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Thread: Mechanics of fusion to sacrum and flexibility

  1. #1
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    Mechanics of fusion to sacrum and flexibility

    There have been many posting on this, but I'm still trying to understand why being fused to the sacrum (as opposed to just being fused to L3 or 4) limits some people so severely. (I do realize some people have no problems and that it is in individual thing). Probably the only way for me to really understand is to meet in person with someone who is indeed fused all the way down. But until I can meet someone, I would like to ask Linda, the moderator of this forum, and others (and I really hope some new people will chime in here) exactly why certain things are so difficult for them.

    Linda has said that she can't lift her foot more than six inches off the ground. Others have said they can't wipe themselves or sit on the floor. Why is this? Does the lower spine need to bend for this? Or is there some other reason? Does the metal poke into your behind when you sit? I also don't understand why those fused to the sacrum cannot do a full bend from the hips to pick things up off the floor since the hips aren't fused? Why do you need to do a golf move/one leg thing to pick things up? Why can't you bend your knees and lower your fused spine forward to pick things up? Does being fused to the sacrum mean you can't lean your torso forwards? If so, why? Its the mechanics of it all that I don't understand. Why can't you sit back on your knees, Asian style? I was also interested in Linda's comments about good knees being important and deep knee bends. I myself have painful, inoperable knee chondromalacia, which I'm thinking does not bode well for me with this surgery. She also mentioned tight hip muscles. Is there any way to loosen yourself up before surgery to the sacrum to avoid some of these severe limitations afterwards?

    I'd also like to ask Linda, as she works in a spinal department, if she was warned about these possible limitations before surgery and what the surgeons are saying now about her limitations - can anything be done to improve the flexibility?

    Thank you so very much Linda and everyone who answers. Just trying to understand the mechanics of it all.

  2. #2
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    I am fused from C2 to sacrum. I had my first surgery in 2010 which my NC surgeon screwed up. When I moved to CA, Dr Bederman fixed me as best as he could and he did a great job. Now in 2014, after a year of many hip surgeries in 2013, I am getting more flexibility than I had. I can sit on the floor. I can sit on the floor outside a bathtub. I can pick most items off the floor without a grabber. I still cannot wipe my self and that I do not think will change. I cannot reach my feet or my toes and this , also, will not change .I was warned by Dr Bederman about my limitations, unlike my NC surgeon.

    What will be the length of your fusion?

    Ask any more questions you would like

    Melissa
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  3. #3
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    First of all, today is Lindaís birthday! Happy Birthday Linda, youíre the best.....

    I posted photos of me on Marks thread.....maybe I should start a new shoe tie and squat thread and link it to my signature.....

    I was also warned about wiping my taillights......and thatís one of those things you just donít forget when discussing full fusion with your surgeon....Thankfully, I donít have issues with this matter.

    I think that the wiping with full fusion has a lot to do with shoulder area flexibility. I broke my right shoulder skiing so I do it lefty now.

    I can sit on the floor with legs out but its not the most comfortable position. We all try to stay as comfortable as we can no matter what it takes.

    Melissa, I cant believe how many spine surgeries you have had.....Someday a list would be neat to see. Its good that you are getting it worked out.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,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

  4. #4
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    Quote Originally Posted by Tableone View Post
    There have been many posting on this, but I'm still trying to understand why being fused to the sacrum (as opposed to just being fused to L3 or 4) limits some people so severely. (I do realize some people have no problems and that it is in individual thing). Probably the only way for me to really understand is to meet in person with someone who is indeed fused all the way down. But until I can meet someone, I would like to ask Linda, the moderator of this forum, and others (and I really hope some new people will chime in here) exactly why certain things are so difficult for them.

    Linda has said that she can't lift her foot more than six inches off the ground. Others have said they can't wipe themselves or sit on the floor. Why is this? Does the lower spine need to bend for this?
    Yes, the lower spine plays a big part in terms of flexibility. I think if you could duct tape a broomstick cut to the length at the top and bottom of your expected fusion, you might get an idea of what it's like. If you were able to add a long screw between the sacrum and ilium (on one or both sides), you'd probably understand even better. It doesn't surprise me at all that you're having difficulty understanding the biomechanics of it all. While I knew about the issues, I couldn't really understand what it felt like until it was actually done to me.

    [QUOTE=Tableone;161508]Does the metal poke into your behind when you sit?

    No, the rods are usually only about 1/2" lower than the lowest screw.

