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JScoli91
12-30-2019, 10:31 PM
Hi all, in light of considering a revision/additional fusion to my pre-existing one, a question has come to mind. If not using your own donor bone for fusion medium, are there greater non-fusion/non-union risks with donor bone or with synthetic analogs especially when fusing over a disc replacement? Any thoughts on different aspects of this?

This would be in a younger patient with no personal or family history of DDD, soft tissue conditions, arthritis, or connective tissue conditions. Thanks!

LindaRacine
12-30-2019, 11:03 PM
Hi all, in light of considering a revision/additional fusion to my pre-existing one, a question has come to mind. If not using your own donor bone for fusion medium, are there greater non-fusion/non-union risks with donor bone or with synthetic analogs especially when fusing over a disc replacement? Any thoughts on different aspects of this?

This would be in a younger patient with no personal or family history of DDD, soft tissue conditions, arthritis, or connective tissue conditions. Thanks!

I don't think this is anything about which you need to worry. Typically, there is enough extra bone in revision surgeries (at least for someone as young as yourself who is unlikely to suffer from osteopenia or osteoporosis), that biologic agents such as BMP are not required.

--Linda

titaniumed
12-31-2019, 08:21 PM
Autogtaft (Your bone) is the gold standard fusion material. It has been for over 100 years.

They are also doing a stacked ALIF and fusing from the front and back which is a strong construct. I have never seen an ALIF patient break their rods.

You could ask for your information.....young people dont usually break rods, and if they do its a rare thing. BMP is usually used on elder patients that might have trouble fusing. Infuse kits, they are also VERY expensive....

Its time to party. Think I will have a yogurt. Ha ha

Ed

LindaRacine
12-31-2019, 11:19 PM
I have never seen an ALIF patient break their rods.


It happens.

https://www.researchgate.net/figure/A-AP-and-lateral-radiographs-demonstrating-bilateral-broken-rods-at-the-lumbosacral_fig3_316055146

titaniumed
01-01-2020, 12:39 AM
It happens.

https://www.researchgate.net/figure/A-AP-and-lateral-radiographs-demonstrating-bilateral-broken-rods-at-the-lumbosacral_fig3_316055146

Linda, I had a feeling you were going to produce the goods.... OMG, those are heavy duty constructs on the dual rod group.

Average age was 68 and 63. I dont know if we have any multi-rod members besides Susan.

There is a 40 year difference in age....

Ed

LindaRacine
01-01-2020, 01:47 PM
Linda, I had a feeling you were going to produce the goods.... OMG, those are heavy duty constructs on the dual rod group.

Average age was 68 and 63. I dont know if we have any multi-rod members besides Susan.

There is a 40 year difference in age....

Ed
Satellite or supplemental rod systems are actually pretty common these days, especially in older people and in people who have previously broken rods.

Scared
01-02-2020, 03:48 PM
Autogtaft (Your bone) is the gold standard fusion material. It has been for over 100 years.

They are also doing a stacked ALIF and fusing from the front and back which is a strong construct. I have never seen an ALIF patient break their rods.

You could ask for your information.....young people dont usually break rods, and if they do its a rare thing. BMP is usually used on elder patients that might have trouble fusing. Infuse kits, they are also VERY expensive....

Its time to party. Think I will have a yogurt. Ha ha

Ed
Ed from what I have read they take autograft from your hip bone. But can also take bone from cadaver. Iím interested in this subject because I already have titanium hips. If you have donít have bone available in the hips where else would autograft come from? Rib? Also will be having ALIF & have osteoarthritis. Thanks Nancy

LindaRacine
01-02-2020, 04:58 PM
Ed from what I have read they take autograft from your hip bone. But can also take bone from cadaver. Iím interested in this subject because I already have titanium hips. If you have donít have bone available in the hips where else would autograft come from? Rib? Also will be having ALIF & have osteoarthritis. Thanks Nancy

I've never heard of bone being taken from the actual hip. It's typically taken from the iliac crests, ribs, spinous processes, or from other spine bone removed for access.

Bone taken from cadavers is allograft, not autograft.

titaniumed
01-02-2020, 05:09 PM
I remember watching an old Dr Winter video on VHS 40 years ago, and of course one of the first things was the removal of the spineous process on each level....They do this with a pair of pliers and they come off pretty easy. There is an assistant that holds a plate for collection. For my surgery all my facets were also removed, but that bone was not used.

https://www.spine-health.com/treatment/spinal-fusion/autograft-patients-own-bone

There have been patients that have complained about harvesting bone off the hip.(illiac crest) I remember specifically asking my surgeon about this and this method was not done on me. I had no bone used on my surgeries, it was synthetics and BMP.

