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failed two level fusion

tcr1130ttcr1130 Posts: 122
edited 06/11/2012 - 8:41 AM in Back Surgery and Neck Surgery
my surgery was in march of 2009, i had l3-4 and l4-5 done., i have fused lat l4-5 and have bearly any fusion showing in the myelogram at l3-4 ... he is giving me till march to fuse and if not says i need to have a plif done..he will pull the screws and redo the fusion the old fashioned way he said... i orginally had an XLIF done....

i have used a bone stimulator for the last three months and the first 4-5 months after the surgery, i have been in the back brace again the last two months.... the want me to try a drug called forteo but havent gotten approval yet for it and of course am running out of time to fuse( found out yesterday my pcp doc WON'T get involved in the forteo drug - very bad side effects ... has anyone used this drug for trying to fuse last minute or at all for that matter??)... i just wonder with all of us that have had back fusions done, how many have failed at fusing at both levels.... how common is this!?? or isnt it!?? and what happens if you dont have the second surgery, and or how bad is it if i do.......... looking for everyones input on this that has some.... how dangerous is this not to be fused at that level!?



  • I had a big fusion 2 of 2009
    At my last every 3 months check up I asked if I had
    started to fuse yet & my surgeon said that takes a special kind of xray to show fusing

    my hardware is all in place = but if it takes a special xray - when would they usually do that???????
  • Do you smoke? Are you eating healthy? Have you had a Vitamin D3 level checked? I know this is rather a holistic way of thinking, but I am doing everything that I can to fuse.

    Susie, I just had a regular X-ray at 9 weeks, and you could see some white streaks. It was the standard type of x-ray that I've always had.

  • I don't have any advice but just stopping in to give you a hug.

    I know I read to limit use of ibuprofin because that can slow fusing. I also know smoking slows down fusing. I'm on over the counter OSCAL and I'm not a fuse patient but with back surgery they want me taking it to help ensure bones stay sturdy.

    I wish you all the best...hopefully others can offer more advice.
  • the test is called a myelogram i had one done in december it showed im not fusing one of the two levels... reading around the site a bit i see that its common to some degree for two levels to fail, but im trying to find out how common a multiple level fusion is at failing compared to one a level fusion... myelograms they dont like to do, but it is the only test available to see if youve fused, it is a painful test, wont lie about that,.. mine was done at 9 months and im at the 12 month marker now and i find out in two weeks if i have to have my original xlif redone as a plif...... im not thrilled at all at this point.... just trying to get as much info before i see him as possible.......

    does anyone know .... what truely does it mean if you dont fuse!? can you live that way!? im in a ton of pain, and i know thats why we are revisiting the plif - that i wish he had just done in the first place instead of this new xlif they did... but, its the pain thing... but what does it mean not to fuse, i now the cage is exposed.. but how bad is it for ones health not to be fused..... im having a hard time excepting i have to have a plif.... thats why im here!
  • oh i didnt comment, i dont smoke ... im not overweight, buy his standards im underweight a bit, but have put some weight on not being able to do much so ... im better at norm now for my height, he has me taking calcium and vitamin d pills ... so im doing everything right that i can

    ive been back in my brace for the last three months and back using my bone stimulator...... but as long as i bend or twist, i cringe with pain
  • SpineAZSpineAZ WiscPosts: 1,084
    A fusion can be re-attempted. Most likely with a more traditional posterior or anterior approach (or a combination of both).

    I had a psuedarthrosis (false fusion or basically a failed fusion) and didn't know it for years. My L5-S1 fusion w/o hardware in 1987 (posterior) didn't fully fuse (and I was much younger so you'd think age would have been on my side). In 1993 I had a second attempt and at first the surgeon told me he'd just go in and make the fusion more solid. He said when he got in there, he didn't see a way to re-do what had been attempted so he had to switch gears and do an L4-S1 fusion with hardware (wasn't expecting to wake up with that). He wanted to do hardware at L5-S1 but my L5 would not take the screws.