    Quote Originally Posted by Tableone View Post
    I also don't understand why those fused to the sacrum cannot do a full bend from the hips to pick things up off the floor since the hips aren't fused? Why do you need to do a golf move/one leg thing to pick things up? Why can't you bend your knees and lower your fused spine forward to pick things up? Does being fused to the sacrum mean you can't lean your torso forwards? If so, why? Its the mechanics of it all that I don't understand.
    If you look at THIS image, you can see the difference between the first and third examples. When you're fused to the sacrum, most of us will be pretty much like the third example. You can bend your knees to get closer to the ground. I can do that, but when my center of balance is off as much as it needs to be in that position, I will fall unless I can hold onto something with one hand.

    Quote Originally Posted by Tableone View Post
    Why can't you sit back on your knees, Asian style? I was also interested in Linda's comments about good knees being important and deep knee bends. I myself have painful, inoperable knee chondromalacia, which I'm thinking does not bode well for me with this surgery. She also mentioned tight hip muscles. Is there any way to loosen yourself up before surgery to the sacrum to avoid some of these severe limitations afterwards?
    I might be able to sit back on my knees if I didn't have a knee problem and really tight leg muscles. I don't, however, have a clue how I'd ever get up from that position. I'm fairly certain that Ed can do this.

    You can definitely loosen up before surgery, and I would highly recommend doing so. I think it would be excellent to work with a physical therapist.

    Quote Originally Posted by Tableone View Post
    I'd also like to ask Linda, as she works in a spinal department, if she was warned about these possible limitations before surgery and what the surgeons are saying now about her limitations - can anything be done to improve the flexibility?
    I absolutely THOUGHT I knew what to expect. I talk to patients at least 3-4 days every week who have been fused to the sacrum. I can only tell you that it's different when it's you. By the way, it doesn't help that I'm older, heavier, and have pelvic fixation. Those issues add up.

    Hope that helps.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
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  5. #5
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    Thanks Ed! I think YOU'RE the best. :-)
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  6. #6
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    Quote Originally Posted by dixiesmommie View Post
    Here you go Ed, I think you mean't me for the list of surgeries.


    Scoliosis Surgery Harrington Rods Miami Children's Hospital age 14 1976 Harrington rods- Dr Shufflebarger

    Revision Surgery 1994 Flat back Syndrome 1994 Health South Miami- Dr Shufflebarger Harrington Rods removed- New rods replaced

    Revision surgery- Late Deep wound infection. 1997 Health South Miami Dr. Shufflebarger

    Revision surgery- 2013 (remained without rods from 1997-2013) Florida Hospital Tampa fused from L2-S1 with Pelvic screws

    Pending surgery December 9th- Exploration of fusions and possible Anterior fusion Tampa General Hospital

    No.. he meant me. I have had probably close to ten spine surgeries . Last year, between August and Christmas, I must had about 8 hip and femur bone surgeries. When I have a chance , I will write them all out.
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  7. #7
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    Since my first surgery was to s-1 and pelvis I cannot compare being fused to l-4 or l-5,but being fused to s-1 does indeed compromise your movement. I don't sit on the floor. If I would try to sit with my legs out straight ,I would look like someone in a Pilates V. I get out of the tub by turning over and getting up backward. As mentioned you have to get in and out of the car in a modified log roll. For me there isn't bending without one leg straight. I am not sure if it is the pelvic hardware. It seems to have made the hamstrings really tight.

  8. #8
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    hey Ed
    knew about Linda's bday and sent her a little note...

    but don't you have a bday coming up this month as well...?
    the 11th, i believe....?
    two Sagg people. huh....?

    hope Linda's was a happy bday...
    and that your's will be the same...

    jess...and Sparky

  9. #9
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    Quote Originally Posted by dixiesmommie View Post
    Wow Melissa, I never thought there was someone who had more surgeries than me. You poor thing!
    Thanks.. and I am having another on Monday

    Melissa
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  10. #10
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    so sorry....did not mean to hijack the thread by discussing
    birthdays...

    i wish all surgery patients with operations on the horizon
    the best of care...
    dixies mommie, i hope your operation is smooth, and recovery
    uneventful...
    i wish the same for Melissa...

    hoping you both start to heal and feel better a little bit every
    day once you wake up after the procedures...

    hugs and woofs to you both...
    jess...and Sparky

  11. #11
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    Quote Originally Posted by jrnyc View Post

    but don't you have a bday coming up this month as well...?
    the 11th, i believe....?
    two Sagg people. huh....?
    I think so.....Half man, half horse ďandĒ fully fused....add the bow and arrow and it makes for quite astrological combination....I kinda wonder what Nancy Reagan would say about this? I do know that we are very lucky in the fact that we do get more gifts than most since our timing is just about perfect. I would imagine that people born on December 26th donít fare so well.

