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360? I need advice and help!!

nursedina001nnursedina001 Posts: 235
edited 06/11/2012 - 8:30 AM in Back Surgery and Neck Surgery
Hello all,

I went for a second opinion to a well respected major hospital about 3 hours form my home.

My new neurosurgeon has a completely different idea about what is going on wiht my back then my old NS does and I am very confused on what to do.

The old NS belittles my on going pain and seems to think that it is caused by an SI joint. Every pian that I have she seems to think it comes form there. If any of you remember, I also had post op problems with getting in touch with her, and her keeping appointments. (She cancelled my surgery 4x and has cancelled EVERY appt I have had with her at least once, if not twice). She has said my MRI and cT scans look fine and everything is going ok but has told me to apply for disability and started me at PT adn set me up for injections (which are not helping)

The new NS has told me that according to my CT scans, there is no bone growth at all in the fusion space. Not even a little bit, none at all and since my old NS did not use a spacer, there is too much movement at the site and one of the screws is starting to come lose and another is showing signs of movement. He gave me a big brace, told me not to do anything at all in the house, no BLT restrictions and said we will re-eval in 2 months (will be 7 months post op at that time) and said if there is still no bone growth at all, he recommends a 360 fusion on L4/L5 redo and then L5/S1 also. He said if the whole from the screw gets too big, it will need ot be a 3 level fusion.

SO..I am so confused on what to do and which surgeon to stay with. And I know nothing about recovery from 360 double/maybe triple fusion.

Any help or advice would be appreciated.

Thanks everyone in advance!


  • Dina -

    I had 360 (ALIF/PLIF) at L4/5 last July 21 & 23rd. My surgeon prefers to do this as 2 separate surgeries to reduce the time the patient is under anesthesia at any one time. So I had the anterior on a Monday and the posterior on Wednesday and went home on Friday morning.

    I am not sure how recovery time differs from PLIF alone - but based on what I have read I am not sure it is very different for most people. My anterior incision bothered me initially more than the posterior one - but I had staples in the front. Once they were out it felt much better.

    At 2.5 months post-fusion I traveled by plane - an all-day trip with the lay-over in Chicago and the 1.5 hour drive to my cousin's house. I expected to be really sore but wasn't. Then the next day we drove 4 more hours to get to my Mother's - and I did fine. I still got tired more quickly than I would have liked but if I paced myself and made sure I got in some lying-down time during the day I did OK. I think it was at about 4 months that I found my energy level got much better.

    Overall, post-op pain was not bad at all. I stopped pain meds at about 2.5 weeks post-surgery (because they made me so sick) and just used heat and ice for the discomfort. Some left hip/pelvic pain has been my biggest issue since about 6 weeks post-surgery and I am still trying to find an answer to that. But I rarely have back pain unless I stand for longer than usual.

    My surgeon insisted on the ALIF/PLIF because he said it is more stable and increases the success rate. I go for my 9 month follow-up visit next week.

    To even think of having another surgery must be very difficult - however, if it would reduce your pain and decrease the chance of further damage it might be worth considering.

    (Sorry this was so LONG!)

  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    I had a 3 level. With my own bone harvest, from hip, mixed with cadaver bone donation.
    There is a much better success ratio with a 360 and less chance for graft rejection with some of your own DNA from your bone harvest. usually from the hip. a little extra pain from that extra surgery but better than a graft rejection! Its a more thorough procedure. With less chance for fusion failure.
    As for your first surgeon, I'd run away from her and RUN FAST!
    I hate to throw in more confusion. But if I had it to do all over again I would investigate a high tech ADR done in Germany!
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • If I were you, I would get a third opinion, this time with an orthopedic spinal specialist. Your first surgeon sounds like someone worthy of investigation! Just from what you've described, she sounds really unprofessional, to say the least. A third opinion would let you know if you are on the right track with the second neurosurgeon, if nothing else. I found in my journey to decide on a surgeon, that the orthos had a slightly different approach to things from the neuros I saw.

    If you like the second NS, then I would just go with him, and never look back. The first surgeon has NOTHING to offer you and it sounds like she botched the first surgery.

    According to what little I know about your situation, what the 2nd opinion neuro is recommending makes sense to me. Are you going to follow his suggestions and wear the brace? There is no reason why he would tell you there was no bone growth if that were not the case. He has nothing to gain from it. Statistically, I think most people would be showing some growth this far out from surgery.

    In a way this is exciting news. I know you don't want to face another surgery, but if this means you can get your life back, it will all be worth it!!

    It is amazing that what the two specialists are telling you is SO different.

    Barring something unusual, the second surgery will not be much different from the first. There will be a bit more surgical pain to recover from, but the fusion itself will be about the same. It will be much more stable and secure and you will just about be assured a complete fusion. This may seem like a lot of surgery to you, but it will probably provide the best chance of recovery for you.

