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6 months post op visit--not great news..HELP!!

sleeprgirlssleeprgirl Posts: 695
edited 06/11/2012 - 8:44 AM in Back Surgery and Neck Surgery
I have been very discouraged over the last month or so, about the pain the I have been having since my PLIF L4-5.
I had an xray at 2 months postop...the hardware/spacers looked great, and you could see a small area where the bone and BMP was located, it had a faint whiteness in that area.

Today was my 6 month postop visit, and there has been no change whatsoever in the fusion area. My surgeon allowed me to talk about going back to work next month before telling me there was no change in the fusion. He said that if I would have a 30lb weight restriction. My job is physically demanding, as I have to lift, turn, position patients in the OR, and there is also heavy equipment that I have to lift and move. My surgeon did tell me that "I would have to tell him when I was ready to go back to work". Ok...I really don't know how to take that. He wants to see me back in 3 months, but said he would not do xrays at that time...duh....am I missing something. He talked about maybe taking a year to fuse...I get that, but would think that there would be some kind of progression in the fusion between the 2 month xray and now. I was in such shock and he breezed right over it, and out of sight in 5 minutes flat!!! I am on LTD right now also.

Is the lack of fusion causing my pain? Should I go back to my strenuous job when I'm clearing not fusing? Am I at high risk of injury at work? When do fusion patients need a bone stimulator? Should I be wearing my brace again...stopped at 12 wks. Where do I go from here?? Do I need to see another spine dr? I am going to call my surgeon in the morning, but I want to be armed with appropriate questions...while still retaining a repoire with him, that I think is important.

Of course, as always I will make up own mind about how to handle this, but I really would like to know how other people have dealt with similar issues.

Thanks for reading...I really need you guys right now!




  • Holy cow, honey, I'm a surgical nurse too. I've already had cervical spine fusion that didn't fuse, two rotator cuff repairs (nope, not the same arm), and next Monday I'll have lumbar surgery. Oh the stories we could tell, huh? ;)

    I know the stresses of the job. You know there is no "light duty" in the operating room. You would have to certify to your employer that you are 100%, and I think at this point you probably are not (not for work in the OR), do you agree?

    Please don't let your stress about your last doctor visit make you read into what he said, or his motivations. Yes, it can take a year or more, everyone is different. I'd get another opinion on your fusion if I were in your place.

    I was discharged back to work after 3-1/2 months after my cervical surgery because my employer said come back now or get a new job; my neurosurgeon recommended against it, but what could I do? I found out not long ago that the bottom level of my graft did not fuse, so I wish I could have taken more time from work the first time around.

    Send me a PM if you need to vent. I'm here for you.
  • You know the answer - probably just dont like it.

    It's too soon to go back to what you were doing. Ask yourself if you would be comfortable working on someone in your family the way you are now.

    Try not to read into the lack of change. Xrays are not that exact so there may be more growth than you realize.

    Call your doc after you write down your questions. A bone growth stimulator is a great question. ANother is when does he think you will be ready to go back to work.

    And if he doesnt think a bone growth stimulator is a good idea then I would get another opinion.

    I know that the unknown is what worries me the most. This is one of those times you need to take a deep breath and find a hobby. Use this time to do all those gentle things you never have time for. Like many peeps on here I rushed back to work too soon and regretted it. Be happy you are in a profession that has full employment. Not many are that lucky.

  • Yes you are both right, and no there is no light duty in the OR. I do think of my patients when trying to decide about work. It is a huge fear. I am such a perfectionist when it coming to giving anesthesia. I have just felt so much pressure to return to work, and would have done so until I saw that Xray today. It changed everything for me, and I don't feel the confidence to work...with the pain and numbness in my extremities. I am going to ask about a CT scan if I'm not better over the next month.

    One of the nurse that I worked with 7 years ago, married a fellowship trained orthopedic surgeon. I just emailed her to get her husbands opinion...so we will see.

    Thanks babybubbles and Kris!!!!!

