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  1. #1
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    Failure to Fuse - What Does It Mean?

    What does it mean when a surgeon tells you that part of your back might have failed to fuse? Does that mean the area of the spine operated on never hardened? Could that be due to osteopenia?

    I asked what could be done for something like this and the answer was "fuse it again". What exactly does this mean? Another operation to do what exactly?

    The surgeon told me this could possibly be the reason for the back pain I've been left with. This is a second opinion surgeon.

    How do you diagnose failure to fuse, with imaging?
    Last edited by Tina_R; 12-24-2020 at 12:30 PM.

  2. #2
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    Quote Originally Posted by Tina_R View Post
    What does it mean when a surgeon tells you that part of your back might have failed to fuse? Does that mean the area of the spine operated on never hardened? Could that be due to osteopenia?

    I asked what could be done for something like this and the answer was "fuse it again". What exactly does this mean? Another operation to do what exactly?

    The surgeon told me this could possibly be the reason for the back pain I've been left with. This is a second opinion surgeon. My own surgeon never tells me anything.

    How do you diagnose failure to fuse, with imaging?
    It means that, at one or more levels, the vertebrae that were meant to fuse together, didn't do that. In the image link below, the dark like between L5 and S1 probably means there was a failure to fuse. (Bone appears as smoky white. The bright white is a cage that was placed during surgery, to aid in fusion.)

    https://www.researchgate.net/figure/...fig1_255975924

    There are some types of images (e.g., CT scans) that CAN show non-unions, but there are probably more false negatives and positives than accurate results.

    --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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    Quote Originally Posted by LindaRacine View Post
    It means that, at one or more levels, the vertebrae that were meant to fuse together, didn't do that. In the image link below, the dark like between L5 and S1 probably means there was a failure to fuse. (Bone appears as smoky white. The bright white is a cage that was placed during surgery, to aid in fusion.)

    https://www.researchgate.net/figure/...fig1_255975924

    There are some types of images (e.g., CT scans) that CAN show non-unions, but there are probably more false negatives and positives than accurate results.

    If images tend to show false positives and negatives what does the surgeon do? Does he cut open and probe to see if there's really non-fusion?
    --Linda
    What causes vertebrae to fuse together? Isn't it a combination of cadaver bone and some kind of glue that is used? And does your own bone grow and merge with it as well? I wear an electromagnetic vest that is supposed to aid in that, a bone growth stimulator made by Orthofix.
    Last edited by Tina_R; 12-24-2020 at 12:42 PM.

  4. #4
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    Tina, Some of us fuse and some of us do not, and they are not completely sure why this happens. It's our ability to grow bone.

    I am having problems growing bone in my face or mouth these days, (Mandible and Maxilla) Jaw and upper facial bone. I have been infected, that's why this happened. They don't know exactly why we get infected....but staph is EVERYWHERE. It's our immune systems....The battle can get harder as we age.

    We had a 25 year old member that did not fuse years ago, it took 2 attempts and they finally got it. They used BMP, which is a protein. Not glue. This protein is made in our body, and some of us need more to promote or speed up the fusion process.

    Dr Lenke has found pseudarthrosis or non unions in patients 8 years post surgery.

    If you ask your surgeon about this, the short answer will be "chemistry" If you don't have a biochem background, this ends the discussion with one word they are not about to explain it because we are not medically trained. I had this happen to me with my vascular surgeon talking about stone formation in the gall bladder.

    Bone cells....
    https://en.wikipedia.org/wiki/Ossification

    https://en.wikipedia.org/wiki/Bone_remodeling

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA 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

  5. #5
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    Quote Originally Posted by titaniumed View Post
    Tina, Some of us fuse and some of us do not, and they are not completely sure why this happens. It's our ability to grow bone.

    I am having problems growing bone in my face or mouth these days, (Mandible and Maxilla) Jaw and upper facial bone. I have been infected, that's why this happened. They don't know exactly why we get infected....but staph is EVERYWHERE. It's our immune systems....The battle can get harder as we age.

    We had a 25 year old member that did not fuse years ago, it took 2 attempts and they finally got it. They used BMP, which is a protein. Not glue. This protein is made in our body, and some of us need more to promote or speed up the fusion process.

    Dr Lenke has found pseudarthrosis or non unions in patients 8 years post surgery.

    If you ask your surgeon about this, the short answer will be "chemistry" If you don't have a biochem background, this ends the discussion with one word they are not about to explain it because we are not medically trained. I had this happen to me with my vascular surgeon talking about stone formation in the gall bladder.

    Bone cells....
    https://en.wikipedia.org/wiki/Ossification

    https://en.wikipedia.org/wiki/Bone_remodeling

    Ed
    Your vascular surgeon gave you an explanation that proved too much, huh? I can see that happening. The surgeon yesterday told me an angle in my spine post-surgery isn't ideal. It was hard for me to even see what angle he was drawing over the x-ray and I didn't want to get too close due to COVID distancing. And I usually feel comfortable discussing angles.

    I wonder how these non-fusions are usually discovered. Why did one escape notice for 8 years. I guess that's partly why they keep taking x-rays on your return visits though Linda says the x-rays can be deceptive.

