I am getting conflicting information esp on something this sensitive and important.

Thanks anyways for all the responses. I do appreciate your sharing your experiences with me. Will keep you posted when I hear back.

Ok so just wanted to get back to the group just incase this helps someone else in the future. I spoke with my Dr yesterday and he said the radiologist is probably right and I am fused but he just wanted to remain conservative in his assessment being that I have ongoing symptoms of pain. He said he doesn't want to say I am fully fused and then oops if something breaks or comes loose 6 months to 1yr down the line. He also said that no one is really able to tell 100% whether you are fused or not so I guess it is a faith based walk :) He also said that it is not unusual for adults to continue to fuse past the 1st year and even into the 2nd year. He says the bone continues to change and metamorphose even in the second year. He said the 9 month to 1yr mark for fusion is typically more common with teenagers.

So question for the group, who is actually trained to interprete these CT scans ? I am not really sure what to believe at this point.

I think for me the emotional roller coaster of this recovery has actually been more than the physical challenges. Somewhat exhausted from thinking about this over the past week so I choose to believe the radiologists report for now, keep a close eye on my symptoms, hope for the best and scream as loud as I can so my doctor can I hear it in NYC if anything changes adversley.

Again thanks to those who chimed in.

I appreciate it.