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Alternative Procedures to Spinal Fusion

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
Hello Everyone,

I have been reading many of your posts regarding your experiences with spinal fusion. Many unfortunately have been less than successful.

At this time ESIs keep me functioning fairly well. However, I do know that in the future I may face the last option - surgery.

I have been reading about some of the clinical studies now underway or about to begin on alternative procedures and devices to spinal fusion. I would much appreciate your thoughts about these procedures/devices, and especially for those of you who are participating in the studies, your experiences.

I look forward to all your responses.

Have a MOST WONDERFUL CHRISTMAS.

RichT
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Comments

  • Hello Rich,

    I don't know much about alternatives to fusion surgery, because by the time I was diagnosed that was my only option. That being said, for me it was a good option, even if you get the idea otherwise from some of the postings. I know that some people have bad experiences with this kind of surgery, but many of us are very satisfied with our outcome. So why I don't discourage your from trying to explore all alternatives, don't reject completely the idea of fusion either. But should you discover that this is what you need, it is very important to do your homework. Do research on the various surgeries, and most importantly, try to select the best surgeon you can with a lot of experience doing the same surgery and a good reputation.

    Good luck!

    Kin


  • Hello Kin,

    I much appreciate your thoughts, advice and wisdom.

    Fantastic that your spinal fusion has worked for you, and I'm sure it has helped many.

    My greatest concern about spinal fusion is that it will limit my ability to be a very active gardener. One doc said I will need two fusions, and another said 3 or 4. I do a lot of twisting, turning, bending and lifting (at the age of 72 only 70 lb now rather than a 100 lb of years gone by lol). Two of the new alternative devices (and there may be more) are designed to enable one to retain most of the spines natural motions. For this ole gardener that is most encouraging.

    YES, I will do a lot of research and I'm at No. 8 in looking for the best spinal surgeon I can find. There is always the possibility of an "emergency" spinal situation and I have to be ready with that "best" surgeon.

    Thanks again Kin.

    RichT
  • Well, what do you know, I am the same age as you are. And I also like gardening. Now it is true that I have to watch my moves (I had three-level fusion in May '08) but in PT I learned how I can substitute good moves for bad ones. So with gardening, as with all bending it is important not to bend from the waist but rather with legs wide apart bend the knees and the a bit of bending from the hips is allowed. When lifting (and my limit is way below 70 lbs) I have to make sure that I keep the weight close to my body and keep my back straight.

    Take care and have a great Christmas!

    Kin
  • Hello Kin,

    GREAT to know that you too are a gardener. It is amazing how many of us Spineys are gardeners.

    YES, it is MOST important to know how to bend and lift things so that pressure on own's back is minimized. AHHHhhh and so important to keep those rocks and things close to ones body.

    Kin, your post validates my concerns about spinal fusion. I can't imagine how one can tie shoes without bending from the waist and a whole lot of other things. You certainly have convinced me NOT to go with spinal surgeon No. 8 who wants to do 3/4 fusions on me.

    You have given me all the more reason to hope and pray my ESIs keep working for several years yet. Your sharing about the limitations of spinal movement after fusion is precisely the reason I am most interested in the devices such as the TOPS system and the TFAS system, which enable one to retain most of the natural spinal movements. I will be following the respective clinical studies of these two devices as well as other new procedures/devices.

    One of the principal investigators for the TOPS system practices about 1.5 hrs away from where I live. I will be contacting him to see if he has had patients who are in the TOPS clinical study, and try to learn as much as I can from him about the device and his thoughts on it (if he is free to comment).

    May you have a most WONDERFUL Christmas.

    RichT

    P.S. - Okay you "viewers", it would be GREAT to have you provide your thoughts on this topic. The more discussion, the more we learn.
  • Rich,

    I don't see how I convinced you not to have the surgery, when I am the poster child of successful fusion. As far as how to tie my shoes, no sweat, I just sit down keeping my back straight and bend my knees enough so I can reach my shoes. I can do everything else more or less, including picking up things from the floor. And best of all, all my previous pain and numbness are gone, even the morning stiffness which I thought was from getting old is gone. So as I told my surgeon, he made me 10 years younger. I can tell you, I am really very glad I had my surgery and did not wait until some of the changes were irreversible.

