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3 month post-op appointment with neuro?????

killian123kkillian123 Posts: 20
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
So Iam 3 months post from a L5/S1 PLIF with cage, rods and screws and had my Neuro appointment 5 days ago. X-rays were done a day prior to my appointment and results showed no sign of fusion…Neuro goes on to say that this is normal and reschedules x-rays a year down the road.
He was happy to see me and listened quite attentively as I explained to him what I have been doing and what I propose to do once I am cleared for work.

In a nutshell he looked at my x-rays, then at me; did a bit of mobility tests and said I was good to go for anything. He even went as far as to say that if I wanted to start smoking again I could. I asked him about PT and he said that he didn’t think I required any due to my age (33) and my fitness.

So I basically went from no BLT to full out BLT as my job requires it…..it’s now been 4 days of 8-10h shifts of ranching. Atm it is very physically demanding as I am getting irrigation ready and lifting in excess of around 100 hand pipes a day that range in size 3” inch diameter to 30 -60 feet in length. Iam also due back on an industrial planer next week.

I explained this to my Neuro and he said go right ahead……I asked him again if I am ready and he stated that there is a 50/50 chance of a successful fusion….he said that after 3 months, if the hardware has not moved that this was a sign of a successful fusion…I meet his “criteria”. So here I am..4 days into my job and iam struggling.. I do not have any back pain in my fused area but my sacrum, as well as my L1-L3 area is very very sore…no pain but very stiff (paraspinal muscle issues?)…I think iam rushing things and iam considering going to physio myself.

Has anyone else been handled like this by their specialist?…A full year b4 he wants to see me?? Does this sound a little brash?? Any info would me much appreciated and I thank all of you who have answered my questions during the past 4 months. All the best.


  • At my 3 month post-op appt. (L4-S1, peek cages, plate and screws, ALIF) my x-rays showed no new bone yet. At 5 months same story. I am still under restrictions of no BLT until he sees me June 2nd.

    After my first fusion my Dr. saw me quite regularly until 1 year out, same with this time. Just my opinion but it seems quite irresponsible for your Dr. to let you go back to a physically demanding job so soon, and to tell you that you can start smoking again amazes me!

    The fact that you are already feeling pain above and below your hardware is a red flag. My second fusion below the first is due to me overdoing it. Once you have a fusion the levels above and below take the brunt of force.

    Again, just my opinion. Please learn from those of us who have been there: listen to your gut, be careful and take care of yourself,
  • From my experience and from everything I've read from others on the board, I would say your surgeon is dismissing you early. I don't know what surgeons do if there are not signs of fusion, as that was not my experience...and mine followed me to six months, and I continued to see him for at least a year.

    It seems strange to me that he would dismiss you. While it is true he can't do much to make your body fuse, I would think he would want to see you at six months and nine months to see if you are fusing. Hardware is not designed to permanently hold you together -- particularly with the top of work you do. My uncle had a cattle and wheat ranch in eastern Colorado and I know how heavy those pipes are to move!! I can't imagine that this is going to help you heal.

    Some doctors would think about a bone growth stimulator. Other members could tell you more about that, as I never had one.

    It sounds like your surgeon. is kind of washing his hands of you...only wanting to see you at a year to make a pronouncement that you are fused, or not. I would think that at a year, it would be too late to try the bone growth stimulator. I'm not sure what to suggest to you....I would agree with your conclusion that you are rushing things by returning to work at this point. I would worry about those upper discs taking the brunt of the burden. You will have muscular issues as they are straining to hold you upright and together since right now, you just have a couple rods doing the job.

    I think the job is much more of a problem than the fact that you haven't had physio. I imagine you are in good shape. You just haven't given your body a chance to completely heal and recover from surgery. With the nature of the work you do, you are daily putting pressure on those discs, and increasing the chance that the hardware will break or come loose. I'm sorry but this just doesn't sound like it will end well.

    I hope others will chime in with suggestions and also, information about a bone growth stimulator.

    Sorry to be less than encouraging...but I can tell you understand the problem too.

  • Here we go again with an early dismissal from their surgeon. It is strange, but not uncommon, from what I have learned from others in here. Inhumane & outright pathetic though. Maybe you should seek another surgeon to take you under his wing during your recovery. I found one to do just that. Do yourself a favor quickly. I was kicked to the curb after just 5 weeks. I found an ortho surgeon who said "its unfortunate that some surgeons are like that". I have been seeing him for 12 mos now. He has been a Godsend & enjoys the fact that he has been there for me. He gave me hope & proper suggestions for therapy, which led to a more comfortable journey during this ever so painful recovery process.
    big hugs
  • Not a lot of helpful suggestions from me, as I am a "neckie" and have no personal experience with back stuff except vicariously. I do agree with Gwennie about the stimulator, though. I had one for my neck, and though they don't exactly make much of a fashion statement, I'm of the opinion that if they can help even a little, then they're worth it!

