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Thread: questions on fusing to the sacrum or not

  1. #1
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    upstate NY
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    questions on fusing to the sacrum or not

    Having a surgical consult with Dr. Lebl at HSS Jan 16. I wondered if there were any good websites to review ahead of time on the pros and cons of how far down the spine to fuse? I want to understand that better, and also the pelvic fixation- what exactly does that mean?

  2. #2
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    Hi Jean...

    Whether or not to fuse to the sacrum is based on your specific anatomy. If it's an option, your surgeon will be able to give you the pros and cons specific to your situation. In general, fusion to the sacrum = significant loss of flexibility and fusion to a higher level= high risk of needing additional surgery to the sacrum at a later time.

    All of the top surgeons are now adding fixation to the pelvis in the vast majority of patients who need to be fused to the sacrum, to avoid the potential of a sacral fracture. The screws used for this purpose are usually placed between the sacrum, across the sacro-iliac joint, and into the pelvis. Some doctors usually place only one screw into the pelvis, to lessen the risk of needing to remove one or both screws because of prominence, while other surgeons almost always place two screws, one in each side. You can see a fusion to the sacrum, with pelvic fixation, HERE.

    --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

  3. #3
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    Linda, it was my understanding the the screws do not go across the SI joint and that the SI joint is not affected.....or do I have that wrong?

    Re: fusion to the sacrum, my lumbar joints were quite degenerated, as is the case with many of us older folks, so fusion to the sacrum and fixation makes a lot of sense. I know that Irina, who is only 44 was given the choice, based on her anatomy of whether she wanted fixation to the pelvis or not with the possibility of another surgery later for the fixation if it was not done with the surgery.

    Susan
    Last edited by susancook; 12-29-2013 at 04:12 AM.
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  4. #4
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    I am 35 and went to the sacrum. Dr. Lenke and Dr. Kelly both said I could stop at L5, but it was a significant chance I would be back in 2-5 years to do the sacrum. So I just said fix it all. They did have to start at T2 once they got in due to the amount of arthritis and the collapsing of T2-T3. And I do have pelvic fixation, but 6 weeks out and I can put my shoes and socks on and tie them. It's not the most comfortable thing, but I was even able to trim my nails

    Tamena
    Diagnosed at age 12 with a double major curve

    Braced till age 15

    SSBOB T12-L2 Anterior age 34. (October 22,2012) Dr. Robert Gaines Jr. ( Columbia, MO)

    Revision Surgery T2-Sacrum with Pelvic Fixation Prosterior age 35 (November 13,2013) Dr. Michael Kelly (St. Louis, MO)

    Revision Surgery L4/L5 due to BMP Complication age 36 (November 20,2014) Dr. Michael Kelly (St. Louis, Mo)

    Revision Surgery due to broken rod scheduled for October 19, 2016 with Dr. Michael Kelly (St. Louis, MO)

  5. #5
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    Oregon
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    pelvic fixation

    Hi Susan,

    I think you are mistaken about the SI joint being unaffected by pelvic fixation…the screws cross the SI joint and are affixed into the ilium. Linda posted a good x-ray showing pelvic fixation above.


    Tamena,

    I am fused T8-sacrum and still have to struggle to cut my toenails --- I am really curious how you do this and put on your socks easily at 6 weeks (on restrictions??)? Maybe I can learn something from you!
    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

  6. #6
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    May 2008
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    Jean

    Here is one from HSS by Br Boachie....


    http://www.hss.edu/professional-cond...l-stenosis.asp


    The long fusion to L5 patients don't do very well, so I am very very careful in selecting them. I have probably done five L5 fusions in adults. This patient is still doing very well; a couple of others are still hanging in there, but what happens is, it just shifts all the load to the 5-1 so it doesn't take long for 5-1 to degenerate and become unstable. So in most cases we extend the fusion to the L5-S1 level, to avoid refusion and extension.

    If you look at my x-rays in my signature, the longest screws down at the bottom are pelvic anchors.

    Ed
    49 yr old male, now 61, the new 61...
    Pre surgery curves T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  7. #7
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    Jul 2012
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    Quote Originally Posted by leahdragonfly View Post
    Hi Susan, I think you are mistaken about the SI joint being unaffected by pelvic fixation…the screws cross the SI joint and are affixed into the ilium. Linda posted a good x-ray showing pelvic fixation above. Tamena, I am fused T8-sacrum and still have to struggle to cut my toenails --- I am really curious how you do this and put on your socks easily at 6 weeks (on restrictions??)? Maybe I can learn something from you!
    I was using the sock aide but still found myself bringing my foot up to pull the sock up. I found it easy to sit in my lift chair and have it up and tilted to do these things. I have a little harder time with my left foot only due to nerve issues that have not gone away completely, but I hope I'm not breaking any restrictions.

    Tamena
    Diagnosed at age 12 with a double major curve

    Braced till age 15

    SSBOB T12-L2 Anterior age 34. (October 22,2012) Dr. Robert Gaines Jr. ( Columbia, MO)

    Revision Surgery T2-Sacrum with Pelvic Fixation Prosterior age 35 (November 13,2013) Dr. Michael Kelly (St. Louis, MO)

    Revision Surgery L4/L5 due to BMP Complication age 36 (November 20,2014) Dr. Michael Kelly (St. Louis, Mo)

    Revision Surgery due to broken rod scheduled for October 19, 2016 with Dr. Michael Kelly (St. Louis, MO)

  8. #8
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    Sep 2003
    Location
    Northern California
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    I think there are many things that affect flexibility including the number of segments fused, the flexibility of the hips, the elasticity of the leg muscles, etc.

    Susan, the S-I joints aren't typically fused, but the screws cross the joint.