    All the best,

    Kin
  • Hey you two,
    well I had artificial disc surgery in September and went back to work in five weeks;however, I will say a couple things about this situation. I did and do things fairly easily and have to avoid hyperextension of the neck (it has just been 3 months). I almost never take pain medications but I am in pain quite often...but not enough to keep me from sleeping or jogging or walking or anything. The pain is enough to keep me somewhat cranky at times but I have lots of tools in order to take care of myself. I did have big expectations about no pain after surgery but I will take great Range of Motion and somewhat tolerable pain with the artificial disc. We'll see and I will keep you informed. For me, I had discectomy and laminotomy in 2002 and it took 2 years for me to be without pain and back to normal; so I figure I have to give my neck that long to heal. Again, I want to emphasize that I have pain but I tolerate it and self-soothe with aromatherapy and exercise. Hope this helps a little for right now..just wanted to give you a little more input but still waiting for how I will judge my outcome.
  • Hello Kin,

    Me thinks perhaps we are on somewhat different wavelengths. That's okay, we will get things sorted out.

    Kin, I'm glad you are "the poster child of successful fusion." You are most fortunate. It is GREAT that the surgery eliminated all your previous pain and numbness, and that morning stiffness.

    Yes, I don't deny that waiting too long has its risks.

    Now to get us on the same wavelength (I hope) - You convinced me not to have the surgery because of the limitations you yourself mentioned. That would literally kill the gardening I love to do.

    Three things are at the top of my list for enjoying life - Good wine, good food, and gardening. The good wine and food are my "rewards" after hours in our gardens.

    Kin, ever work with a 12' pressure-treated 2X12 in your gardening? I'm sure not. Try that with 3 fusions in your back and you would most likely end up back in the hospital because of the damage to the vertebrae above and below the fusions. I'm not ready to give up my type of gardening.

    Each must make the decision that seems best to us as an individual. No one else can make that decision for us.

    You have provided me with thoughtful advice which I appreciate very much. Your thoughts and those of others all gets put into my "equation".

    And all the very best to you.

    RichT
  • Hello Marram,

    Thanks for sharing your experience and thoughts regarding your artificial disc surgery. AWEWOME that you could go back to work five weeks after your surgery.

    "but I will take great Range of Motion and somewhat tolerable pain with the artificial disc." AHHHhh, Marram, you think as I do.

    May I ask which type/manufacturer of artifical disc your surgeon used? I would be most interested in learning more about it.

    YES, please do keep us informed. That is how we all learn from each other.

    Sorry to read about the rather long extended time it took for your '02 surgery to "heal". I greatly appreciate your sharing this with us.

    I wish you a WONDERFUL Christmas.

    RichT
  • OK Rich,

    here is my final (well, maybe not) thought. I don't mean to minimalize surgery and what it involves. What it boils down to, are you better with it or without it? If you can continue on with your regular life by taking pain killers (I am not too much of a believer in that, unless absolutely necessary), getting injections, and whatever therapy, and there is no danger that your nerves will suffer permanent damage, then by all means avoid or postpone surgery. But if you have to give up things you love because of pain or inability to do so, and if your surgeon says that you have a good chance of recovery with surgery that is your only viable alternative, then it is time to consider it.

    Best for the new year,

    Kin
  • Good Morning Kin,

    I'm totally with you regarding pain killers. My first spinal surgeon put my on Vicodin (sp?) and after 2 weeks I knew I had to slowly get myself off of the pain killer because I was literally sleeping the days away. That is NOT how I want to live the rest of my life. Took about 10 days to slowly get myself off of the medication and another 2 weeks for the withdrawal symptoms to go away. Was not pleasant. I like you will stay off of pain killers unless absolutely necessary.

    As long as the ESIs work I'll stay away from the knife unless advised differently.

    My objective is to have a spinal surgeon selected so that when the time arrives that I need surgery I can do so without delay. I'm already looking into seeing another spinal surgeon who is very highly regarded, and who is the primary investigator of the TOPS system clinical study.

    Have a GREAT New Year!!

    RichT
  • Hello Everyone,

    Yesterday I did a bit of searching on the internet regarding new approaches to/for spinal surgery. I came across two EXCELLENT publications/articles which I would like to share with you. (I hope this is okay Admin.)

    Both are on the Medscape web site.

    "Artificial Disc Preserves Range of Motion, Restores Disc Height" by Karla Harby. This was published on Medscape Medical News 2005.