I guess I am fused since I have not broken any rods. I guess thats the acid test. I am almost 12 years post.

I am NOT lifting anymore....No way, Jose. I am not taking any chances.

Osteoarthritis or Osteoporosis? or both?

Ed

Tina_R
01-02-2020, 05:54 PM
I remember watching an old Dr Winter video on VHS 40 years ago, and of course one of the first things was the removal of the spineous process on each level....They do this with a pair of pliers and they come off pretty easy. There is an assistant that holds a plate for collection. For my surgery all my facets were also removed, but that bone was not used.

https://www.spine-health.com/treatment/spinal-fusion/autograft-patients-own-bone

There have been patients that have complained about harvesting bone off the hip.(illiac crest) I remember specifically asking my surgeon about this and this method was not done on me. I had no bone used on my surgeries, it was synthetics and BMP.

I guess I am fused since I have not broken any rods. I guess thats the acid test. I am almost 12 years post.

I am NOT lifting anymore....No way, Jose. I am not taking any chances.

Osteoarthritis or Osteoporosis? or both?

Ed

What aren't you lifting? You mean lifting weights in the gym? Is that something you think a fully fused person shouldn't do?

titaniumed
01-02-2020, 07:04 PM
Lifting a weight off the floor while bending over produces a lot of force in the lumbar spine....I think if I wanted to break my rods, this would be the choice method.

Holding an object in front of you comes in 2nd place.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035320/

(1650 Newtons=371 pounds of force) 10.8 Kilogram box= 24 Pounds

Ed

Tina_R
01-02-2020, 08:27 PM
Lifting a weight off the floor while bending over produces a lot of force in the lumbar spine....I think if I wanted to break my rods, this would be the choice method.

Holding an object in front of you comes in 2nd place.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035320/

(1650 Newtons=371 pounds of force) 10.8 Kilogram box= 24 Pounds

Ed

Are all weightlifting exercises off limits? What about bench press? Others I can picture but can't name.
Ironically this is good exercise for osteoporosis.

LindaRacine
01-02-2020, 10:03 PM
I remember watching an old Dr Winter video on VHS 40 years ago, and of course one of the first things was the removal of the spineous process on each level....They do this with a pair of pliers and they come off pretty easy. There is an assistant that holds a plate for collection. For my surgery all my facets were also removed, but that bone was not used.

https://www.spine-health.com/treatment/spinal-fusion/autograft-patients-own-bone

There have been patients that have complained about harvesting bone off the hip.(illiac crest) I remember specifically asking my surgeon about this and this method was not done on me. I had no bone used on my surgeries, it was synthetics and BMP.

I guess I am fused since I have not broken any rods. I guess thats the acid test. I am almost 12 years post.

I am NOT lifting anymore....No way, Jose. I am not taking any chances.

Osteoarthritis or Osteoporosis? or both?

Ed

Hi Ed...

If you ever get the chance, you should ask your surgeon why he didn't use the spinous processes. Maybe they didn't have the device that morselizes the bone.

--Linda

LindaRacine
01-02-2020, 10:07 PM
Are all weightlifting exercises off limits? What about bench press? Others I can picture but can't name.
Ironically this is good exercise for osteoporosis.
I've never been a weightlifter, but I probably wouldn't do any super heavy lifting. I don't recall, however, ever hear a surgeon say that a patient couldn't do it after the typical 3-6 month post-op restriction.

While weight lifting is good for bone building, any weight bearing exercise, including walking, is also very beneficial.

--Linda

titaniumed
01-02-2020, 10:18 PM
Are all weightlifting exercises off limits? What about bench press? Others I can picture but can't name.
Ironically this is good exercise for osteoporosis.

I am concerned with activites that break rods.

It seems that lifting items "off the floor" and bending over, getting into lower cubboards are in the testimonials from the rod breakers....they dont break on their own, there is always that catalyst. "Yes, I was lifting, and then I heard the pop".

I cant comment on "all weightlifting". The study has a few examples with values.

There is or was a poster from England that was actually weight lifting years ago using bar bells and such. He was much younger, and it all worked out ok for him. As long as nothing breaks, thats all fine.

At my age I am not going to gamble on the integrity of my fusions. I dont think its worth it.