  • I ran into my colleague today who is 5 months postop PLIF, and he went back to work 3 weeks ago because of a glitch in his disability, and had to have the money. He is not doing well lifting/turning patients and is in a great deal of pain, and his legs are numb. He has probably lost 30 lbs since I saw him last, so you absolutely spot on, Kris about going back to soon.

  • SpineAZSpineAZ WiscPosts: 1,084
    Have you and your doctor discussed a bone growth stimulator? It's a small unit you wear to help enhance the bone fusion. I've had one since week 2 post-op.

    Are you on some kine of LTD or WC? If so, and you are still considered disabled by the entity paying you for your disability then I would say do not go back until you are either able to do the job, find a new job in the same company that will not do any strain to your back even in the future, or seek a sedentary job.

    I have been out of work one year. First on STD, then on LTD. Now it looks like I may not return to work and my LTD insurance company agrees with me and has asked me to apply for SS so that is the next step.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • going to look into the bone growth stimulator. I do have risk factors for non fusion. I am osteopenic, and I have to take hydrocortisone because I don't make cortisol, and I think my spondylolisthesis was high grade.

    Thanks Karin,

  • I am in the same sort of boat. I have had a L4/L5 fusion about a month ago, spent 2 nights in hospital. They sent me home with pain medication, and a exercise sheet to strengthen my back.

    Its so frustrating when your whole working career is based around having a strong back, I hate that!

    At this point I find that if I go into town, or walk to much I need to take the highest amount of pain medication just to help me through the day.

    Like you, I need to change my career options.
    Which is so hard.

  • Sorry to hear your appointment didn't go the way you had hoped. As you know yourself as a nurse, X-rays don't always tell everything - but are a tool. Did the radiologist report for the films match what your surgeon was seeing/saying?

    As you know, I am not in the medical field, mine was aviation and law enforcement. The only parallel was that neither of our jobs truly have 'light duty', and as such, we have to be 100% upon return to status. I lost the next level at just a year, so I guess there is a piece of me that wonders if going back at week 7 might have helped in losing the next level so fast? I don't know. I do know that going back around the same time off this last fusion has resulted in me retiring under federal disability. I will never fly a helicopter or jet again, nor chase bad guys. Regrets? No, I enjoyed what I did, but there is a little piece of me that wonders if I helped do 'me' in?

    If they truly don't allow for some sort of modified duty, and I was on LTD as you are, I would focus as much as you can on healing. This way you will at least give your body a fighting shot of the best healing. I think in your own body and mind you know the answer though, and though I am sure your logic side may not like it, I think you know. :)

    Bone growth stimulator. I was given one at 4 months due to the top of my fusion being in question. It did not make any difference with me. The representative that came to my house to educate me on its use did state that it is best used on recent fusion recoveries, and was not intended for people more than a 8 weeks out of surgery [to first start using it], but in fairness too, they hadn't done a lot of testing yet on those 3-4+ months post fusion surgery. I am sure it can't hurt to try though, as short of going back in and looking, no one knows what status your bones and graph are.

    Please let us know what the surgeon says, and too if your friends hubby gets back with you and his opinion. We are here for you woman!! *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Give yourself another 2 months at least to feel well. You are very, very early in your recovery. I'm so sorry that you have a labor intensive job also.

    Brenda, you are right about my focus. I have not allowed myself the right to be less than 100%. I have had so much guilt about my job, and felt the pressure cooker to return to work, or lose my job and benefits.

    At least now I know the score, and may the lack of fusion has been causing much of the extreme pain I've been having...especially after doing PT.
    Even my Physical Therapist was pushing me...and even said that I should have fused by 8 weeks. She made me feel that I was exaggerating my pain. She has been doing very aggressive PT with me, and even wanted me to go mow the lawn, so I could get ready for going back to work. I left her a message this afternoon to tell her that I am not fusing. Ok..so I'm officially on holiday!!!

    Thanks guys!!


  • You go Lisa!!!