    L3 slipped forward in teh last year so I just had an L3-S1 fusion. Again L5 was resistant to screws so I have screws at L3, L4 and S1 with rods on each side. This time is was a combination posterior with lateral approach. I have a 4" horizontal incision on my left side. Not like an Axial LF or XLIF, just a lateral assisted posterior approach.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • spine az, did your doctor tell if you mandatory to get the refusion done, is it dangerous to go around with out being fused!!!??? no one has really said if this is dangerous, ...... i know he is going to say he wants me to have the plif in a couple weeks... my head is telling me once again i have to push for a myelogram to prove that everthing ive been doing the last three months isnt making any improvement towards it fusing more... and if it did show a little more bone growth, would that mean eventually it would fuse... he said normally they get a full fusion at 6 months, but they will go up to a year waiting for to....... im scared how this will turn out.... i have a congenital fusion as s1 and i wonder sometimes if my l4-5 shouldnt be locked into that l5-s1 because what if its causing some of the pain...
    before surgery i had horrible back pain, and sciatic pain so bad i couldnt work the pedals in my car.. after surgery i woke up with rsd in my right foot, and unable to move my left foot or left arm above my wrist.... it was the scariest feeling in the world.. over 4-5 weeks my arm started coming back, the rsd in my right foot got worse, and now im not fusing, i dont want a plif, and if they do one i want them locking everything down so i dont have to do this again..... the doc suggested the xlif for the first one, should of been plif from the get go.... because of that decision i have to do this twice.... i think...... what would any of you do at this point!? do you live with the pain, where your brace the rest of your life,hope you dont injure your back, or do you go back in and get it fixed?????

  • my doctor totally changed what he said at christmas from his last visit, he rushed me into the office in december after reading my xrays, seeing that i wasnt fusing and that he may have to back in and do a traditional PLIF ....... in march when i saw him, almost put me on the floor, said he had been trying to talk me out of the surgery from the get go ( which is not true) and said that surgery was not the way to go., even though the diagnosic shots for the surgery seem to be helping .. im so confused, why do we have doctors to change there minds that quickly, nothing changed in my symptoms of the spine fusion., he wanted me to take a drub called forteo, but after saying it doesnt matter if i fuse , why go thru all the appointments, all the side effects, and find out all the reasons non of my other doctors would give it to me., so i decided not to do to it., but i am confused., this is my doc., i need him to stay on even ground with me, how can i make the best decisions for me if he doesnt tell me the same thing everyweek...... need help!>> anyone offer any insight on this!!
  • Have you considered seeing a different doc for a second opinion?

    Sorry that you are still having so many problems. It's good to see you again, but not under these circumstances.

  • Sounds like you need to have an open and honest talk with your doctor. And bring someone with you!! It sounds like you like your doc and want to stay with him so don't give up or get frustrated. Just tell him honestly what you are feeling. Obviously you are upset, nervous and confused. You need him to understand this and explain all your options along with the pros and cons of each.

    Surgery is a big deal and shouldn't be rushed into. Maybe get a second opinion just to get some reassurance. But talk to your doctor first.

    Good Luck
  • Can you get a second opinion?

  • sleep,

    i did go for a second opinion., and as my primary prepared me, he said its hard to get doctors to give second on other doctors surgeries, etc, so last time i needed a second opinion i didnt have any problem ( 10 years ago ) so i expected it to go fine., well he was right, he really wanted nothing to do with the it., once he heard i got rsd after the surgery, he was kind of out the room., never looked at my scans, never looked at the paperwork send from the papers i had sent over.. it was a waste and left me feeling like shit, actually drove to my primary's office in tears i was so pissed off..... i have tried one second opinion., may need to do it again, but this rsd seems to be the problem now for them., but for me i have a back that isnt working, ive been in my back brace for over a year now., and am in pain within minutes of trying to do things without on it.... i still have pain with the brace., but nothing like if i try to do things with it off., the doctor told me in the one visit im not stable at that l3-4 level., and in the second visit with my surgeon he kinda do a wipe of his hands., its not fair, we get 10 minutes with these people., and my life and livelyhood depends on that 10 minutes, because i want to get better
  • Even though the last "second opinion" didn't go well, I wouldn't give up on finding a doc who is just as concerned with the mechanics as he is with compounding the RSD.

    The RSD is serious and should be a concern by all your docs, but it shouldn't be the "great erasure" so to speak. Since your primary doc seems to really want to help, can he try again to find a surgeon to give you a good evaluation?