    Thanks for the birthday wishes Jess

    And Melissa on Monday and Dixie on Tuesday.....Both of you have done your share of painful surgeries and deserve the best turnouts this go around.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,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

  12. #12
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    Melissa on Monday.....Both of you have done your share of painful surgeries and deserve the best turnouts this go around.

    Ed

    Thanks Ed
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  13. #13
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    fusion to sacrum and flexibility

    Thanks to everyone who wrote in, especially those Like Linda who addressed the "why" of the limitations from being fused to the sacrum. The drawings Linda posted were also very helpful. Several people have now used the same words to describe the feeling...both in this thread and in private emails to me...words like "broom handle taped to your behind," and so forth. People have also said it depends how flexible you are before surgery. If this is the case, I think surgeons should specify this. Linda, if there's anything else you can add about the mechanics of it, please do. For instance, why you can't lift your leg higher from a sitting position if this doesn't involve bending the spine? Is it because of the pelvic fixation? I know you've explained about this before, but I'm still having trouble understanding. Also, I thought it was interesting that you say you talk to several people a week who are fused to the sacrum. Is UCSF doing some kind of a study? Do these people that you talk to have similar limitations and does it get any better for them as time goes on? Is there any tracking on how many people get actual pain relief from fusion to the sacrum surgery?

    Thanks,
    T1

  14. #14
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    Quote Originally Posted by Tableone View Post
    Thanks to everyone who wrote in, especially those Like Linda who addressed the "why" of the limitations from being fused to the sacrum. The drawings Linda posted were also very helpful. Several people have now used the same words to describe the feeling...both in this thread and in private emails to me...words like "broom handle taped to your behind," and so forth. People have also said it depends how flexible you are before surgery. If this is the case, I think surgeons should specify this. Linda, if there's anything else you can add about the mechanics of it, please do. For instance, why you can't lift your leg higher from a sitting position if this doesn't involve bending the spine? Is it because of the pelvic fixation? I know you've explained about this before, but I'm still having trouble understanding. Also, I thought it was interesting that you say you talk to several people a week who are fused to the sacrum. Is UCSF doing some kind of a study? Do these people that you talk to have similar limitations and does it get any better for them as time goes on? Is there any tracking on how many people get actual pain relief from fusion to the sacrum surgery?

    Thanks,
    T1
    Hi...

    I actually don't know why I can't lift my legs higher. I suspect it's just the biomechanics of no longer having movement at L5-S1, but I'll talk to some of our docs. I'm sure they can explain it. I don't think it's pelvic fixation, as I've only got a left-sided bolt, and I actually get slightly less lift on the right side.

    We're doing lots of studies. While one of my duties is to identiI mostly talk to patients because one of the surgeons or one of the practice assistants tell them I have a long fusion to the sacrum. I don't have any statistics for you, but I can tell you that the vast majority of patients get some pain relief. That means that a small number of people get no relief, or in fact, might be worse after surgery. I think one of the best things you can convince yourself of before surgery is that you will almost certainly not be perfect after surgery. That sounds easy, but I think it's actually a lot harder than one thinks. While I'm REALLY happy to no longer have my back and leg pain, there isn't a day that goes by that I don't wish I had my flexibility back. No question that I'd make the same decision over again, but I would still be unhappy that I have to give up something precious to have a better quality of life.

    While I can talk a lot about pain levels and the effect of surgery on pain, the only thing I can tell you at this point about flexibility, is from my own experience and what I read from others here. Thankfully, we are recruiting patients for a large, multi-center study of scoliosis surgeries for adults. One of the questionnaires is used in that study is called the Lumbar Stiffness Index. I'm really anxious to start seeing some of details from that questionnaire. It's amazing to me that we've been conducting multi-center studies on scoliosis since the early 2000's, but it wasn't until a few years ago that anyone thought to start asking patients about the effect of stiffness on their function.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  15. #15
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    Glad I'm not the only one who can't lift my knees high any more. Even stepping into my undies is a trial. One hand dangling my undies, whilst trying to step into them, the other holding onto something to stop from over balancing! <hysterical laughter from the bedroom most days.>
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

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