Flat Back Syndrome

[LindaRacine]

I can force myself to be somewhat upright as well, but it's not a position I would be able to hold for more than a few seconds. If you don't mind my asking, was that your doc's diagnosis, and if so, what are they saying is the cause of your low back pain? Thanks.

My L3-L4 is almost completely shot, so there's only a tiny space between the two vertebrae. When I'm in pain, and walking in the bent forward position, I can stand up straight by pushing down on my right hip, which stretches out the muscles on the right side of my back. I'd like to reiterate that I only stand/walk in the bent forward position when I'm in pain.

--Linda

[trulyaries]

Flatback syndrome confirmed

Well, I diagnosed myself correctly with flatback syndrome - it was confirmed by two different surgeons. I had appointments with Dr. Stanley Lee in Ann Arbor, MI and Dr. Herbert Roth in Troy, MI. Their diagnoses and recommended treatments were virtually identical. I liked both doctors but I have decided on Dr. Roth from a practical standpoint, because he is affiliated with the hospital where I have had everything done and where all my records are for quite a number of years. Also, I live alone so will have to rely on friends and family and I felt that a 2-hour roundtrip to AA was a bit much to ask. They both said they would remove the hardware added at L4-L5 in 2005, do two osteotomies, and re-fuse, going to the sacrum this time. Both said this would be only a posterior approach. Dr. Roth also said that he doesn't believe I am completely fused at L5. I'll be seeing Dr. Roth again soon, to answer many more questions I have, but some post-surgical things he mentioned were new to me and I would appreciate input from anyone who has undergone this type of surgery. He said I would be put in a plastic brace (don't know for how long) and that I would not be able to drive, or SIT, for three months. He said for most of the 3 months I will either be walking or lying down. For some reason, I'm more nervous about this surgery than the last two, perhaps because I consider this to be my last one, and I'm putting a lot of faith in it. I'll be 64 by the time of the surgery on May 14. (Dr.Lee told me that Drs. Lenke/Bridgwell put 65 as the age limit for this type of surgery.) Anyway, any info, suggestions, support would be appreciated.
Trulyaries

[CHRIS WBS]

Hi Truly,

I read your post with a great deal of interest. I note that you had your original surgery at age 57. Were you working at the time, and if so, were you able to return to work following recovery from surgery? Now seven years later you are facing more surgery at age 64. If the cutoff for this additional surgery is 65, what does one do then if problems arise after age 65? Do you just have to live with pain? It’s kind of a Catch-22 situation.

It’s my understanding that fusions to the pelvis can be problematic as well. One surgeon told me that roughly 50% of patients experience problems with the iliac bolts. I’ve decided against surgery because I would require a very long fusion to the pelvis and I’m afraid that I might not be able to return to work following this surgery. In addition, I lack a support system. I’m 57 and self-supporting and I cannot afford to retire.

Good luck with your revision. Hope all goes well for you.

Chris

[trulyaries]

Flatback syndrome

Hi Chris - Thanks. I'll try to answer your questions. If you check the Physician Feedback site, topic Dr. Roth, today, I give a little more detail as to how I ended up having a third surgery. At the time of my first surgery at 57 I was working at a mentally and physically high stress job (program producer for automotive events). I was off work for three months. I then went back to work, but it didn't take long for us to realize that I wasn't ready. So my company allowed me to work from home on budgets and such. I think I did that for another month, then returned to work. I had some pain, but felt I was getting better every day - until the second surgery. After that, I returned to work, but continued to have problems. In January 2006 I voluntarily quit my job - two reasons - I hated the company and I thought perhaps I wasn't devoting enough time to getting better, because I wasn't due to working 60-hour weeks. So I spent all of 2006 on PT, strength training, acupuncture, etc. only to find out that no matter what I did it wasn't going to fix what was wrong. I fully intended to go back to work in a few months, but obviously that didn't work. I'm living off my retirement money for now, and I have applied for early social security which starts in May. I still fully intend to go back to work doing part-time freelance work, or work from home - however, trying to find work in metro Detroit right now, where probably 1 in 2 jobs relies on the disastrous domestic automotive industry, won't be easy.