  • Hi C,

    good to chat with ya again., i guess im going to have no choice but to try with my primary again....... he was the one that warned me second opinions are getting harder and harder to get, saying a lot of doctors dont want to get involved with it., and second, they arent going to get the business from the opinion, so why give it!! ya know what i mean.....

    i have my third round of shots tomorrow for this year...... they are focusing on that l3-4 area that isnt fused...... with the shots and the brace, i can get around to do basic stuff, so that has to tell them thats the area that needs to be held together better., maybe that xlif just wasnt the way to go for me., should of had the plif from the getgo!!!!
  • tcr1130 said:
    Hi C,

    and second, they arent going to get the business from the opinion, so why give it!! ya know what i mean.....

    should of had the plif from the getgo!!!!
    No I don't know what you mean. If you go into another opinion with the idea that the first Dr. is going to do the surgery, the second opinion Dr. will most likely pick up on it. Why go for a second opinion if your just going to have the first Dr. do the work? It is the opinion of the Dr.'s you are looking for, and it is just that, an opinion. It has to make sense. I've had 4 back surgery's and the second opinion Dr. did the work in 3 out of the 4 times. Actually you should probably get at LEAST another opinion, if not 2 more. You are approaching the area where you are going to be running out of options if this surgery doesn't work. So what happens if you have a PLIF done and it doesn't fuse? This would be my biggest question to any Dr. that would do a revision surgery, which is what you are talking about.

    The PLIF and XLIF are not the same surgery's. In one they are taking out the disk and putting in a cage with bone, or matrix and some will use hardware to tie the mess together. In the other they are just putting in rods and screws along with some bone matrix under the screws. Usually with a PLIF they also will do a nerve opening procedure, or two to uncompress the nerves. They don't usually take the disk out and put in a cage using the PLIF procedure. So in my eyes the 2 procedures are for different problems even though they both are labeled fusion surgerys.

    Just my opinion based on having been through the medical wringer.

    Why did they do a fusion (XLIF) on you in the first place?

  • hi david

    i had the two level fusion, for two badly herniated discs, and bad sciatic pain, that last for almost a year and a half before we went to surgery, i tried everything available before going that way...

    it was my doctor that oscilated between xlif and plif.. from day one, so i am only typing from what i have experiences., right up to i believe a week or two before the surgery did he finally make the call that he thought the xlif could help me more with my problems than the plif..... when we spoke at christmas the comment was to go and do a plif with all the heavy hardware screws, i have horrible pain on anytype of movement in that area of my back..... and they found that l3-4 didnt fuse, (hardly at all) l4-5 fused nicely.....

    a lot of what i say is either what ive gone thru, or what im being told by doctors, never assumptions i am making, opinions i will get as i go... i know this RSD i have ways heavily on all my doctors minds, even my primary doesnt know how to advice me with this....

    so i am having my shots tomorrow., and i see my neurosurgeon again in june to see how things are and if the pain is getting anybetter., i try going out without my brace for an hour here or there, but the pain is to much., i have tried stretching out my fentynal patch, but last time the RSD got so bad i couldnt stand it...... im just relying on a lot of things doctors say and i only get 10 minutes to all this information and make some sense with it., maybe my insecurity with all this, is from listening to my neurosurgeon and pain management doctor ( they are in the same office - and constantly tell me the exact opposite thing) it ways on ya., then to go get the second opinion, and have him bearly open the folder. - its just keeps you from wanting to go thru that again....

    i hope that makes sense..... i do the best i can everyday, with what i know, and with im being told., and i come here for advice inbetween.. so thats my life... im trying!!!
  • I have no experience with RSD so I will not comment on that. It has been my experience that ALL these Dr.'s seem to want to blame problems on things other then what they have done. How many Dr.'s have you heard of that say oops we should of done this or that. I know lawsuits. I live in a area of the country where it is easy to get second opinions and thirds for that matter. Just have to have the coin to pay for them.

    If I were getting conflicting information from 2 Dr.'s in the same group I would be changing one or the other or both. There are Dr's out there that will help you even with your problems. You may not like what you are told but I would rather know what the odds are going into something. I have always asked to many questions and done a lot of research before hand. I have pissed off a few Dr.'s with my questions. To the ones that won't answer or evades my questions, I am done with.

