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Thread: Failure of fusion

  1. #1
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    Failure of fusion

    Haven't posted here for a while, so hallo to everyone. I had spinal fusion (T2-T12) in Nov 04, and recovery has not gone well. I am having a crosslink which has been a source of constant pain removed on March 27th. Another problem is permanent spasms from shoulder blades to waist (the length of the rods?), round the right ribs and front. It is like breathing into an ever-encroaching steel wall. The spasms are 24/7 and have got more intense in steps every few months, to the point where they are close to seriously impeding my breathing. They do not respond to any medication tried so far (pain medication, diazepam, gabapentin), and any form of stimulation (eg massage, heat, movement and stretching) trigger the highest levels. My surgeon thought it was neurological damage from the rib removal, but the pain specialist thought not and suggested it might be due to failure of the fusion. The surgeon now thinks this is a possibility and is going to look at the fusion while he is removing the crosslink.

    Any experience resembling this would be good to hear, plus what the implications and/or treatment are for failure of fusion. In some ways this is good news, as improvement might be possible - I was beginning to give up hope of ever getting back even a vaguely normal life. I would be very grateful for any information or experience that anyone has.

  2. #2
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    Hi Lavinia...

    I believe it's really difficult to diagnose pseudarthrosis (failure to fuse) definitively. The most common way I hear of getting the diagnosis is that the implants break, or, the implants are removed and the curves return.

    The people I know who have had pseudarthorses tell me that the pain is fairly localized right at the area that isn't fused.

    Good luck. Hope you find the problem.

    Regards,
    Linda

  3. #3
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    Thanks Linda. I am lucky really that the surgeon will be able to check for areas of non-fusion along the whole spine if necessary, while the crosslink is being dealt with. Plus it occurs to me that the pain may be due to non-fusion rather than the crosslink. So at least one thing should get clarified.

    I gather that the usual procedure when fusion fails is to graft bone from the pelvis - I would be very grateful if anyone who has experienced this or knows anything about it would let me know about it.

  4. #4
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    I had a bone graft from my pelvis for my normal fusion, since they were fusing so many vertebrae. I am very lucky, and I don't have any pain from the graft site. I made sure they did the graft from my left hip, so I could still bowl and not have any problems (I bowl right-handed).

    Good luck with your surgery-I hope all goes well for you, and you'll be in my prayers.

    Erin

  5. #5
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    Thanks Erin, that is very nice of you and helpful.

    Just sorry to see of your problems. You are very young to have such bad ones, and isn't it disappointing when such a big op has a bad result in terms of pain.

    Wish my surgeon had done as yours did! since my fusion is quite like yours - T2-T12 - and I am much older, 56.

    They might be able to just take out part of the instrumentation - with me they are taking out just a crosslink. I think they might also eventually think about taking out a couple of screws. But the metalwork pain is a horrible pain and you have my sympathy. Let me know how it goes for you,

    Lavinia

  6. #6
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    Quote Originally Posted by Lavinia
    Thanks Linda. I am lucky really that the surgeon will be able to check for areas of non-fusion along the whole spine if necessary, while the crosslink is being dealt with.
    Having a surgeon check for fusion during surgeon is far from fool-proof. So, if you have the crosslink removed and the surgeon doesn't find any area of non-fusion, but you still have pain, it's something to consider.

    Regards,
    Linda

  7. #7
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    Quote Originally Posted by Lavinia
    Thanks Linda. I am lucky really that the surgeon will be able to check for areas of non-fusion along the whole spine if necessary, while the crosslink is being dealt with. Plus it occurs to me that the pain may be due to non-fusion rather than the crosslink. So at least one thing should get clarified.

    I gather that the usual procedure when fusion fails is to graft bone from the pelvis - I would be very grateful if anyone who has experienced this or knows anything about it would let me know about it.
    Hi Lavinia,

    I had my first surgery in '97, and they took the bone graft from the pelvis, wich hurt- the right hip. I had pain in my upper/right side so bad that a year or so later they took out a hook and most of my pain was gone for 6 years.I mostly had pain in my non fused areas since they were stiff and I have a few pinched nerves in my neck. What happened after those 6 years in 2004; I broke a rod. The pain was sharp, and eventually all the screws from that side came loose and I have to say that most of my pain was from the hardware and not the bone fusion failing in that area, b/c I had no specific pain for six years until the rod broke and my fusion did not heal well from the beginning, obviously.

    So last December, they opened me up again, from t5 to l2(wich is the whole lenght of the fusion), and they replaced the rod, put slitghly bigger screws on that side(since you need bigger ones once you replace them in order to fill the gaps that the old ones formed when loosening), put two new connectors and they added loads of BMP mixed with bone from my fusion bed where the rod broke. I didn't want them to open my hip again since the pain was bad there the first time and the surgeon didn't think it was necessary, since I had a nice fusion bed formed around my fusion.