Another thing thats interesting is that it seems that younger fusion patients fare up better. They break less rods. Unless Linda or Sharon can find a study, I believe this is the case. I dont know the stats on what age group breaks the most rods. It would be nice if more younger posters posted here. The younger posters that have posted here in the past seem to do quite well (with fusion) and then we dont hear from them anymore. Jay Moe and Bendy Bill are our youngest recent posters.

I didnt know there was a specific exercise for osteoporosis. If there was one for dementia, I would be all over that. (smiley face)

Ed

LindaRacine
01-02-2020, 10:26 PM
I am concerned with activites that break rods.

It seems that lifting items "off the floor" and bending over, getting into lower cubboards are in the testimonials from the rod breakers....they dont break on their own, there is always that catalyst. "Yes, I was lifting, and then I heard the pop".



I don't agree at all. I can't tell you how many time I've heard someone say they were laying still in bed, or sitting quietly in a chair.

I know you heard from the countless surgeons who spoke at support group meetings, that rods can be compared to paperclips. When bent back and forth a bunch of times, they weaken at a specific spot. Eventually, they just finally break. Strong rods that haven't been weakened by continuous stress do not just break.

With that said, I agree that some weightlifting moves might be detrimental.

--Linda

titaniumed
01-02-2020, 10:26 PM
Hi Ed...

If you ever get the chance, you should ask your surgeon why he didn't use the spinous processes. Maybe they didn't have the device that morselizes the bone.

--Linda

We talked about it up front. For some reason he didnt want to use my bone and that he was going to use some newer bone pastes of that era (2008) (Along with BMP Infuse kits)

Once again, I guess I am fused.....

Until I lift that 40# box out of the trunk or off the floor and hear that pop.

Ed

titaniumed
01-02-2020, 10:47 PM
I don't agree at all. I can't tell you how many time I've heard someone say they were laying still in bed, or sitting quietly in a chair.



The rods could be 90% of the way to failure during recovery, then you fuse and all is good, wait a few years, crack your fusion, then it takes a week to complete the rod breaking process, or the final 10% and this happens in bed. Who is really going to know the failure rate?

And of course, I guess it all depends on what you are doing in bed. (scoliosis forum humor)

Ed

LindaRacine
01-02-2020, 11:03 PM
I've also known plenty of patients who had broken rods and didn't know it.

titaniumed
01-03-2020, 10:17 AM
I've also known plenty of patients who had broken rods and didn't know it.

Yes, very interesting that the rod or rods can break not even know it, and it takes soft tissue inflammation to trigger off the pain.

There have been a few rod breakers over the age of 50 here over the last year. These testimonials are from people that made it through their surgeries ok, and many years later these problems arise. You have to wonder why such a delay? I dont believe that one goes 7 years and then lifts the heaviest amount of weight or creates the highest force thus breaking their fusions. What is really happening? Does the fusion material degrade with age?

I think its best to clip the heavy weights off and limit to 10# over age 60. Heavy weights really dont get you anywhere anyway unless you really need it. For example my legs from skiing were huge back in the day, you need strong legs for the G forces in skiing hard. My workouts in PT were done all with light weights under 5#

Lifting a 40# box off the floor is not a great idea at our age. I will either get somebody else, or pull the contents out of the box and do multiple trips. Its just not worth taking the chance.

Ed

LindaRacine
01-03-2020, 01:11 PM
Yes, very interesting that the rod or rods can break not even know it, and it takes soft tissue inflammation to trigger off the pain.

There have been a few rod breakers over the age of 50 here over the last year. These testimonials are from people that made it through their surgeries ok, and many years later these problems arise. You have to wonder why such a delay? I dont believe that one goes 7 years and then lifts the heaviest amount of weight or creates the highest force thus breaking their fusions. What is really happening? Does the fusion material degrade with age?

I think its best to clip the heavy weights off and limit to 10# over age 60. Heavy weights really dont get you anywhere anyway unless you really need it. For example my legs from skiing were huge back in the day, you need strong legs for the G forces in skiing hard. My workouts in PT were done all with light weights under 5#

Lifting a 40# box off the floor is not a great idea at our age. I will either get somebody else, or pull the contents out of the box and do multiple trips. Its just not worth taking the chance.

Ed

Ed....

I honestly think it's the paperclip thing. You never know if/when that paperclip will break. Sometimes it break after 3 or 4 bends and other times it might take a dozen bends. I've heard surgeons speculate that someone's rods might weaken in the early post-op recovery period, and that the patient goes on to have a solid fusion, and have the rods eventually break due to the minute amount of movement that even a solid fusion allows.