    Maybe you need to go out of your immediate area and away from your current Dr.'s area of control to get another opinion. I don't know where you live so I can't make any suggestions. Any large teaching hospital that specializes in spines would be my first choice. A teaching hospital is current with the way things are done and also the Dr.'s tend to be a whole lot less arragant and more forthcoming.

    You have to be your own best advocate and ask questions, ask questions, ask questions. It has to make sense. I am not saying you didn't ask.

    Good luck in getting some relief from your injections.

  • thanks david, i think thats the one thing i do they get tired off - i do ask to many questions., someday i will be able to run the place (lol, l0l)....

    i guess i will see what happens after this round of shots and what he has to say, i think i will take husband for a little intimidation, sometimes i feel woman get jerked around a little more than men do!!!! so cross your fingers,
    althoug if he does it again i have no choice to back to my primiary and tell him everything thats going on!!!!

    thanks the time to chat with me, means alot!!!
  • I hope that you get some relief from the injections today. I agree with Dave, that if your doc shuns away from answering your questions, that's not a good sign. Try not to let them lull you into just accepting things as they are.

    Hang in there!

  • There is no way to really tell if you are fused except to open you up and see it.

    Regular x-rays, that white stuff is not really showing fusion but compared to a baseline (one before) they use it to say the white stuff on each side of your spine is lying down bone.

    I was told to irritate my bone, it's okay, it will cause it to lay down more bone and yes make sure your Vitamin D 3 level, Calcium, levels.

    One doctor said I was fused, my neurosurgeon, the neuro radiologist said I was not, from myelogram,
    finally orthopedic said I was, then nuerologist but I had hardware to held me together.

    When the radiologist said I was not fused, I was angry, I am x-ray technician and we argued over the
    white stuff cannot assure you are fused.

    So, I just quit worrying and thought if I fall apart, I will worry then but I am holding together with
    a fracture to my T-9 I got from falling backwards in the yard, the hardware held me together, it scared me.

    Your insurance should be able to give you a list of doctors that do second opinions and I have found most doctors I tell up front I am coming for a second opinion and i do not discuss my first doctor at all, just what is recommended.

    Most doctors will say, At our facility, we do this..
    The better the doctor is, the less he is worried about other's opinion.

    I had no problems getting three opinions and I said I wanted to do the right thing for me and two doctors said no and one said yes and I had to decide why he said yes and if it would help me and I had a three level fusion.

    I hope you do well have your heard about:

    s Spinal-Stim safe?
    A: Yes. Spinal-Stim produces a signal at the fusion site like the one your own body generates to induce normal bone healing. The PEMF therapy emitted by Spinal-Stim was specially designed with your safety in mind, and is similar in strength to what you’re exposed to naturally from the magnetic field of the earth.

    I haven't heard about anyone that has used it but you could ask.

    I don't come here often and I hope the best for you especially with RSD to deal with also.

    I am sending you well wishes and visualizing a fused spine and that's what I do with mine (its probably falling apart , No it's not) it gives the doctors something to argue about.

    Hope the best for you.
  • The white showing up on a x-ray is the standard of care any Dr. I've ever been to uses. If there was no white before and now there is to me bone is growing and you are fusing. I won't argue the degree that someone is fusing, just that you are fusing. Dr's use the same white on x-rays to look at broken bones and whether or not they are healing, growing more bone, or not. I have no training as a radiologist so I will leave it at that.

  • Spinal-Stim said:
    Is Spinal-Stim safe?
    A: Yes. Spinal-Stim produces a signal at the fusion site like the one your own body generates to induce normal bone healing. The PEMF therapy emitted by Spinal-Stim was specially designed with your safety in mind, and is similar in strength to what you’re exposed to naturally from the magnetic field of the earth.
    This came directly from the Patient's Guide

    When quoting copyrighted material, please make some sort of indication that it is being quoted. This reduces the chance of copyright infringement and plagiarism issues.



