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Failed interbody graft

AnonymousUserAAnonymousUser Posts: 49,900
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
Has anyone ever had two interbody grafts (cages) fail to fuse? I had my first surgery April 2007. Continued to have pain and MRI revealed failed fusion at L4. I had L5, S1 fused using ALIF, L4 was fused using a cage, which failed. I had surgery again in April 2008. The surgeon removed the cage and replaced it and he also added two screws to help stabilize. Well, I started experiencing the same pain again. I had another MRI, which revealed the same problem. For some reason my spine refuses to fuse. I started taking Lyrica 3 weeks ago. It really helps with the pain, but I am concerned. The neuro didn't really address what to do about it. He said that since the meds are helping that he didn't want to operate again. He suggested that I wait a few months and then have another MRI taken to see if there are any changes. I go back in 6 weeks. What do I need to ask?
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Comments

  • Your second surgery is really "failed" until your one year out unless there is notable hardware movement. Was the option of bone stimulator discussed?
  • I had cages with hardware 6/07 and am still not fused. I've had many complications since and am preparing for my 2nd surgery since the fusion.

    I would get a second opinion just to make sure someone else might think of something else.

    There are many reasons why someone might not fuse. Sometimes it is just dumb luck. I understand that sometimes loose hardware, too big of hardware, smoking, NSAIDS, obesity, and other things might contribute. I've read where some believe that overpacking the cages with graft material can cause pseudoarthrosis(non-fusion.)

    If Lyrica is helping your pain, I assume you have nerve pain. If the problem is pseudoarthrosis alone, I understand that most people complain mostly of back pain. If you are having nerve pain(and Lyrica is helping), it stands to reason you might still have nerve compression and therefore pseudoarthrosis might not be your only problem.

    I have lots of questions for my surgeon after this next surgery(he is not the one who did my first surgery, the fusion.) After I have surgery and find out all what he discovers, I will post an update on myself.

    I really think you should get a fresh set of eyes look at you and your scans. Your surgeon might be right on and you not fusing is a fluke, but if it were me, I'd want the peace of mind to make sure nothing else could/should be done.
  • if you have suffered a pseudoarthrosis talk to your doc about revision using BMP. It's non FDA approved for the neck but it works very well and has some well know side effects that are easily treated with pulsed steroids.

    BMP will get you a fusion for a failed neck. Its a greast option.
  • ernurse

    I am considering a second opinion. I think I fall in the dumb luck category. The surgeon and I both believe that I have nerve damage. I have spondiloythesis. We did not know why until I had my first surgery. He found spina bifida occulta (mild) and some deformity of the the lower spine and pelvis. All that in addition to sponiloythesis and a herniated disk. I never had any back problems. The problem actually started out as hip pain and progressed to leg and lower back pain. Thank you for the information. I wish you luck with your up-coming surgery.
  • Looks like her issue is lumbar, L4-L5-S1. BMP is FDA approved only for use in lumbar, and only for anterior approach last I read. Very dangerous for neck (and considered "off-label").

    Ann - BMP (bone-morphic protein) is a "matrix" of sorts that when mixed with cadaver bone, stimulates or tells the bone to grow.
  • BMP is worthless CR*P! I'm sure it's helped one or two people, but the risks are NOT worth it. One of the reasons I'm up for a 2nd surgery after fusion is because of BMP. BMP grew bone on nerve roots on both sides that had to be cleaned out and now the other side needs cleaned out. The package insert from the FDA actually warns doctors of this possible complication(you can read it on the FDA website and I've previously posted links to it.)

    BMP grew a complete boney tunnel around one of my nerve roots completely compressing and flattening the nerve. This did NOT show up on MRI or CT. While my leg is better since removing the bone, I have permanent nerve damage in that leg-which sucks because after fusion surgery all leg pain was gone then returned at 5 weeks(when the bone grew.) BMP did not cause any sort of fusion between my vertebrae as it was supposed to. I have a different surgeon now who has done the follow up surgeries(one is coming soon.) Know that BMP induced bone growth is not my only problem, but is the worst.

    Like I said, I'm sure there are some lucky folks that BMP actually helps, but no one who saw me preop and now sees me would ever consider letting anyone use BMP in their fusion. I am a mess. I went from being a very physically active person, wife, mother, and working to someone who is using a handicapped parking tag and feels lucky if a day goes by where I don't cry from pain.
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