How do they determine fusion?

[Karen40]

Just curious - how do the doctors know when a spine is fused or not? Is it apparent in the x-ray?

We're going for our 6 months post op check in mid-June. We are anticipating that all restrictions will be lifted based on what we've been told. What concerns me is that some of you still had restrictions after 6 months and I'm wondering why we were told that my daughter can go back to doing everything after 6 months.

[txmarinemom]

Just curious - how do the doctors know when a spine is fused or not? Is it apparent in the x-ray?

We're going for our 6 months post op check in mid-June. We are anticipating that all restrictions will be lifted based on what we've been told. What concerns me is that some of you still had restrictions after 6 months and I'm wondering why we were told that my daughter can go back to doing everything after 6 months.

Karen, it can be seen on an x-ray (although I'm not sure how they tell when it's complete).

Even though the post-op x-rays in the timeline (see my signature) are relatively early (3 weeks and 8 weeks), if you look closely you can see the hardware angles look a little more blurred/fuzzy at 8 weeks. You can also see a little more opaque white along the fused vertebra. That's bone fusion. I'll add my next film to the series on 6/10/08, and hopefully the difference will be more dramatic (more straight AND lots more blurry! ;-).

I wouldn't be too concerned about your daughter's restrictions vs. anyone else's. There are many factors to how long restrictions are in place ... physical condition pre-op, evidence of fusion, whether BMP was used, but most of all, how conservative the surgeon is.

Almost ALL my restrictions (bending, lifting, twisting - even to gradually start lifting weights) were removed at 8 weeks.

At about 10-12 weeks, I was released to the batting cages and driving range. About the only thing I can't yet do is actually *play* golf or softball and he wants me to wait a bit longer to deep sea fish.

It really just varies from patient to patient ... and surgeon to surgeon.

Regards,
Pam

[LindaRacine]

Hi Karen...

On average, kids fuse to a safe level in 6 months. In adults, it takes 12 months. Fusion can be seen on x-ray, but there's no way of knowing if fusion is solid.

Regards,
Linda

[txmarinemom]

Hi Karen...

On average, kids fuse to a safe level in 6 months. In adults, it takes 12 months. Fusion can be seen on x-ray, but there's no way of knowing if fusion is solid.

Regards,
Linda


Linda, according to my surgeon, that is not a concrete timeframe. It's even too flexible (by person - and their pre-op condition, age, etc.) to blanket as "on average".

rhBMP2 also makes a HUGE difference.

[LindaRacine]

I agree. Notice that I stated "on average."

Karen, here's an excerpt from Moe's Textbook of Scoliosis and Other Spinal Deformities, in a section on Pseudarthosis (non-fusion):

Diagnosis can occur early or late. Early recognition is important. Routine supine oblique radiographs taken at the time of the removal of the postoperative immobilization are carefully examined for adequacy of the fusion. The fusion mass is carefully inspected for any defects crossing it, all visible facets being evaluated. A facet joint that is easily visible and not obliterated indicates a possible area of weakness; the defects in the fusion mass usually pass through these unfused facets. In an anterior fusion, the defect is seen as an open intervertebral space. These areas are also very tender to palpation and percussion. There is usually no loss of correction yet, as the instrumentation and the immobilization have supported the spine and maintained correction. If a pseudarthrosis is diagnosed, the treatment depends on the quality of the fusion; if the fusion is still generally immature and nontrabeculated, then continued immobilization is indicated. If, on the other hand, the fusion is well trabeculated with obvious defects present, the pseudarthroses are repaired unless they are absolutely painless, with no loss of correction.

Here is a much more patient-friendly reference:

http://www.spineuniverse.com/displayarticle.php/article2048.html

"Biologically speaking, the process of spinal fusion to completion takes three months to one year. During that time, the progress of the fusion is evaluated on x-rays."

Happy fusing!

--Linda

[txmarinemom]

I agree. Notice that I stated "on average." -

As did I. I also elect to present the positive side of "on average".

Hopefully, my x-rays set for 6/10 will show a year is not necessary for adults, in good physical pre-op shape, with the assistance of newer techniques (i.e., BMP) ... especially when I *should* be released to play softball the same day. ;-)


Regards,
Pam