Help-what is a "long fusion"

[leahdragonfly]

I had an L4-S1 fusion in 1984 for spondylolisthesis at age 17. I also wore a boston brace for two years in jr. high for scoliosis (32/33* curves). My back has been great for all these years.

Now at age 40, I have had a gradual onset of lower back pain, severe with prolonged standing, with some sciatica, but the most troubling symptom is now I have tingling in my legs.

My x-rays show that the fusion from L4-L5 is gone (probably never healed properly), and I have a new forward slippage of L4, as well as a lateral shifting of L3. I saw my local spine specialist (not SRS) and he basically said OMG your back problem is so complicated. He thinks I will need a "long fusion" of my entire scoliosis to stabilize the spine. I was shocked to say the least. I thought at worst maybe I just needed the fusion redone or something. I am having an MRI Monday.

I scheduled an appt in a couple weeks to see a spine specialist that the local ortho recommends, and a second opinion appt in May at Oregon Health and Sciences Univ in Portland with a SRS specialist.

My question is, what exactly is a "long fusion"? Also, I thought all "good" spine deformity surgeons should be SRS members--so if they are not, but are fellowship-trained in spine surgery and do only that, how do I judge their qualifications? I am just so overwhelmed at this point!

[LindaRacine]

Hi Gayle...

There is no formal definition of a long fusion, but I think it usually is meant to encompass at least 8-10 vertebrae.

I'm sure there are good surgeons who aren't members of the SRS, but it's a good place to start looking. I suspect there's a lot of difference between the disciplines of deformity and trauma, so you probably want to be certain that your surgeon has been trained and has a lot of experience in spinal deformity surgery.

Sorry to hear that you may need more surgery. Best of luck finding the right surgeon.

Regards,
Linda

[Susie*Bee]

Gayle-- I'm so sorry to hear you are having problems now. My immediate thought when I read your post was to encourage you to find an SRS surgeon who does a lot of revision work. It doesn't sound like your doctor has much experience with your problem...

As far as what "long" fusion may mean... I know that my scoli nurse always reminds me that I had a long fusion (when she's reminding me why I have some of the aches I have, and why it is going so slowly...) and in that regard she's referring to the number of levels that were fused--15. If you google long fusion, you will also get at least one technical paper that compares long and short fusions-- and in this instance the levels aren't long-- it has to do with whether the fusion begins at the upper end vertebrae of the deformity or above it (or something like that...). Here's a link to where I found that: http://www.springerlink.com/content/36016l0674074224/

It's hard to know which your doctor might have been referring to. I also had lateral listhesis (shift), L3L4. It is all fixed now, thanks to my surgery. Best wishes!

[CurvySAT05]

Remember also that just because a surgeon is an SRS doctor, does NOT mean that they are a 'good' surgeon, it just means that a certain amount of their practice is devoted to scoliosis/spinal deformity and they do research of some sort.
I have now had 4 surgeries for my scoliosis, the first 3 with a SRS surgeon (found on the SRS website). It took 3 surgeries too long to find out that this surgeon was not a 'good' surgeon and after many failed attempts I ended up at the office of a non-SRS doctor who treats a great number of scoliosis patients each month, but has elected not to join SRS yet. I am happier after 4 months post-op revision from my non-SRS surgeon, than I am with the 3 surgeries my SRS surgeon did.
You really need to ask questions about how many scoliosis surgeries (and spondy surgeries) your surgeon does (a month, a year, etc), what the outcome of his/her surgeries are, if you can have the number of some of their patients to talk with before you make a decision (either happy or unhappy patients), and anything else that is important to you.
I was plesantly suprised one day when I was at an orthopedists office (jumping through an HMO hoop trying to get my surgery approved) and overheard them talking about how great my new (non-SRS) surgeon was. You can always expect to hear good things about your surgeon in their waiting room, but when you are at someone elses office and you hear patients talking about another doctor, that really says something.
Sorry for the rant.

[nate03]

Hi Gayle-
I don't have any helpful info to offer you, but I did want to say that I am so sorry that you are dealing with your own scoli issues along with your concerns for Leah.
You have a lot of worries right now, and I hope things "fall into place" for you and your family soon.
Thinking of you,
Cara

[JulieBW]

SRS member qualifications

In searching for a qualified physician in my area, I found two SRS members who don't even list scoliosis as a specialty on their medical center web site. There are different membership levels described on the SRS web site. The membership level is not given when a name pops up in response to a "find a Physician" search through the SRS web site.

[sparklegirl59]

hope you'll b ok!

hey! don't worry everything will b fine! i'll definitely b prayin 4 u!!! don't worry tho cause God will guide u thro it! just remember that God will ALWAYS b with u!!! He luvs u and will guide u thro all of it. it's a test of faith, and how much u trust God in these kinds of situations. but i'll b prayin 4 u so remember that!!! TTYL!

[CHRIS WBS]

I reread Michael Neuwirth’s Scoliosis Handbook over the weekend and there was a question raised about loss of mobility. He made reference to a VERY long fusion as 10 or more vertebrae, so I’m thinking even if you have all five lumbar vertebrae fused without involving the thoracic spine, it’s considered a long fusion.