Natural fusion from calcification/arthritis

[livingtwisted]

If you are speaking to an orthopedic surgeon soon, you may want to ask him about where he thinks the natural fusion is going in your lumbar and if you still can avoid a fusion into the lumbar at this point.

I'm still not sure I understand how the natural fusion would affect the levels that would need to be fused now or in the future. Wasn't this your original point?

While the concept of "one stop shopping" is tempting, all you have to do is venture into the Revision section of this forum to know that isn't true for everyone. Or even worse is the people that don't even make it to a second surgery. You may have had a good surgeon, but like you said, you also got lucky.

[Pooka1]

I'm still not sure I understand how the natural fusion would affect the levels that would need to be fused now or in the future. Wasn't this your original point?

I am going to preface my remarks with the proviso that I have no expertise here and am only piecing together a response from things I learned from my daughters' cases and what I have read.

I am suggesting that you ask your surgeon about what your functionality is in your lumbar NOW compared to what it will be if the calcification/natural fusion is allowed to continue unabated compared to what it would be if he fused your thoracic curve either with or without breaking up the fusion in the lumbar.

Is your lumbar mobile? Do you want to preserve that mobility? Will fusing the thorax aid in preserving that mobility? Questions only a surgeon can answer.

There are questions about ancillary damage to other parts of the spine that occur simply in response to having an unfused structural curve over the years. It sounds like this calcification/natural fusion might be a type of ancillary damage associated with having the large T curve over the years. If you corrected the T curve maybe you would not suffer further damage to your lumbar. Avoiding damage to the lumbar has been achieved with the T fusions in my daughters because the lumbar curves are now either nonexistent or very small.

These are questions that may or may not be useful. They are simply questions that I would ask my surgeon knowing what little I know if I was in your shoes. I'm very analytical and maybe these questions are overthought out or something. I don't know. The surgeon may say it is all for naught or irrelevant or whatever. I wish Linda would throw me a lifeline here as she knows more that I do about these issues.

While the concept of "one stop shopping" is tempting, all you have to do is venture into the Revision section of this forum to know that isn't true for everyone. Or even worse is the people that don't even make it to a second surgery. You may have had a good surgeon, but like you said, you also got lucky.

Please ask your surgeon about the track record of most thoracic fusions in the LONG TERM. I would be surprised if his answer was different than that our surgeon gave. Now you have ancillary issues in the lumbar that maybe not so many other patients have. So I am not sure you would be considered a typical thoracic fusion so you would have to ask specifically how that would affect your risk of one-stop shopping for surgery. Linda may know about the prevalence of calcifications in lumbars under T curves and how that plays out.

I am suggesting if you look at those adult revisions cases, they are largely NOT thoracic only. I am further suggesting that the adults who get only the thoracic fused generally have a far easier and far quicker recovery compared to all other fusions in adults.

And I suggest the testimonials are consistent with those general claims. That said, individual results for adults though do tend to be more all over the map compared to kids who generally sail through very successful surgeries with very quick recoveries. My one kid returned to school full time at 3 weeks and the returned at 3.5 weeks for example. These are typical recoveries per our surgeon.

You are young and I suggest, again based on testimonials, that your recovery would resemble a kid's more than the typical older adult. But of course I don't know that. Your surgeon would know that though.

[Pooka1]

Last thought...

I think Linda mentioned that if there is calcification/natural fusion in your lumbar then breaking up the fusion wouldn't matter because the disc is likely damaged and it would just re-fuse.

I am suggesting IF you have damaged discs driving the calcification that they may be able to recover if you have the T curve straightened. I have NO IDEA if that is possible. I am just saying most people would try to do everything to preserve the lumbar motion.

Have you noticed any loss of lumbar motion from the calcification? I can't say I have noticed anything different with on two-level fusion other than the recent pain which is likely countdown related.

[jrnyc]

"most people would do everything they could to preserve the lumbar motion..."

i have not opted for surgery...yet...as i need fusion T4-pelvis, though we did agree to T11-pelvis, as a compromise...

you stated the main reason i havent had the surgery yet, Sharon, and so very succinctly!

jess

[Pooka1]

you stated the main reason i havent had the surgery yet, Sharon, and so very succinctly!

Well actually Jess I was going to nominate for post of the month your comment in the other thread about everyone doing the best they can. That is so true and so important for everyone to remember about themselves and others.

[jrnyc]

i'd send you a smiley face for that nomination, Sharon, but the new ones just don't convey the feelings...and you cant tell what the pix are anymore!

jess

[Elisa]

What "smiley faces"? Seriously, there are none here. I've tried but nothing. Have they been permanently dismantled? Just wondering.

[jrnyc]

those boxes on the side of the posts..."emoticons"...they used to be smileys or frowns or puzzled faces on the "old" forum...

my husband says they are not loading onto the page properly...instead of little squares, there should be the actual images, which apparently aren't displaying correctly...

when i try to open the links to the images it says "the link appears to be broken"

jess

[Elisa]

Yes, I see the little rudimentary icons on the right but they're inactive. Even if I do the manual keyboard format it doesn't work. I guess we're not allowed to emphasize smiling or be mad around here, lol!

[livingtwisted]

Is your lumbar mobile? Do you want to preserve that mobility? Will fusing the thorax aid in preserving that mobility? Questions only a surgeon can answer.

I really don't have anything to compare to to know if the mobility in my lumbar region is normal or not. I imagine if it has changed it's crept up on me slowly enough that I didn't notice a difference. I have some pain in my low back if I sit or stand for too long. But that started about the same time I started working in an office full time so I attributed it to a sedentary lifestyle. I haven't been monitoring things as closely as I should have been over the years so I really don't know when it fused to try to correlate that to any other changes.

Yes, I would like to preserve as much mobility everywhere as I can. I suppose those that are fused would be able to tell me whether the trade-off is worth it...

large section of thoracic surgically fused, but mobile lumbar
vs.
unfused thoracic, but 1 or 2 lumbar vertebra naturally fused?

I am also going to email my ortho and see what he says. In the past he has said that at my age there is no reason to have surgery for preventative measures (which is what this would be), but I will ask the specific question.

[livingtwisted]

Just another thought... I have read that the inversion table, which I have been using for pain relief, is also really good for keeping the discs healthy. I wonder which has more likelihood of preventing further natural fusion -- the inversion table or fusion of the thoracic. Any ideas?

[livingtwisted]

Response from my ortho

Like I said, I emailed my ortho yesterday with some questions. He left me a pretty long voicemail today, which I will try to summarize without changing the language...

Q. If I wait for surgery, will I be risking the need to fuse a larger area, potentially causing loss of mobility in the lumbar region?
A. Maybe, but if you fuse now it can degenerate an area around it, which would need to be fused at a 2nd surgery.

Q. Is it possible that the natural fusion in my lumbar area will continue to progress, even if my curve doesn't change?
A. It's possible, but it won't progress very fast.

Q. Is it possible that if I fused the thoracic now, the lumbar would stop fusing on its own?
A. It would probably take the strain off the lumbar, but it's not going to stop the natural occurrence of fusion over time.

He also reiterated that the only reasons for surgery are progression of pain or deformity, or neurological issues, all of which I don't have.

I feel satisfied with these answers. But I'm really glad to have this forum to think through these things with me. Any thoughts?

[Pooka1]

Excellent questions! Great job.

I wonder if other surgeons would have different opinions on some of that.

It's hard to know how things will play out it seems.