    Another thing, you've been pretty much off your feet and taking it easy for quite a while now. Going back to such a physically demanding job and jumping in with both feet, you're going to have some soreness. Add to that your fusion, and things still trying to heal in there, and I'd think your surgeon would want to keep a closer eye on things. Just my opinion.

    If you're uncomfortable with how you're being treated, find another doc who will take better care of you, and makes you comfortable. Being able to trust your surgeon is a big thing, and if he's not taking good care of you (I've never heard a doctor encouraging a patient to start smoking again!!!!) then you need to find one you can trust. When dealing with your health, it's better to err on the side of caution!

    Good luck, and keep us posted!
  • I think that's a question with many different answers. Some only want to operate. They don't diagnose the problem and they dont want to follow up. They cut and put you back together - period. Others seem to want to do it all. They are diagnosing problems, ordering tests, referring to PM and following up for months or even years. And then there are all variations in between.

    In most specialties there is usually one doctor who does the testing and diagnosis. If he feels you need surgery he refers you to the surgeon. After the surgery you probably belong back at the original doctor who diagnosed your problem. This makes sense on a lot of levels. The original doctor is best able to judge if the surgery worked to cure your original problem. He can also get you any additional help you may need. (ex cardiologist/heart surgeon, dentist/oral surgeon)

    My guess is that how much the surgeon stays involved depends primarily on how busy he is. If he doesn't have that many surgeries to do then he can fill his time with office visits that don't pay nearly as much as surgery. Some may not need to make more money and may be happier with a lighter case load. In my experience a good surgeon is too busy operating to hold patients hands for long. Unless of course it relates directly to the surgery.

    Killian was this your surgeon or your neurologist? Either way it seems a bit too soon to jump back into everything you do. At the least a little PT to make sure your muscles are ready would be good. You will need to take some care for the rest of your life because of the changes to your body. I wonder if his attitude is that the hardware is in place so nothing you do will affect the fusion?? I've met people years after fusion who do not even know anything was done.

    Bottom line is to listen to your body. It may take a few weeks for you to get back into shape. It's kinda like running a 26 mile marathon when you have been on the couch for months. You have to start slow and build up.

  • I have had a similar experience. At 7 weeks I went for a check up. Neurosurgeon only ordered a CT scan because I was complaining of continued pain in my right leg. He wanted to check the hardware etc. I asked him about checking the fusion. He said one does not see any at this point. He said my ct looked excellent. He said come back in 6 months. I continued to have leg pain and finally got into see him at 3 1/2 months. He listened and ordered a MRI. Finally got it just prior to seeing him at 6 months. He advised me that the surgical site looked excellent and he does not see any compression anywhere. I asked about fusion. Said I may not see any till a year and that my hardware has not moved and everything looks good. So he has discharged me from his care. I continue to have leg pain and he has referred me to a neurologist for further followup. I had asked him if a bone growth stimulator is something I should have. He said the literature says that they are not really effective for bone growth. After visiting my family doctor I asked her who follows my fusion process. She said it is not standard care for the surgeon to follow the patient till the fusion is complete. I am in Canada so things may be different. I feel somewhat abandoned. I try not to bend too much or lift more than about 5 pounds. I still have leg pain and await my neurologist appt on Jun 14. Do you take medication? I am really surprised that he said you could start smoking.
  • My surgeon also told me NO PT, like yours. I was reading in here of so many doing stretches & me nothing. I asked my PT why did they wait until 7 mos post op to start me stretching & they explained with open surgery, my muscles, tendons, ligaments, fibers, tissue, nerves, etc were fighting to get back home, after the intrusion, they were mad, on fire mad. Therefore stretching would be the worse thing I could possibly do.
    That's why its important for you to find someone to help you in your own unique sitiuation. I learned that from Ron in here. He always said just because PT is good for one, may not be necessarily true for another. Ask as many questions as you can, and don't do anything that puts you in more pain.
    Also, I made an appt with an orthosurgeon after my neurosurgeon was done with me at 5 wks, & asked him if he would help me out with my recovery & he was actually thrilled. So, don't be shy, get some post op help, even if its from your family doc. They will find someone to help you. You shouldn't have to suffer all alone through this.
  • My first surgery in 99 I had a surgeon that although was very, very good surgically was not willing to do any followup past a 3 month period of time. I ended up having 2 surgeries with this Dr. mainly because of his reputation. I have discovered there are equally as good Dr.'s out there that also care about you not just their reputation. It is confusing why your Dr. seems to listen to you but tosses you out so early. Maybe because of your age. I don't know what has caused your back problems but I would be pretty concerned with going back to a heavy lifting type of job based on what you have had done. Your disc area, at least on the top side is going to get abused based on the fusion you have had done. I personally would be looking to protect that area if I could. You have a long life ahead of you.