    This surgery is still hard to recover from 3 months post op now, since they opened the whole scar again and the nerve pains are still there, but I'm better, slowly. The surgery for taking out the hook was really easy compared to it though, only a few weeks of pain and recuperation, b/c the incision was small, and they didn't replace anything that time. So it depends what they do to you as far as pain goes, and also when they add fusion you have to not bend for three months at least and only walk and take it real easy, like I have and still do.

    If you have more questions feel free to ask, even if we're all unique in terms of pains and recuperations we can still shed some light on some things and help each other. Good luck

  8. #8
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    Quote Originally Posted by sweetness514
    Hi Lavinia,

    I had my first surgery in '97, and they took the bone graft from the pelvis, wich hurt- the right hip. I had pain in my upper/right side so bad that a year or so later they took out a hook and most of my pain was gone for 6 years.I mostly had pain in my non fused areas since they were stiff and I have a few pinched nerves in my neck. What happened after those 6 years in 2004; I broke a rod. The pain was sharp, and eventually all the screws from that side came loose and I have to say that most of my pain was from the hardware and not the bone fusion failing in that area, b/c I had no specific pain for six years until the rod broke and my fusion did not heal well from the beginning, obviously.

    So last December, they opened me up again, from t5 to l2(wich is the whole lenght of the fusion), and they replaced the rod, put slitghly bigger screws on that side(since you need bigger ones once you replace them in order to fill the gaps that the old ones formed when loosening), put two new connectors and they added loads of BMP mixed with bone from my fusion bed where the rod broke. I didn't want them to open my hip again since the pain was bad there the first time and the surgeon didn't think it was necessary, since I had a nice fusion bed formed around my fusion.

    This surgery is still hard to recover from 3 months post op now, since they opened the whole scar again and the nerve pains are still there, but I'm better, slowly. The surgery for taking out the hook was really easy compared to it though, only a few weeks of pain and recuperation, b/c the incision was small, and they didn't replace anything that time. So it depends what they do to you as far as pain goes, and also when they add fusion you have to not bend for three months at least and only walk and take it real easy, like I have and still do.

    If you have more questions feel free to ask, even if we're all unique in terms of pains and recuperations we can still shed some light on some things and help each other. Good luck
    Thank you very much for the info, Linda, and for sharing your experience, Sweetness. I am so sorry you have had such a long hard journey. It is so disheartening when such a big surgery does not go well. I hope you continue to improve. I will let people know if they find out anything about what my spasms might be due to. They are a real mystery and do not conform to any post-op syndrome that I can track down. So if they are due to non-fusion it would be surprising, but the pain specialist and surgeon both seem to think that could be it. Presumably then the whole length of the fusion, since the spasms are not localised to a small area.

    I shall also bear in mind that even if the surgeon doesn't find an obvious non-fused area there still may be hidden areas.

    Thanks and best wishes,

    Lavinia

  9. #9
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    My doctor diagnosed my pseudarthrosis about a year after my surgery (I had anterior spinal fusion) and I generally feel pain in that area. It also makes a popping noise? Just wondering if anyone has experienced that? I'm having surgery in May at the end of this semester and my doctor said FDA just approved something I think he said BME which he could use instead of taking bone from my hip. I don't know I guess we'll see what happens.

  10. #10
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    BMP = bone morphogenetic protein

  11. #11
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    Here's a link to an abstract from a study showing recent pseudarthrosis (non-fusion) rates:

    http://www.ejbjs.org/cgi/content/abstract/88/4/721

  12. #12
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    Hi everyone I was sorry to read about a lot of pain in this thread and I'll be keeping everyone in my thoughts for some relief.

    Does anybody know what does arthrodesis to S-1 mean, in this abstract?? (as opposed to L-5 - what that comparison means in practice)

    Thanks so much Linda for the info.

    Laura
    30y/o
    Upper curve around 55
    Lower curve around 35

  13. #13
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    Fusion Failure

    What this abstract tells me is that fusion failure is significant in those of us who are well into our 50s and who require fusion to the sacrum. Almost a guarantee for more surgery in the future. Not good.

    Chris

  14. #14
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    Quote Originally Posted by lrmb
    Does anybody know what does arthrodesis to S-1 mean, in this abstract?? (as opposed to L-5 - what that comparison means in practice)
    Hi Laura...


    Arthrodesis is fusion, so they're just comparing fusion to L5 to fusion to S1 (sacrum).

    Regards,
    Linda

  15. #15
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    Quote Originally Posted by CHRIS WBS
    What this abstract tells me is that fusion failure is significant in those of us who are well into our 50s and who require fusion to the sacrum. Almost a guarantee for more surgery in the future. Not good.

    Chris
    I will add that pseudarthrosis is not always visible in bone scans and tomograms, as it wasn't with me and my ortho knew many cases like me as well. I lasted over 6 years with a non union and didn't really have pain in that area prior to my rod breaking, so many patients don't even know that they could have a failure in their fusion, so the percentages are not always accurate. But a few orthos that I discussed the issue with confirmed that it happens pretty frequently, and with patients of any age. A bummer, I know.

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