    --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

  9. #9
    Join Date
    Apr 2012
    Location
    San Jose, CA
    Posts
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    I was given a choice of fusing to either L5 or sacrum because my L5 was in a gray area. The doctor told me that if we stop at L5, I'll be back for a revision and extension to sacrum in 5-10 years. I hesitated for a moment thinking about losing flexibility and she asked me: "How would you feel if you'd have to go through another surgery in 5 years?". I said that I would absolutely hate it and Dr. Hu said: "Here is your answer". We went to the sacrum and I am glad we did. I can still do anything I need to do, but a bit differently. I am 45 and not being able to do rumba or cha-cha is not the end of the world for me :-)
    I am stronger than scoliosis, and won't let it rule my life!
    45 years old - diagnosed at age 7
    A/P surgery on March 5/7, 2013 - UCSF

  10. #10
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    Jan 2012
    Location
    Yacolt, WA
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    I found an article and YouTube video that I thought demonstrated the screws going into the pelvis only, not into the SI joint. I will look at it again, maybe I misunderstood. Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  11. #11
    Join Date
    Jun 2006
    Location
    Texas
    Posts
    137

    Fusion to L 4 or sacrum: how do get up off the floor?

    Hello friends, right now the surgeon recommends fusion from T 2 to L 4 because L2-L3 are "bone on bone"/ my concern- my knees are shot, I cannot squat at all - too much pain and stiffness, but I enjoy getting on the floor with my dogs. how do you get up off the floor with a fused spine? I will discuss this with PT and maybe we can actually practice before I am discharged. I am paralyzed by fear of the unknown but .... as Bilbo said in LOTR "I've put this off for far too long" ! I will meet with my surgeon next month. thanks to all for sharing - I love this forum! Jamie in TX
    57 years old.
    thoracic curve 68 degrees
    lumbar-sacral curve +/- 41 degrees
    Cspine C3- C7 fusion Nov. 2011 <done! success!!>, then scoli surgery T2- L4 or maybe to sacrum.
    Discogram/ myelogram pending. Surgery to be scheduled, maybe fall 2015. <scared but I know this is not going to get better>
    THANKS TO EVERYONE FOR SHARING EXPERIENCES AND KNOWLEDGE!

  12. #12
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    Oct 2007
    Location
    Indiana
    Posts
    1,978
    Scooter-- I am fused T2-L4. My surgeon felt I had an 80% chance of not needing further surgery, so we played the odds. He felt it would be of more benefit to have that extra flexibility, but left the decision up to me. I must admit a few things... I find myself to be fairly careful not to do repetitive bending, because I don't want to go back for more surgery, and that is what will cause the wear and tear on those lower lumbars. I have also noticed that some people who are fused completely have said they have no weight restrictions, whereas I do-- and I can tell (it begins to bother me) if I am trying to hold or lift more than about 20-25 lbs. That being said, I still think I have more flexibility and I think that is beneficial. It may be one of those "six of one, half a dozen of the other" sorts of things. You give up flexibility entirely but are more stable and have no fears or restrictions, or you are more flexible but need to take care of yourself.

    As for getting down on the floor... I also have arthritis in my knees and hips, although do pretty well since I take diclofenac for that. I am a librarian and need to get down to the bottom shelves (and read the spine labels which are at the bottom end of the books) and I can do it alright as long as there is something that is stable that I can use to help myself back up. I don't squat, but go down on one knee. You can probably then just move to a sitting position, but I find that uncomfortable. I also would need to make sure that sitting position would allow me to grab hold of something when it's time to get back up. Best wishes for you! And where there's a will, there's almost always a way.
    67 and plugging along...
    2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15°
    CMT (type 2) DX in 2014, progressing
    NEW 10/2018 x-rays show spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  13. #13
    Join Date
    Mar 2014
    Posts
    2

    Will I ever be able to reach my toenails to cut them again

    I am 4 months post op from t-10 to pelvis fusion and cannot cut my own toenails. Will my flexibility improve as time goes by.

  14. #14
    Join Date
    Apr 2010
    Location
    Waterloo, IL
    Posts
    1,707
    I am fused T4 to the sacrum and my flexibility has definitely improved even after my 2 year anniversary. I would advice you not to attempt to reach your toenails this early in your recovery. I can trim my toenails by crossing on leg over the other knee or by propping up a foot on a chair, but enjoy having a pedicure instead. I still used a razor with a foot long handle attached at 4 months. Be patient and improved flexibility can come later when you are fused. Don't rush it now.
    Karen

    Surgery-Jan. 5, 2011-Dr. Lenke
    Fusion T-4-sacrum-2 cages/5 osteotomies
    70 degree thoracolumbar corrected to 25
    Rib Hump-GONE!
    Age-60 at the time of surgery
    Now 66
    Avid Golfer & Tap Dancer
    Retired Kdgn. Teacher

    See photobucket link for:
    Video of my 1st Day of Golf Post-Op-3/02/12-Bradenton, FL
    Before and After Picture of back 1/7/11
    tap dancing picture at 10 mos. post op 11/11/11-I'm the one on the right.
    http://s1119.photobucket.com/albums/k630/pottoff2/

  15. #15
    Join Date
    May 2009
    Posts
    3,745
    hey Jamie...
    you have all my sympathy...i have bad knees as well...
    and now bursitis in left hip, caused, they tell me, from uneven
    loading of spine due to scoli...ugh....falling apart...
    BUT...am allergic to NSAIDS...
    when i took diclofenac, (which i should not have even been given)...
    it took away at least 50% of my pain....now i cannot take any NSAID....

    i think patients are not allowed to take NSAIDs for a while after
    surgery....but i think you can then go back to taking them after
    everything has fused....

    just thinking they might help you, whenever you are allowed to
    be on them...

    best wishes...and all my sympathies...
    jess....and Sparky

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