    It is just plain silly of you to start smoking again if you have quit. I don't get that at all. I don't agree with not being able to see any fusion on a x-ray as the ones I've seen do show some white areas where fusions are taking place, otherwise why take a x-ray?

    There are both schools of thought about a bone growth stimulator. Some Dr.'s want one used and some don't. I have one after having a non fusion on level l-3,l-4. I am going to do anything I can to help the process along. I am a good bit older then you are but this I can tell you--- A revision surgery to fix a non fusion is much more involved and will take you out for a good long time. You need to ask yourself what kind of further damage you may be causing youself by going back to work early and by doing the type of work, lifting, that your job requires. I would be looking for a different position so I didn't need to do lifting to earn my money.

    It sounds as though you are between a rock and a hard place and that maybe you would benefit by getting another opinion, as has been mentioned by other posters.

    Good luck.

  • Kris -- That may be how it's done in New York, but out here in the hinterlands, it is quite common to have a spinal specialist doctor who diagnoses, does the surgery and the follow-up...commonly until six months, unless their are problems.

    Some do their own diagnostic testing and things like injections, nerve blocks, etc...but I think most refer to a pm doc, physiatrist or anesthesiologist for those procedures....

    In the case of non-fusion, I would think it common for the surgeon to continue to follow the patient until fusion occurs, or the doctor decides it is a failed surgery and sends the patient on to someone else.

  • Do not start smoking again!! I can not believe in this day and age that a physican said that to you. Of coarse I am an oncology nurse and smoking has always been a big deal to me to see all the suffering those things cause. And if your not fused yet and smoking is not good for fusion, why would he tell you you could start !! That is just crazy. I think you are setting yourself up for trouble starting right into heavy lifting and bending, your muscles are still not up to par if you haven't used them in 3 months and you will have a higher risk for pulling muscles etc. Please be careful!!

    I see my md in 2 weeks for my 3 month f/u and they said I will have more xrays and then lose the brace and start pt. They gave me a basic f/u sched and I will see someone in the office every 3 months up to a year. Lynette
  • For postop fusions ultimately? Is their an actual number limit? Killians post about lifting >100 lbs, made me wonder what is globally accepted limit.

    I still can't lift 10 lbs without feeling things pull in my back.

    Since I'm going for my 6 month visit in 2 weeks, i need to have my surgeon give me these limitations in writing to give to my boss when I'm ready to go back to work.

    Killian, please be careful, take it easy...this is from one that knows. I've had three times where Im one step forward, and three steps back, just be pushing a little to much.

    Take it easy!!!

  • When you get the weight limitations from your surgeon, please let us know what he says :-)
  • to what I was told Killian 123.

    I had one appointment with the surgeon post PLIF L5-S1 at about 7 weeks. He had an x-ray taken, said that the hardware was where it was supposed to be, and told me that I was good to go. He "doesn't believe in bringing people back over and over again", so unless I have a problem I won't be going back. Otherwise I can call and schedule an appointment.
    He threw in physio almost as an after thought, because he thought I seemed like I had a "fairly active" lifestyle. I'm 40, have a physical job plus some farm chores.
    When I asked him if could really do "anything", he said yes, but when pressed he pointed out that if I over did it I'd be miserable for a couple of weeks at a time. Pretty vague advice...
    I've been going to a great physiotherapist ever since. He seemed surprised that I had all restrictions lifted so early.
    I'm just over 4 months out from surgery now. Ask me one week and I think I'm doing fantastic. Ask me another and I think I need to call the surgeon back up. It's very much been a two steps forward, one step back kind of recovery. I do know though, that his "you'll be back to work in 6 weeks" was VERY optimistic. I'm doing light chores now, but I'm no where ready to go back to doing what I was.
    I'm another Canadian. I do think things are handled differently up here.


  • Killian:

    I'm at over 3 months too, I'm still on BLT restrictions and sometimes its felt like if I could bend it might help as in certain pains(stiffness).(I'm 41) Mine is supposed to see me in a month, then I start PT, then at 6 months then a year.

    All I could say is be careful. Him to not see you till 12 months, My last appointment they said they were going to check on this next one to see if it was fused at 4 months or fusing.

    Good Luck
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