    That last sentence on your post Lisa, did you proud! I am amazed how many people do exactly what a PT tells them too, to include even to the point of injury. PT's might be very well educated and experienced in the mechanics of our bodies, but they are NOT doctors. I went to PT months ago, and the pain they gave me, I was in tears for 3 days - nope, did not go back. My surgeon even agreed, "Yes there should be some pain or discomfort due to inactive body parts being used again, but 3 days hurting so bad your in tears!?!" He was almost as unhappy as I was about the whole deal!

    I tried to put off retiring, but in the end my body had the final word! Now my job is to focus on as much healing/fixing as I need, and that of my health and that of my family. It is not a shame on 'us' if our bodies tell us we either have to back off or change jobs. I look at it this way, in my much younger days I was an avid gymnast. Floor, beam and uneven bars. If my spine were normal, could I still do that near 50? NOPE!! So I looked at my need to leave my career in similar light. My spine is old even though my feelings and thoughts are young! Make sense? Peace all!! :-)

    The inner child remains!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • As you have read everyone fuses at different rates. I don't know if x-rays or a CT scan really tells or gives indications of fusing. I think the standard of care says x-rays and insurance company's balk at doing CT scans because of the cost.

    This I can tell you from experience, if you don't fuse and have to have a revision surgery to fix it it is a much more involved surgery and the recovery time is long. Usually in a revision they do a 360 and you end up with more places to heal. Knowing what I know now I wouldn't even consider going back until someone showed me I was fused. Not what you wanted to hear I'm sure. I agree with trying to pinpoint your surgeon down for a direct answer. It is very easy to get blindsided during a office visit and not get a answer or clarification for something. Good luck.

  • I agree. I didn't expect to see a complete fusion. Just some progress. Since there is no improvement, I can't go back to work. What if a patient fell on me? Not going to take that risk!

    CT scan is on my list of questions for my surgeon.

    Thanks for the response!!!

  • Hi Lisa,

    I had the same surgery as you on the same day. I agree with Brenda You go girl!!! Do what you need for yourself your PT person does not feel like you do!! I had to stop PT due to pain. I went back to work but my job is a sitting job and that is my problem sitting. I can at least get up and stretch and walk. I had an appt today with my surgeon but they had to cancel. They got caught up in surgery. I was soooo wanting to know how or if my fusion was progressing. The last time there was white spots and they said everything looked ok but I was counting on this 6 month one. I will find out on the 29th and let you know. Good luck I will keep you in my prayers if thats ok! Keep on keeping on!! Sheila
  • Hi Lisa,
    I can't imagine all that you're going through right now, but please take the time that's needed for your healing. I haven't worked in 6 months and I work in the federal government. I started out with a fractured vertebra from an accident at work. Work comp covered everything including fixing the fracture. I noticed however that I wasn't getting better, so I went to my own Neurosurgeon and had an MRI and a Discogram and found out I had one blown disc at L4, and 2 badly herniated ones at L3, L5. I'm having surgery and a fusion on June 29th. I said all that to say this... The last time I went to the work comp doc. he released me to work, but with a "permanent" no lifting over 20 pounds. My job could not accommodate that, so now I lose my job of 8 years making allot of money. I filed for Social Security Disability, but I don't know if I'll get that. I'm 59 and also have Osteopenia which is going to make it even harder to fuse, but they already are going to put a bone stimulator in during surgery. Also, as much as I don't like Osteoporosis drugs, I am having a once a year infusion in a couple of weeks with the drug Reclast.
    I know how you might feel in not being able to do what you were doing before, but you have to take care of "you". Every one has been telling me that, and I kept brushing it off. I am a very independent person, even being married 41 years and supporting my hubby on his disability. It's very frustrating to be the one that needs taken care of, compared to the one doing the caring. Please keep us posted, because I have found that just coming to these boards and sharing with someone else makes my problems a little lighter. :)

  • So sorry to hear your news! :S

    You definately need to talk to your surgeon again now you have had time to think about the x-ray results.

    Form a list of questions to take with you.
    Things that come to mind are;

    What about a bone stimulator?
    Does he expect fusion to continue growing?
    If not, what happens now?
    Is there further treatment that he can offer?
    Should you stop PT completely?
    Is there anything else that could help?