    What Jim said about the trip to Germany might be appropriate for some, but not for you. As far as I know, with DDD and spondy, you would not be a good candidate for ADR.

    I know I am not the one facing this big a surgery, but I am excited for you. You were being told to file for disability, and now you have a chance of getting your life back! I think this is very good news.


    xx Gwennie

    (I see we all had our fusions at L4-L5. I had a PLIF with a PEEK cage, rods and pedicle screws and BMP mixed with my ground up bone from the lami. )
  • I have a similar situation! I will have a 360 at L5/S1 this coming Tues. I had a 2 level PLIF (a rough surgery) in Nov. '07. They got a cage in at L4/5 but couldn't at L5/S1 b/c the disc space was so narrow and the nerve dammage so bad. They left the slip and disc the way it was, crammed BMP in the space, and hoped that it would fuse with the hardware. Well....it didn't! So, I now still have my slip at L5/S1, no fusion there, a hard fusion at L4/5, and 2 loose screws from the micro movement. I go in for the 360 so they can do more decompression at that level (they suspect spurring), put a cage in (a wedged one to prevent anymore slipping) and then new screws (larger ones) to tighten what I have. My fusion will be one level, but the 360 will be for (about) the same reason. I have heard the same stats on the 360 success stories. That's why I'm doing mine. I agree to run from the other surgeon! The NS sounds somewhat conservative (giving it a little bit of time to try and heal), but realistic (to suggest the 360). I can keep you posted (since you're waiting on any changes anyway), and let you know how my 360 goes. They're doing mine all in one shot (I'm glad).
    Hopefully you get more info! I'll write when my surgery is done and I'm up and running.
  • Thank you for your advice and support. I have decided to go with the new NS and follow his treatment plan. I talked it over with my family and decided that was the best route.

    Thanks again

  • I had the 360 done almost 6 weeks ago. My postop was this past Tuesday, I already have fusion starting! He actually encourages me to bend, a little to keep the muscles from getting week, nothing repetitive though. It is much more stable, he told me a standard fusion from only one side is like stacking coke cans on top of each other and then screwing them together at the sides, eventually they will move, impeding fusion. 360, the discs can't hardly move at all. Good luck!
  • I had my 360 fusion and ADR about 5 months ago and so darn happy I did it. I had the same surgeon as the previous poster and man does the doctor know his stuff wtihout being arrogant. The surgery was done in just over 2 hours and I went home the next day. The first days ar the hardest but I was pain free with the meds and ice. I stopped all meds after 1 week and never looked back. Things have progressed well and I have been back at work for a while now. I don't get to post as much because I am now back to my old self but I truly love this site and hope the best for everyone.
  • I just want to comment on the dr saying you may need a three level if the hole is too big from the screw. I wouldn't trust that myself. If there is nothing wrong with the third disc, why fuse that level? just to put more hardware in? I had a two level fusion and due to a screw problem had two on one side and three on the other and it worked fine. If the hole is too big, why not just leave that screw out?
    It just sounds iffy to me when someone wants to fuse an entirely new level due to a screw hole...hmmmmm.
  • His reasoning was that if the hole got too big, (we mean real big not just bigger) there will be nothing to hold the disc space together since my old NS did not use a spacer or anything, there is nothing in between the vertebrae right now...just a big hole...so there would be nothing to hold L4/L5 in placce - he said if hole got bigger he would just hold in place with bigger screw but if it got too big, (really too big) that he would have to place hardware in upper level (L3) to stabilize vertebrae if nothing could be put in L4/L5 due to damage from screws..

    not sure if i explained that right...:) Its in my head right but to explain it on here is hard..lol..
  • I am so sorry you are having such problems. i had the same surgery Dec 11 only l4/l5 and l5/si. I am still having alot of pain and saw my Dr last week. A month ago I had MRI cause of really bad pain. Felt like post op. I had predisone and waited. It didnt help pain much but inflammation. He told me last week that everything is looking good and he wouldnt do a cat scan until at least 9 months. He also told me that he told me it would take 6 to 12 months and that I was only 4 1/2 months out and I need to walk walk walk. I was supposed to start water therapy this month but he nixed that until my visit back to him on June 4. Sooo. I guess I will wait. I hope that the surgery goes well for you. I havnt had anything that shows screw problems and he did put cadavar bone in when he did the discectomy along with BMP. I will pray for you that your outcome will be favorable to you. Its is a long hard road isnt it. But I am glad you found a Dr you feel will help you. If you need any help, feel free to PM me. Im always here. Not much else I can do except walk. I am also on B LT and no work. So sweeite,,,Good Luck...
  • By the way, today I turned 49. I had the flu, yesterday got a steroid injection behind my kneecap, back hurts,and am on steroids and penicillin for bronchitis. Maybe next year will be better. They say 50 is the new 30?? :)
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