    "Treatment of lumbar spinal Stenosis With a Total Posterior Arthroplasty Prosthesis: Implant Description, Surgical Technique, and a Prospective Report on 29 Patients" by Paul Mcafee, M.D., et al. This was published in Neurosurg Focus, 2007; 22(1) and is on Medscape.

    If you have difficulty finding these, do let me know.

    Have a GREAT 2009.

    RichT
  • I have read through this thread and from what I gather you are wanting to avoid the surgery or postpone the surgery as long as you can. I also think I read that the fusion would be L3 to S1 is that correct? I am 27 years old and I just had a fusion, and I wanted to share with you a quick insight that I was given when I was told I needed surgery. As long as you are having disc degeneration, loss of disc material the space between each vertebrae is going to get closer until suddenly you will have bone on bone and mother nature will attempt to fuse you on her own anyway. I have a friend who is my age, and she has bone on bone now because she waited to long and the surgeons can only assist the fusion that is already taking place. The bone is grinding on bone. She can no longer have spacers anymore because it all collapsed from L4 to S1 and the pain she has is worse than ever. The one thing she wishes she could do is go back and have done the surgery.
    There are alternatives, there are medical break throughs, there are all these other things that we can do, but one truth so many miss, is that mother nature will fuse your back for you, and she may not be the best surgeon out there.
    Just food for thought...thought I would post something, and please dont think I was trying to sway you, its just info to chew on. Best of luck
    Erica
  • Hello Erica,

    Thank you very much for your concern, thoughts, advice and wisdom.

    Erica, I have seen eight spinal surgeons todate. Not a single one has brought up the subject of "if you wait too long and the discs collapse then mother nature will attempt to fuse you on her own." I do know that the "thickness" of the discs are about half of what they would have been when I was 20 or so. I REALLY appreciate you bringing that to my attention, BECAUSE I know I must consider ALL issues/factors in this spinal equation of mine.

    Thank you for the example of what can happen if one waits too long. That issue has been on my mind for some time. And part of the reason I have seen eight spinal surgeons todate.

    Yes, you are very correct in that the worst areas of my spine are from L3 through S1. After my "current" spinal surgeon said to me that I have one of the worst spines he had ever seen, I asked him "okay doc show me where on my spine is normal from the MRIs so that I can "compare"" to which he replied "there isn't a normal spot on your spine." That took me back a bit to say the least.

    In the early stages of my searching for spinal answers my PM doc told me that shortly after my MRIs were taken the entire medical staff at the spinal institute where I go got together to discuss my spinal situation. Appaarently there was quite a discussion amoung the spinal surgeons as to what should be done, what could be done that I could tolerate at my age of 72, etc. It was then that my PM doc (to be) spoke up and said "should we not first try non-surgical options" to which I understand the surgeons agreed. For which at this point I am thankful.

    Erica, it took me several months in the summer of '07 to come to a decision that I feel comfortable with and that is right for me.

    ESIs todate still are working. I can basically do the things I want to do like GARDENING!!!. Oh yes, I have made compromises, compromises which I accept.

    I also know that at some time I will most likely need to have surgery. That is why I continue to search for the surgeon that I REALLY feel is the one for me. Something like searching for "Mr. Right" for you ladies. lol

    I am continuing my search for a spinal surgeon for I know I must be ready in case there is an emergency situation. In fact, tomorrow I will be calling to make an appointment with spinal surgeon No. 9 (and that will be a 1-1/2 hr drive one way).

    As you know Erica, I am most interested in some of the current clinical studies underway, especially those in which the spines normal motions are preserved. YES, it will be a tight race to the finish so to speak. AND if necessary, I'll opt to have surgery in another country if the process in the U.S. is taking too long.

    With all of that let me put my thoughts and decision down in writing. - As long as the ESIs work, I will stay on that path unless a situation as you describe comes up. I will if at all possible go with surgery where I will retain the greatest "normal" spinal motion. I will avoid as THE VERY LAST option spinal fusion surgery.

    Erica, THAT is how important my gardening is to me. More important than good wine and food - WELLLll a very close race. lol

    Take care, and thanks again for your very thought provoking post. I value it greatly.

    Now a bit off topic - Ever see someone and say "I have seen that person before but I can't remember where". So it is with the photo of yourself. Erica, that is driving me CRAZY. Were you on SH say 1-1/2 years ago? Have you been on other health forums where you shared a photo of yourself? Some place, SOME PLACE I have seen your smiling face before.

    Have a FANTASTIC 2009.

