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Fusion Places?

BkinsBBkins Posts: 364
edited 06/11/2012 - 8:44 AM in Back Surgery and Neck Surgery
I was doing some reading here this morning and began to wonder whay it takes a spine so long to fuse while a broken arm, or leg seems to heal up or show signs of fusion much, much quicker. To me when a cage is put between the vertebrae and locked down with the rods and screws there shouldn't be any more of a gap then in a broken bone. Many, many years ago I broke my ankle and had 2 plates and 46 screws put in and that showed signs of healing, or fusing, pretty quickly. Just curious. Any thoughts?


  • Hi David.

    That's an interesting question. We all know that spine problems are completely different from problems in other parts of our bodies, just by the nature of how complex and delicate the spine is.

    My though is that when you break a arm or leg, they don't put in extra materials that must adhere to our original bones, they just put the existing bones together and add a plate and screws to hold everything in place until it grows together.

    With our spines, surgeons always have to add in either our own bone or cadaver bone, some other materials, BMP (real or off-label) and then all those things have to work together to create a fusion.

    I'd also imagine that because the spine is the core of the body, it moves regardless of how much bracing you wear. Limbs have casts - but we're not put in casts with our spines.

    But what I've said could all be a bunch of hooey. I really don't have an answer, just my above thoughts, but am interested to hear if anybody knows the real answer.


  • You might have a point Cath, that they have to use all sorts of 'stuff' to try to aid fusion.

    I know that they rough up the bone surface where the fusion is going to take place, to make it raw and bleeding, before putting in the bone graft. That is to try to fool the body into thinking that an injury has taken place that needs to heal.

    I guess our body knows that something isn't quite right, and so fusion gets delayed. :-)

    I think before screws and rods were used, they used to use a hard brace for a year or so, to keep the spine still while it fused. I have a friend who had scoliosis surgery 20 years ago, and she was in hospital on her back for 3 months and had to wear a hard brace for a year! I think that fusions these days are much easier and quicker to recover from. I'm so glad that I have had my fusion recently. It still seems to take a L O N GGGGG time though! #:S

  • I think of it like when you break an arm, ankle or leg as said before, those bones are put back together touching all surfaces. As well as when they are broken our bodies just begin to start callus formation from the jagged edges. That "break" signals something is wrong and new bone formation to start. In our spine our vertebra have disc spaces between the bones. So those bones were never meant to grow together. Even though we may have severe disc herniation or dessication as I did, there was still some disc material in there not allowing the bones to fuse.

    Does that make sense? lol
    That is how I think of it.
  • Tonya,

    I think you bring up a very valid difference/point here. We break our arm, it is reset, the body knows there are problems and start osteogensis as fast as they are reset. Like was also said, our spines were not designed to fuse, and too I don't think the amount of marrow is even close to the density of 'regular' bones - which also might make a difference.

    Another is loading. Even if for the sake of argument we could fully make it such that the fusion area wouldn't move, there is constant load on the fusion site where as a broken arm or leg is casted and load is not a factor. Just my thoughts there... :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Lots of good ideas. I've wondered if the makeup of the spinal bone is different in some way then the other bones in our body. Maybe bones that have marrow running through them heal, or fuse, quicker but then I think of the skull and that has no marrow, in most of us anyway, and I think that heals quicker then the spine. I asked my PT today and he gave me a deer in the headlights type look. Knowing him he will make a comment on it after being able to think about it for a while.

  • my thoughts are because the spine is thicker then any other bone in our bodies. but i'm quessing.
    beside being a load bearing bone.
  • I just realized you said you had two plates and 46 screws in your ankle...is the 46 screws a typo? That's a heck of a lotta screws there, mister...
  • contribute to how we heal. Let's face it, if you break an arm or a leg when you're a kid, you've got a lot of growth cells and your young age helps you knit together so much more quickly. The spine is a tricky thing. First of all, we have to have it all screwed together, but our attempts at normal movement will put strain on those rods and screws no matter how firmly they are placed. Lots of people shy away from BMP -- I've heard some horror stories there, but this is all stuff you need to discuss with your surgeon pre-op. I had cadaver bone, plastered together with some BMP and some of my own bone marrow. I was beginning to fuse at my one month check-up. It wasn't even a full year when I was totally fused. So far, I don't think there is any tremendous over-growth. I seem to be doing really well. If you smoke, you won't heal well, if you don't eat properly, you won't heal well. Watch your nutrition (seriously) and take your vitamins, along with calcium citrate and D3. It will help you in the long run. I eat a lot of dairy products -- cheese, cottage cheese, yogurt (greek), skim milk, etc. I also make sure I get my fruits and vegetables. I NEVER (and I mean NEVER) eat at fast food places. If I can find McDonalds, I can find a grocery store!!


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • 46 screws was not a typo. I broke my ankle very badly playing racketball in 85' I had screws everywhere. I had the plates and screws removed a little over a year later. I went back to playing racketball but not on a team. If I could get my spine to heal up as well as my ankle did I'd be in great shape. I've had no ill effects from the ankle after the screws and plates were removed.


  • You must have had more metal than bone in your ankle! :jawdrop:
  • I no longer have a x-ray of it. Back when this happened one didn't take control of their medical records. I went through a lot to get a x-ray as they didn't want to let it out. Thru many moves and the fact that I healed completely I let it go. Yes, it was a lot of metal and some of the screws were large and long and some were very small. The 2 plates were pretty good sized also and you could clearly see them by just looking at my ankle. I spent 1.5 hours a day doing exercises to get all movement back. This lasted for 4 months. The work paid off. Just wish/hope my PT and home exercise progam pays the same dividends for my lumbar spine.


  • I think that doing exercises regularly definately does pay off.
    In my case, before surgery, I walked and exercised daily to desperately try to avoid surgery. That didn't happen, because I had a structural problem with my spine. It did help with my recovery after surgery though, so it was well worth doing. I have amazed my doctors, nurses and physio by how well I have managed in my recovery after surgery.
    My PT says it is definately due to all the exercises I was doing.
    Now I'm working very hard to keep up the good start I made.
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