--Linda

Tina_R
01-03-2020, 02:33 PM
I am concerned with activites that break rods.


I didnt know there was a specific exercise for osteoporosis. If there was one for dementia, I would be all over that. (smiley face)

Ed
The newsletter of my local hospital featured a woman in her 60's with osteoporosis who greatly improved her condition by dedicatedly pumping iron. She did not have a fused spine, I presume. I have heard elsewhere that this can help, too.

Yeah, young people make me sick with their quick recovery times and resumption of normal activities. I realize there are limitations at my age.

Tina_R
01-03-2020, 02:34 PM
Isn't it dangerous when rods break? Can't it puncture something internally?

Tina_R
01-03-2020, 02:39 PM
I've never been a weightlifter, but I probably wouldn't do any super heavy lifting. I don't recall, however, ever hear a surgeon say that a patient couldn't do it after the typical 3-6 month post-op restriction.

While weight lifting is good for bone building, any weight bearing exercise, including walking, is also very beneficial.

--Linda
I've heard that walking is good for osteoporosis, too. It seems less intuitive than allover strength building since it targets only the lower body. But bone density is fairly even all over the body, isn't it? They determined my bone density from my forearm alone.

LindaRacine
01-03-2020, 05:57 PM
Isn't it dangerous when rods break? Can't it puncture something internally?

Never heard of that happening, but thereís always a possibility. Most times, the rods donít move very much, as theyíre usually anchored on one end. If a rod were to come loose if the construct, removing it would be a relatively easy surgery.

Confusedmom
01-03-2020, 06:50 PM
These testimonials are from people that made it through their surgeries ok, and many years later these problems arise. You have to wonder why such a delay? I dont believe that one goes 7 years and then lifts the heaviest amount of weight or creates the highest force thus breaking their fusions. What is really happening? Does the fusion material degrade with age?

Ed

Hi Ed,

I guess I am one of those people now. Broken rods at nearly 8 years post-op. My doctor believes I have nonunion at one or two levels. Apparently it took 7 years and 9 months of just slight movement against the titanium rods to wear them out. I did hear a slight pop, but I can't even remember what I was doing. Pain started a few weeks later. It turned out I have three breaks - and I only heard one. Looks like I'm headed for revision surgery, which will mean additional rods placed along T3-T4, where the breaks are. If I knew how to upload a photo, I'd post pics of the x-rays. BTW, the pain of broken rods for me is about the same as post-op, except it is actually worse than post-op when I am laying down. I think a nerve is pinched or something.

Anyhow, getting back to the question that started this thread, I would certainly want them to use everything they can use for an initial lumbar fusion: allograft, autograft and BMP. Whatever makes a strong fusion! I'm not sure why they don't put multiple rods in everyone, really. At least at the most vulnerable levels. Interestingly, my break is right above where they put in BMP. I have heard the same from another person who had a late break. My guess is the BMP levels fused first, so all the tension/stress of movement went to the level above.

P.S. I have tried and plan to continue to try very light free-weights to help with overall bone strength and health. 3-5 pounds.

LindaRacine
01-03-2020, 09:37 PM
Hi Ed,

I guess I am one of those people now. Broken rods at nearly 8 years post-op. My doctor believes I have nonunion at one or two levels. Apparently it took 7 years and 9 months of just slight movement against the titanium rods to wear them out. I did hear a slight pop, but I can't even remember what I was doing. Pain started a few weeks later. It turned out I have three breaks - and I only heard one. Looks like I'm headed for revision surgery, which will mean additional rods placed along T3-T4, where the breaks are. If I knew how to upload a photo, I'd post pics of the x-rays. BTW, the pain of broken rods for me is about the same as post-op, except it is actually worse than post-op when I am laying down. I think a nerve is pinched or something.

Anyhow, getting back to the question that started this thread, I would certainly want them to use everything they can use for an initial lumbar fusion: allograft, autograft and BMP. Whatever makes a strong fusion! I'm not sure why they don't put multiple rods in everyone, really. At least at the most vulnerable levels. Interestingly, my break is right above where they put in BMP. I have heard the same from another person who had a late break. My guess is the BMP levels fused first, so all the tension/stress of movement went to the level above.

P.S. I have tried and plan to continue to try very light free-weights to help with overall bone strength and health. 3-5 pounds.
All the additional implants and BMP add significantly to the cost of surgery (probably somewhere in the neighborhood of an additional $100K+). Also, there is a risk of cancer with BMP, so most surgeons only use it when there are significant risk factors for non-fusion.

titaniumed
01-04-2020, 09:10 AM
Evelyn, did Dr L do TLIF's on you? Just wondering? Did you ever get your hospital reports after your surgeries?