    RichT



  • Thank you for reading my post and responding. I understand how important it is to you to find the right surgeon with the right skills to do the right procedure whatever that may be for you. I some how lucked out with both my knee and back surgeon. Niether one of them gave me some BS beat around the bush answer, and for me that is what I appreciate in my doctors. I trust thier confidence. Each one said, here is the problem and here is the solution, and after we fix this and we WILL fix this, you will have the best after care we can offer to give you your quality of life back. Trust me I can relate, if I didnt think for one second I understood or felt comfortable with anything they were saying I would make them bring me a book or medical journal and break down the process to me. I am not a typical patient. My NS was so good my fusion was same day outpatient, my pre op and post op team were great as I was relaxed and comfortable through all of it. I am glad you found my tid bit useful as you weigh out your options because like me you want to research and have the knowledge upfront to make the decision that is BEST for YOU. My friend (the bone grinding bone I mentioned) went to see him for a second opinion after I had such success and it was too late for her to get spacers in her back, the doctors prior to him had let her down and now she is paying the price for not having the knowledge. So trust me when I say I understand why you are searching for the best solution for YOU and why you spend the time to research options. For me it was cut and dry when he laid that on the table, I was going to fuse one way or the other so I chose to let him do it while I had room for spacers. I didn't want mother nature to do what she is doing to my friend. I do hope you find the answers you seek and the surgeon that fits your personal needs.
    As far as who I look like, Ive been told countless times that I look like Melissa Joan Hart, she was the actress in the sitcom Sabrina the teenage witch several years ago. Maybe that is the resemblence you see, Im not sure. I joined this site three weeks ago so it hasnt been that long. Let us know as you find more out about your situation. Have a blessed and wonderful beginning of the new year.
    Erica
  • Hello Erica,

    "My NS was so good my fusion was same day outpatient" - A fusion outpaient - that is something I have never heard of before. TOTALLY AWESOME!!!

    May I ask a question - Did your doctor ever explain to you perhaps why at your young adult age you have (had) the spine issues that you list? I've come across some only in their late teens with spinal issues, and it is not always because of an injury. I honestly can't recall that as I was growing up.

    Melissa Joan Hart? Perhaps, but there still is that crazy feeling that I've seen your face before.

    Erica, thanks so very much for sharing. It is all much appreciated.

    Have a GREAT Day!!

    RichT
  • Yes it was outpatient and yes it was a fusion that was multi level. I get the jaw drop a lot. 99 percent of his patients with this type of surgery are outpatient. I had a PLIF done L4 to S1. My young age, there is nothing I can recall that was the point of injury, but I did do alot of back lifting in many of my jobs. Lifting way more than I should have for quite a few years. A good majority of the population has buldging discs but they are a-symptomatic so they never realize they have them. I was one who had symptoms because of the direction it slipped and it hit a nerve. I imagine it was the lifting I did, the shot put I did in track and over all bad posture. I did show signs of dehydration and degenerative in the discs that were effected. My L3 looked fine on the discogram so it could have just been an injury that took a while to present itself. We couldn't pin point (me and the surgeon) how it happened but it was a slow progession over about five years when I first noticed it, and it really presented itself with full on pain in 06.
    As for recognizing me, I dont know haha. Wish I could tell you maybe I have one of those faces that reminds people of someone else. Who knows.
    Yes the outpatient was totally awesome! Like I said I trusted my surgeon and that made the difference. He was no BS and got the job done. What more can you ask for, except the final product of fusing.
    Erica
  • Good Morning Erica,

    Thanks for your response to my questions, and sharing of your spinal "history".

    May your recovery continue to go well. A word of caution if I may - It takes longer for ones body to heal from surgery than the mind thinks it does. So be patient and follow your doctor's recommendations.

    Take care.

    RichT
  • You are very welcome, and sharing my own experience is really what these forums are about. None of us are experts in this field, and I dont claim to be. Its nice to talk it out, as I very well know from a previous surgery, the mind does have its ways of making you think you are ready to take on more than your body is able. So I am taking all the precautions I have been given to heart, I follow them and I just keep with forward progress. Down days, or up days, they are all days leading to a better day. That is all I can ask for, and pray for. Thank you for the converstations and let us know if you find another treatment that works better. All the best,
    Erica
  • Hello Everyone,

    Just a bit of an update - Called to make an appointment with spinal surgeon No. 9 this morning, the one who is a principal investigator in the TOPS system clinical study. After a few questions from his secretary, she recommended I have a new MRI since the last one was in Mar '07. That I will do. Then I will send them the new MRIs and the old ones along with my spine x-rays. Dr. M's associate is then to review all of the images upon which I will see the associate and get his/her thoughts. This seems like a reasonable way to go, BUT -

    I really was hoping I could make an appointment to see Dr. M on the first go around. I'm sure he is trying to operate his office in the most efficient manner possible, but two 3 hr round trips before I get to "the man" doesn't make me happy.