As far as the cutoff date of 65 for surgery, I didn't pursue it with the doctor. I assume that anyone any younger feels that at the age you have one foot in the grave so why bother ??? I'm sure that decision would depend on the circumstances and severity of additional surgery. As far as fusion to the pelvis, I asked my last surgeon why he wouldn't fuse to the pelvis, and he said they don't like to do that because it is more complicated and causes more problems. However, Dr. Lee, who I consulted this time, said that they usually like to leave at least two lumbar vertebrae unfused, and if I understood him correctly, he said that 50-60% of your lordosis occurs at L5-S1. So if I was fused to L5, and L5-S1 disk collapses, I end up with flatback.(Can anybody confirm this?) What I hate most is trying to sort out all the conflicting information you get from doctors.
As far as whether or not you should have surgery, I can't say. I can't think of any reason, if your health is otherwise good, that you couldn't return to work after a reasonable recuperation period. A lot depends on how much pain and discomfort you are in now, and what kind of work you do also. I found myself very exhausted at the end of the day for quite awhile after I returned to work. Do you have anyone at home that needs care? If not, being able to hit the bed as soon as you get home is a good thing.

Good luck.
Trulyaries

[Karen Ocker]

Too old for help?

As far as the cutoff date of 65 for surgery, I didn't pursue it with the doctor. I assume that anyone any younger feels that at the age you have one foot in the grave so why bother ??? I'm sure that decision would depend on the circumstances and severity of additional surgery

trulyaries

I know my surgeon has operated on 80 year olds. There are more complications after 60. The way I looked at it, barring any catastrophic illness or accident, and since I had no other chronic diseases, I figured I might have 20+ years life expectancy(I was 60 with the revision surgery) and I didn't want it shortened by scoliosis(I had breathing issues from it already).There is longevity in my(nonsmokers) family. My mom is 90 and even great grandparent lived to hight 80s.

A lot depends on the skill and experience of the surgeon, his team and the hospital. One doc may say it's impossible the other might do the surgery all the time. There is a difference between a good surgeon and a great surgeon-my 2cents.

It takes a lot of courage to do this but, to me, it would take more courage to go slowly downhill the rest of my life.

[trulyaries]

Karen -
I couldn't agree with you more. I hope you realize I was trying to make an ironic joke with that comment. The doctor who told me was quoting Drs. Lenke/Bridwell in St. Louis, recognized "great" surgeons at revision surgeries. I don't look, think, or act old. And my response to those who question why I would go through a third surgery "at my age" is: I'm not ready to be old yet - I will "rage against the dying of the light" (thank you, Dylan Thomas). I don't care if I have 5-10-20 years left, I refuse to be miserable and give in to health issues. I DID say I thought the
decision would depend on the circumstances and severity of additional surgery.

I had noticed before that you were fused to the sacrum in 2002. Do you mind my asking how you are doing?
Trulyaries

[Karen Ocker]

fusion to sacrum

Do you mind my asking how you are doing?

trulyaries

I am now almost 65(May), working everyday-standing and pain free.
I am planning a trip to Europe in June, hiking in the Alps.

I basically don't even think about being fused to the sacrum-except when I try to clean my 90 year old's mom's oven, wedged in a corner.
In my case, my discs below the 1956 childhood fusion were too degenerated. I don't even think about the hardware there. It's 4 1/2 years since the revision.

I am proactive about exercising and doing Pilates-modified acording to my flexibility. I also take the new higher doses of Vit D my bone metabolic doc recently recommended.

[trulyaries]

Karen -
Thanks for responding. That's great that you are doing so well. I hope I can say the same after my surgery - I'm confident that the third time will be the charm!
Trulyaries