  • hi, i appreciate everyone taking the time to email me back, we had the myelogram done round xmas,that showed complete fusion at l4-5 and nothing at l3-l4. he kept saying fusion is expected at one year at the latest, he talke of going i and doing a plif with the old fashion rods at that point, thats when i rent to the primiary and asked is there anything else i can do try and grow bone around this cage., he finally found a doc( had a hard time himself) that would do the second opionion, he figure since he was a orthopedic surgeon he might hav another idea, wheni got there he was a neurosurgeon, and is attitude couldnt of been more flipnt... all he said i would do it with the rsd, never looked at scans, folder... nothing... i felt really like crap when i left there, how do doctors not understand we are asking for their help!!!

    anyway my doctor when i saw him next truely change his mine totally, saying that i didnt need a fusion and then said i ran into the doctor that gave your opinion - i went thru the explanation that it was really suppossed to be a second opinion, but an option to grow bown at that level... he said whether your fused or not wont control the pain, so at that point i was life why investigate this drug called forteo that none of my doctors want to get involved with - two expensive, two many side effects. and etc, and etc... just everything... so after his attitude last visit i was like why bother going thru that,he says my pain is my pain whether i fuse at this point or not.... i know if i dont stay on my pain patch, and stay in my back brace i cant do anything at all, im in so much pain from my back painl with the brace and pain patch, i can funtion, cant do a lot ... but can funtion.........

    my doctor sounded irritated that i got that opinion, and he changed his mind to everything i said...... i dont see him again till june... will take the hubby this time i think... but does anyone have any direction that i should push for., do i push for the lack of movement without the brace, should i question taking more time, i just dont know really wwhat to approach him with next time!!!!

    well thank you again, have a happy sunday!!!!
  • I have found the approach that worked best for me when faced with uncertainty like this, is to go in with everything outlined as to daily, weekly, monthly pain and ability to function or not function. Remind (in a nice way) the doc about everything he has tried and what did or did not work. I always am upfront if I am frightened about my future and dissatisfied with my life in its current state. Then I basically ask the doc if there is anything he can think of to try, because at this point I am generally desperate.

    I hope this makes sense, it's a hard concept to write in words.

    What I also do along with this, is I refuse to give up on getting help for myself. Where there's a will, there's a way ... I just gotta stick with it until I find it.

  • thanks C.,

    sometimes i forget that because i get so frustrated with the situation or the doctors...

    thank you for reminding me of this!!!!
  • C,

    do you know if you can go into a hot tub with the spinal stim, someone has been asking me if they i would like to use theirs for my back, and i keep forgetting to ask the doctors if its okay to use a hot tub with a perm stim.
  • as much as i have put this off, i need to schedule my myelogram in january, discuss with doc after that, fine out if any of the damage i have felt room time to time, is causing me any of the shoulder problems i am having..

    otherwise, its time to figure out what this part of it is!!!

    i appreciate more than you realize the info you have given me!!!! and much other <3

    i can not lie i am scared of this plife, i went thru the alif in march of 2010, and nothing went right, two of the screwes were placed in the wrong area, the rsd in ended up with during the surgery, and third the lack of having the ability of having the kids change clothes

    may sound different, but thats were i am at!!

    amy help would be appreciated!!

    thank you,

  • hey all, been awhile since ive been on line, hope everyone had a happy holiday season..

    ive got my next round of spinal injections coming up next week ( we always do 6 of them, l3,4,5 on both sides) and they i have my myelogram scheduled for the 10th., this is the year that i have been dreading, the decision about redoin my xlif is this year, they want to remove everything done from my xlif, and do a plif., and i have that added factor of the rsd in the right leg that started after the original surgery, .. the first surgery will be two years old this march, they say the fact im such high meds, and still wearing a back brace is unacceptible and warrants the next surgery, i fear that my problems could get worse because of the next surgery, we are kind of at a stand off at this point... but i know i have to decide this year!!! any help is always welcome!!!!!!!!!!! thank you again, for being my ears, eyes, and help when i didnt know what to do, or how to handle it alone!!!
  • take it off before you go in. It's not like you are in a hot ub for hours.
  • I wore bone stimulator for 6 months one level not healed after 18 months going to dr. on the 6th jan. to scedule sugery again thats a bummer I feel for all you that did not heal I do not smoke , not over weight, followed dr orders to the t the thought of going through that again sucks good luck to you all
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