    First is a call to my PM doc to hopefully get a prescription for the MRIs and to ask him his advice if now is the time for another ESI.

    Have a GREAT Day!

    RichT
  • I really hope this is the right doctor for you and you get good news about treatment options. I also hope your MRI shows that everything is as it was and nothing has progressed, you'll be in my prayers. Please keep us updated :) Best of luck
    Erica
  • Hello Erica,

    Yes Erica, those are my hopes too. Thanks for your prayers, much appreciate, especially after yesterday's GRRrrr arthritis flare-up.

    I had an appointment to see my PM doc yesterday, but because of the "bad day" I rescheduled for next Wednesday. Also scheduled an ESI for next Thursday. Will of course first see what my PM doc has to say.

    Erica, how is your recovery from surgery going? I hope all is proceeding well.

    May the new year be all you hope it will be.

    Take care. May your days be GOOD days.

    RichT


  • Rich, a lot of the hospital stay depends on the approach used. My Neurosurgeon is one of the best in the area, but I had to stay 4 days. When you have a 360, you're definitely supposed to be kept overnight. The thing is, when they go in through your stomach, they move around your organs and things get a bit screwy. They aren't supposed to send you home until your digestive system regulates. Which means, you have to be able to have a BM, and you have to be able to digest solid food. I was on a clear liquid only diet until the day I was discharged, because I had such a problem with my stomach. I probably could have stayed 2 or 3 days instead of 4, if I didn't have the problems with my stomach. I didn't mind, though, because my pain was unbearable, and I really needed the IV pain meds.

    Also, as for young people with spine issues not related to injury... Sometimes it can be genetic. In my case, I didn't injure myself. I had back problems since I was 15 or 16, and neck problems from some time around then on. My mom has had back problems as long as I can remember... She has about 5 affected levels. My older sister also has back and neck issues. My Neurosurgeon said that it very well could be hereditary, seeing as how we all had natural degeneration of our discs. Basically, a person can be genetically damned to have a bad spine. We really can be born with not so great discs... And that's pretty much my problem. I will more likely than not need future spine surgeries, but... What can you do? I really have no choice, since I didn't have any control over my genetics. Heh. At least I have a great surgeon.
  • Hello Lo,

    You have made some excellent points!!

    YES, the approach AND expertise of the surgeon is extremely important as a factor in how long one must stay at a hospital.

    I frankly don't have much love for hospitals, and the sooner I can get out the better. HOWEVER, I'm with you in that it is far FAR better to spend and extra day or two in a hospital so that just in case there is an unforseen difficulty you are there and they can take care of you immediately.

    Most interesting that you should bring up the genetic issue regarding spine problems. My Dad suffered from the same sort of back issues that I now have. It started for me back about when I was 45. Same happened to my younger brother. Now our daughter mentions that now and then her back hurts. AND it hurts me to know that "bad gene" will continue to be passed on to future generations.

    What a medical milestone it will be when science will be able to correct the "bad genes" and eliminate this "handing down" of body difficulties.

    Not much left of 2008. I wish you the best in 2009.

    RichT

  • Hello Everyone,

    I've been doing a bit of researching regarding spinal product/devices being clinically studied.

    I'm BLOWN AWAY by the number. Seems like the "activity" started to take off in '05, and since has really been on a roll. Sure will keep FDA busy.

    SH has a number of studies listed. To see more may I suggest you go to Google and type in "FDA spinal clinical studies".

    RichT
  • Hello Everyone,

    The subject of Artifical Disk Replacement (ADR)has come up recently. In searching through the internet I came upon a very good website which I would like to share with you called ADR Support. The link is as follows:

    www.adrsupport.org

    Wishing you a VERY Good Day!!!

    RichT

  • Rich,
    Did you find out more about the TOPS trial? I am also interested in it, but cannot find people who have had this surgery.
    Randy

  • Does anyone have any current information about the TOPS clinical trial?
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