    I'm sure that you will have other ideas.

    This is a BIG disappointment, and will have caused you to wobble, but you are strong (You have had spinal surgery!! - that is a measure of strength!)
    You just need to know the plan and then work towards it.

    I hope that I don't sound like I'm trivialising this. I'm just trying to be positive. :-)

    I really feel for you Lisa. Do let us know how your visit to talk with your surgeon goes.
    We are thinking of you and will be hear to support you whatever happens. >:D<
  • Sheilee...I'm praying for you girl!! Think positive thoughts!! I did not prepare myself for this at all.
    After this, I will always have a contingency plan.
    There are just 5-6 questions that need to be answered, but my mind went blank, and I could tell that he was done talking. "there is not much change, but we will see you in 3 months". I said, "will we be getting xrays at that time, and he said "NO". That answer blew me away also, and I was just wide eyed, and shaking my head because I could not comprehend the logic in it all.

    Mindy, I sure hope you are able to get you SSD. About the osteopenia, my last bone density showed me borderline normal/osteopenia. That was three years ago. I saw my gynecologist yesterday, and he wanted me to have a bone density test yesterday. Too much going on yesterday, but am having the test tomorrow at 8am. If I'm osteopenic, that will be addressed as well.

    Jelly, thank you so much. I have written down your questions. Love the way you worded everything.
    I'm going to give my surgeon an opportunity to pony-up and give my some answers. Also he did not say that he was making me go back to work. The way he worded it was "you will have to tell me when you are ready to go back to work". Well, I think that is a bunch of BS... He is pushing me to say I'm ready to work, instead of saying " you can go back to work with a nonfused spine". HA I can not even tie my own shoes, let alone take care of a patient. I have felt so much pressure to work, that I was just giving into their BS...

    This is a great lesson for all spineys. You have to be your own advocate. Everyone else around me has pushed me to go back to work, instead of working to heal my back.

    Thanks for all the sweet and supportive responses. I so blessed to have you guys.

  • I will get no answers today. My surgeon is working out of town today, but will be in the office tomorrow. That is probably for the best...gives me time to formulate my thoughts.

    I'm having my bone density scan tomorrow at 8am, and will probably just take those results up to my surgeon's office, and give all the questions to his assistant. He operates till 1pm tomorrow.

    My friends husband is a fellowship trained orthopedic surgeon. She told him last night of my dilema and he said come see him. I am still going to give my surgeon a chance to give me some answers.

    My physical therapist who was treating me as if my fusion was complete, and could not understand my pain, and thought I was begin whiny..has not returned my calls for the last 6 days. Very non-dependable. At least she will get my last message about the nonfusion.

    I'm going to the health food store and buy some supplements for bone growth. Also going to make sure I'm not taking/eating anything that would inhibit the fusion.

  • I know how frustrating this must be. PLIF's are a very rough recovery. Please do not go to back to work too soon, give your body more time to heal. Having such a physical job is going to put stress on the discs above and below your fusion.

    Have you thought about doing something in the nursing field that would be easier on the spine (is there even a nursing job out there with "light duty"??)

    Put yourself first for awhile. I wonder how many of us out there in spineland assumed after a certain amount of time could just go back to what we were doing? Being a stay at home Mom I had not much of a choice but to take care of my two little ones. It never occurred to me that I should make changes to what I could do, thus, the second fusion came along six years later.

    I know this is a difficult time for you, keep us posted as to how you are doing, PM to me if you want to vent some more.