    I hope your tooth and jaw problems resolve. I knew they're treating infection there, are they trying to regrow bone as part of that?
    Last edited by Tina_R; 12-24-2020 at 02:02 PM.

  6. #6
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    Quote Originally Posted by Tina_R View Post
    What causes vertebrae to fuse together? Isn't it a combination of cadaver bone and some kind of glue that is used? And does your own bone grow and merge with it as well? I wear an electromagnetic vest that is supposed to aid in that, a bone growth stimulator made by Orthofix.
    When the surgery is done, the surface of the vertebrae is usually roughed up a bit before bone (usually bone removed from your vertebrae during surgery and morselized), is applied to the surface. I've heard this described as a process similar to a scab forming on a skin wound. Additionally, older patients frequently have one of the many bio-medical materials available (like BMP) to aid in fusion. The hardware placed during surgery is meant to keep the vertebrae from moving during the early postop period. Over time, the bone will "scab" over, and bridge the vertebrae together. If there's a lot of movement, especially in the first 6-12 weeks, it's harder for the area to fuse. That's thought to be the most frequent reason why a non-fusion takes place.

    As to why you didn't fuse (if that's the problem), there's no way of knowing. In the end, it doesn't really make any difference. The problem just needs to be resolved. The good news is that, if the problem is a non-union, the fix is usually pretty easy compared to the original surgery, and recovery is typically fast.
    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

  7. #7
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    Quote Originally Posted by LindaRacine View Post
    When the surgery is done, the surface of the vertebrae is usually roughed up a bit before bone (usually bone removed from your vertebrae during surgery and morselized), is applied to the surface. I've heard this described as a process similar to a scab forming on a skin wound. Additionally, older patients frequently have one of the many bio-medical materials available (like BMP) to aid in fusion.
    Bio-medical materials including cadaver bone?
    Are you not supposed to grow new bone of your own, and isn't that what the bone stimulator helps with?
    If you fail to fuse, does this mean the bone never hardens?

    Quote Originally Posted by LindaRacine View Post
    The hardware placed during surgery is meant to keep the vertebrae from moving during the early postop period. Over time, the bone will "scab" over, and bridge the vertebrae together. If there's a lot of movement, especially in the first 6-12 weeks, it's harder for the area to fuse. That's thought to be the most frequent reason why a non-fusion takes place.
    Yet you swam without a brace in your first 6-12 weeks, didn't you?

    Quote Originally Posted by LindaRacine View Post
    As to why you didn't fuse (if that's the problem), there's no way of knowing. In the end, it doesn't really make any difference. The problem just needs to be resolved. The good news is that, if the problem is a non-union, the fix is usually pretty easy compared to the original surgery, and recovery is typically fast.
    If it's not resolved, what problems can you have?

  8. #8
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    I just went through another fusion surgery. My thoracic was first fused in Feb. 2011. Apparently it never fused. I had part of the hardware removed last January, due to a non healing wound.I
    After that, in about 7 weeks the pain in one area of the spine was insane. We started looking at why.
    When the doctor did a myelogram he found a nonunion, during the surgery in October, he found that the entire thoracic had not healed. So he removed the hardware and refused with my bone, cadaver bone and BMP. Without the fusion, I was going into a very fast moving kyphosis.
    T10-pelvis fusion 12/08
    C5,6,7 fusion 9/10
    T2--T10 fusion 2/11
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16
    Broken neck 9/28/2018
    Emergency surgery posterior fusion C4- T3
    Repeated 11/2018 because rods pulled apart added T2 fusion
    Removal of partial right thoracic hardware 1/2020
    Removal and replacement of C4-T10 hardware with C7 and T 1
    Osteotomy

  9. #9
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    Quote Originally Posted by Tina_R View Post
    Bio-medical materials including cadaver bone?
    I'm unsure whether cadaver bone would be considered bio-medical.

    Quote Originally Posted by Tina_R View Post
    Are you not supposed to grow new bone of your own, and isn't that what the bone stimulator helps with?
    Yes, fusion involves growing bone. And, the theory of bone stimulators is that it helps. Like anything else, it doesn't always work.

    Quote Originally Posted by Tina_R View Post
    If you fail to fuse, does this mean the bone never hardens?
    It means that the fusion mass never completely bridged. I believe it's that the bone bridge never completes attachment to the vertebra.

    Quote Originally Posted by Tina_R View Post
    Yet you swam without a brace in your first 6-12 weeks, didn't you?
    After my first surgeries, I didn't swim until about 3 months postop. After the second surgeries, I didn't swim, I water walked. The theory is that the implants will hold the spine in place while fusion takes place. For whatever reason, that doesn't work for everyone. If you think about the natural movement of the spine, especially with pedicle screws and rods, you'll notice that movement toward the posterior is nearly impossible, so swimming isn't necessarily risky. On the other hand, bending over to tie one's shoe, probably allows for some amount of micro movement, even with implants.

    Quote Originally Posted by Tina_R View Post
    If it's not resolved, what problems can you have?
    Pain and eventually, broken implants.
    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

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