You will need an experienced revision surgeon......its going to be up to him. Funny, they train scoliosis surgeons in Indianapolis, do you know about this? Maybe Linda knows. My secondary scoliosis surgeon was trained in Indianapolis. Dr Halki.

ALIF or stacked ALIF involves 2 surgeries, front and back. These procedures can get extremely expensive as Linda mentioned.....

You know if you think your going to need surgery at any point, adjusting your insurance policy is a must. I dont know what you have, but as a general statement, its important to be highly proactive months before our procedures. I had the best insurance I could afford and it WAS NOT CHEAP.

On instructions for attaching photos, its here someplace, try search. If you cant find it, I will start my own thread so this doesnt get lost again.

I have used NSAID's for pain for 18 years now. You could try Celebrex, or Diclofenac. Gabapentin is strong stuff, for nerve pain. Hot water soaks in a deep tub at 106 Degrees works well for pain. Measure it with a pool or hot tub thermometer. Drink a LOT of water if you do this, dont get dehydrated, you will cause more problems.

Hang in there

Ed

Confusedmom
01-10-2020, 08:33 PM
Evelyn, did Dr L do TLIF's on you? Just wondering? Did you ever get your hospital reports after your surgeries?


Ed, Thanks for the tips! You are a champ. Can't believe you are still out here constantly supporting the scoli community. You and Linda. Thank you!!!

I think I had TLIFs. I guess I don't know what technically qualifies as a TLIF. But I can tell you that my surgery was all posterior, and I do have some cages and BMP. A couple discs were removed. Does that answer the question? I did get hospital reports -- I have about 100 pages! I have been told by a couple of acquaintances that broken rods are not uncommon around the 7-year mark, and they don't know why. I'm guessing the titanium just wears out at that point if you didn't fuse.

Regarding insurance: Thank God for that! We have a high deductible, but it pays 100% after we meet it. They are giving me a hard time about Tramadol, however. Not as free with the opioids as they were 8 years ago. Guess that's a good thing! But it is a little inconvenient when they make you get re-authorization from your doctor every seven days.

Regarding pain: A friend on a Facebook page suggested a brace for pain. Has been the best advice! I am almost pain-free during the day now (while wearing a brace). But, I can't lay down or everything goes haywire. Seems like there is some instability back there. Which is not surprising given three breaks. Ahh well, here's to fixing things in February!

LindaRacine
01-10-2020, 10:28 PM
Ed, Thanks for the tips! You are a champ. Can't believe you are still out here constantly supporting the scoli community. You and Linda. Thank you!!!

I think I had TLIFs. I guess I don't know what technically qualifies as a TLIF. But I can tell you that my surgery was all posterior, and I do have some cages and BMP. A couple discs were removed. Does that answer the question? I did get hospital reports -- I have about 100 pages! I have been told by a couple of acquaintances that broken rods are not uncommon around the 7-year mark, and they don't know why. I'm guessing the titanium just wears out at that point if you didn't fuse.

Regarding insurance: Thank God for that! We have a high deductible, but it pays 100% after we meet it. They are giving me a hard time about Tramadol, however. Not as free with the opioids as they were 8 years ago. Guess that's a good thing! But it is a little inconvenient when they make you get re-authorization from your doctor every seven days.

Regarding pain: A friend on a Facebook page suggested a brace for pain. Has been the best advice! I am almost pain-free during the day now (while wearing a brace). But, I can't lay down or everything goes haywire. Seems like there is some instability back there. Which is not surprising given three breaks. Ahh well, here's to fixing things in February!
Yes, it sounds like you have TLIFs. Dr. Lenke used that technique frequently.

titaniumed
01-11-2020, 09:37 AM
They are giving me a hard time about Tramadol, however. Not as free with the opioids as they were 8 years ago. Guess that's a good thing! But it is a little inconvenient when they make you get re-authorization from your doctor every seven days.


Yes, this is part of the Opoid crisis.

Doctor charged with 2nd murder.
https://www.beckersspine.com/spine/item/46606-neurosurgeon-faces-murder-charges-in-california-over-opioid-over-prescription-4-details.html

7 days? Its funny that they know that scoliosis patients need a few weeks of meds....Somebody is making decisions that doesnt know what it takes.

I am guessing that scoliosis patients will have to be assertive on weaning now. Or at least elder scoliosis patients.

Ed