    Take care,

  • I am about 1 month further along than you. I am very interested in what your surgeon has to say. I am continuing to have leg pain. Unfortunately here in Canada one's surgeon does not follow you until you fuse. My surgeon said that my hardware, surgical site etc look great and he does not see any reason for my continuing pain so bye bye. He has referred me to a neurologist whom I see on Jun 14. Have you had any addl testing? emg? It seems I may have continuing problems with my L5 nerve but why who knows. I don't know if I am fusing properly. I had a ct scan at about 9 weeks which is pretty early and an Mri at 6 months. I asked him after the MRI if I was fusing and he said "You must be, because the hardware is still positioned perfectly" What?? So maybe CTs and xrays don't tell the whole story. If I may ask, what sort of pain do you have? Is it continual or only with activity? I also have osteopenia and take fosamax. Thanks for posting and keep your chin up. I know it's very hard at times. It's a rollercoaster ride.
  • Well, my cervical hardware is still positioned perfectly after 3-1/2 years (3-level ACDF 11/06), but we know now (and apparently it was visible in a 2008 MRI, but nobody said) that I never fused at the bottom. Oh, and my graft has stress fractures.

    But nope, that hardware hasn't migrated at all. Yet. (Note to self: It may never migrate, short of some trauma. I'll just continue with pain, stiffness, and a heavy-headed feeling. My option is some posterior mucking about with instrumentation, but I'm not going there unless I have to.)

    I would think that a lumbar non-union would be fairly important to know about and try to correct, since the load on the lumbar spine is so much great. But then, I'm not a surgeon, so what do I know?
  • My pain is constant now, with pain in the lumbar/sacral area, down my left leg and bilateral feet. It is a throbbing/burning/with numbness of extremities. I so love the analogy that Jayhawk used...she said it was like pouring hot acid down your back...what a great description.

    Considering this pain and the status of my fusion, I think it is so inappropriate for the people around me to make my job the priority. This has been going on since I was 8 weeks postop. No more...I'm done!

    I may have osteopenia as well. Will know the bone density results tomorrow. In the meantime, I researched foods and supplements that enhance bone formation and calcium absorption. My fridge is full of those foods now, and I took about 20 supplements today. Yek!!

    I'm going to get my bone stimulator tomorrow, or die trying...lol

    Babybubbles...does the tramadol work well for your pain, and what do you think about the cymbalta...a anesthiologist friend of mine suggested that I might try cymbalta also.

    I have not posted much over the last month...I just felt very depressed and isolated over the never ending pain. At least I know now what may be causing it. I appreciate everyone who has come to m rescue. I want to try to give back to everyone once I get over this hurdle.

  • Awww, Lisa, stay strong. You have us! Yay! We mean it when we say "we got your back"... some of us actually do! ;)

    Yes, the tramadol does help with my general bone "achey" pain. I take it PRN, usually two 50 mg tabs a couple times a day. I think that the Cymbalta does as well, and I've been upped to 60 mg per day with no problems, and I do feel both my depression/anxiety and my pain are helped by it.

    For that acid burn feeling (I have idiopathic peripheral neuropathy that's moving to my trunk and up to my lower face, and that's exactly what it usually feels like) I like many others am helped by Lyrica. I take a total of 300 mg split into two doses. I think this needs to be increased, as the spread of the burning is so complete, I feel like I've been dipped into a vat of acid. It's not fun.

    I'm having surgery Monday morning, so I'm hoping at least some of my problems will be address, like my loss of bladder control, need to use a cane, and hopefully some of the grinding pain. I'm optimistic. :) I really respect my surgeon.

    Good for you for filling up the fridge with good stuff! I'm proud of you that you're choosing to be proactive instead of letting others be in control and letting fear and the unknown rule your life.

    I've been meaning to PM you today, but I had to drive an hour to pick up my brace, then drive home. I HATE driving because I hurt so much, and if I know I have to, I don't take pain meds. But once in a while I have to, but I'm exhausted by the high-speed traffic both directions. Will catch up tomorrow.

    Be good! And eat your spinich!
  • Oh dear, I feel so much for you right now. I too have a tough, physical job that paid well. Today, I had my 6 month & 2 week follow up neurosurgeon visit. Much to my surprise, the x-rays show no fusion. Man, I'd really expected a little something ya know? I'm also visited by the same leg pain, but mine's in the right leg. The description of the pain you have sounds like a carbon copy of me. I'm going to post a complete gripe on the forum, but I sure feel for ya..and I sure wish you weren't in this particular boat with me. Or is it I who am in it with you? Either way is bad eh? Oh well... Tomorrow is another day.

  • I really feel for you Lisa and hope you can get some answers from your neurosurgeon.

    Good that you stopped the PT. When I first started PT, I felt that what my physio gave me was way too much and a couple of times, I had bad pain flares. Since then, I've just done what I've been comfortable with and walking is my main exercise.

    Hope you'll start to go forward soon.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • I am so sorry you are going through this! I so understand your pain, it is aweful, unrelenting, and very isolating!

    I am sorry that it has taken me so long to post, but I have been thinking of you and keeping you in my prayers!

    We are here for you, so please reach out and let us carry you through this difficult time! :)

    We'll be here, waiting to hear how it went getting your bone stimulator!

    gentle hug! xxxx Shari
  • Lisa,

    If you are on weight restriction that pretty much sums it up given your job. My 6 month xray doesn't look startlingly different than my 3 month to me. My surgeon was happy with it and said it showed progress. He also said I was able to resume normal activity. However I must be careful with weights. He knows I'm a desk jockey so job-wise was not a problem. So I beyond something like a bag of dog food or a wheel to put on my car. I don't even attempt to lift heavier. He said he would not go with unrestricted life until after the 1 year eval where I do xray and CT scan.

    I can see your predicament though. Anyone with a nursing job can't have restrictions. Can you get a desk job for now? I've been in a hospital, I know how much paperwork you all generate ;-) LOL

  • that 1) I was not in such bad pain to work, and 2) I work for an anesthesia group, and there is no position other than mine as a CRNA. I obviously can't loose my insurance right now.

    Yesterday I did what Jellyhall recommended. I wrote all my questions to my surgeon, and made a copy.

    Early this morning, I had a bone density scan, and I have lost 15% of my bone since 2008. That is a significant bone loss. My gynecologist is AWESOME!!!
    He spent 30 minutes with me, and devised a plan of care to help with bone growth. I am on hormone replacement therapy, which he wants me to stay on. He increased my calcium supplement to 750mg twice/daily. I am on vitamin D3 30,000iu weekly. Vitamin C helps absorption of calcium, so I increased that dose. Starting Actonel for three months, and I started today on a new drug called Forteo, which is the only drug that actually grows bone. It is a sub cutaneous injection taken daily for two years.

    Afterward I went to see my surgeon. His nurse took my questions, and I told her about my severe osteopenia. I wanted to know if I need to wear my brace again, does he want me to continue PT and what restriction I should adhere to, and wanted him to know that my physical therapist said that we should only do gentle PT, and she also recommended that I get a bone growth stimulator. I have yet to hear back from him.

    After he has had an opportunity to decide about the bone stimulator, I am going to discuss getting a pain management doctor. I just have to take on one project at a time with my surgeon.

    Shari and Trish...thanks so much for the support...I've really needed it!


  • Oh man..I never thought I might need to get an OB/GYN for myself, but hey, it sounds like you do have an actual plan in place. That sounds NOTHING like what I have had recommended for me. Hmm.. I'm no doctor either, but something is starting to smell fishy to me. Perhaps it's time for me to ask around of other doc's.

    Thanx Lisa..you've renewed my hope and energy
  • Excellant plan Lisa! It sounds fantastic!

    I have appointments coming up in the next several weeks with my PM, surgeon and then endocrinologist (sp). I have most of the risk factors for osteoporosis and I think that I will be pro active and start talking now. I think my thyroid levels are off also.

    Again, I am very impressed and thank you for giving the rest of us food for thought!

    You go get 'em girl!!
  • The 6 month visit is so important, and I missed an opportunity to have a sound discussion with my surgeon. My advice is to outline questions for that visit beforehand. One set of questions if you are fusing, and one set if you are not.

    Now I am playing the waiting game for my surgeon to get back to me with answers to my questions...

    Another pearl of wisdom...don't assume you are fusing, and slack off living a healthy lifestyle.
    Google foods/supplements/exercise that promote bone growth. Avoid like the plague, things that inhibit bone growth.

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