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11 Months since failed L5-S1 fusion. How long until hardware "gives out"?

BrihtwulfBBrihtwulf Posts: 69
edited 06/11/2012 - 8:45 AM in Back Surgery and Neck Surgery
I was given the news several weeks ago that my fusion from last year had failed and that there was no sign on healing in the bones. The concern then became an issue of how long before the hardware "gave out" as my doctor said. Now, I've been reading about what can actually happen, and it looks more like the hardware damaging the surrounding bone tissue over time. But, I'm not sure if there is a typical "time frame" in which that tends to happen.

How long do I have before I have to start worrying about some other surgery to correct this issue? And what are they going to do once it becomes a problem. I was told that it isn't so much IF the hardware will fail as WHEN it will (which is not encouraging information). Also, is there anything I might be able to do in the meantime to limit the chances of that happening more quickly (aside from the no bending/lifting/twisting)?

I really wish there was someone I could point a finger at, give a good sock in the face, and order them to fix the problem. It's so frustrating having this "sorry, there's not much we can do" response from doctors. They've adjusted my pain medication, but that of course just masks it as I'm sure you all know.

This is a bit of a tangent, but I've actually had several people often say, "wow, aren't you always tired or groggy? Doesn't that medication make you all loopy and drugged out of your mind?" And I just say "No, not really. It just takes the sting off what is otherwise excruciating pain." Anyway, that just popped into my head as I was talking...

If anyone has some advice on this whole "failed fusion" garbage, I'd love to hear it! I am getting some second opinions from a couple different specialists, so at least I have something to hope for. Maybe they'll have a better idea how to proceed.



  • SpineAZSpineAZ WiscPosts: 1,084
    Have they proposed a date to go back in ,take out the hardware and fix the problem? Sounds like it's only a matter of time so maybe the sooner the better?

    As for the pain med thing.....I totally understand. I have friends who think if I am on disability and on pain meds I must be at home in bed in a haze. Yes, if I handed most of my friends the meds I take and told them to take them they'd pass out on my couch. But you develop what I call a "healthy tolerance to the bad side effects of the meds"
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • What type of fusion was done that has failed and was a cage put in?
  • I believe it's referred to as a PLIF or maybe TLIF? I have 4 screws in the back of my vertebrae, and 2 rods connecting each pair that run vertically. They are at the outside of my back (not that they're actually outside, but they are at the posterior). I also have an artificial disc made of some sort of polymer, and some sort of bone growth protein was used.

    The problem is that my bones will not fuse. There is no bone growth or "fusion", so the only thing holding my spine in place is the hardware they used.

    So far there has been no talk of plans to go back in to do anything. I was told by my surgeon that surgical intervention would not be useful at this point because it would have the same outcome. My Neuro seemed to have a very "wait and see" attitude about things. (Another reason for the second opinion)

  • I had a fusion done in the beginning of 06'. Mine was on level l3-l4. My fusion failed and had to be redone in Jan. of this year. I had a steady 2 years of getting worse and worse almost to the point of not being able to walk. I did not have my disk removed and replaced with a cage on the first go around but did on the second. I had a broken screw on one side and a loose screw on the other. Things kept moving in my spine, which is what happens. In my case after my first surgery in 06', I was told very early on that I could go back to my normal life so I did. It was a big mistake in my opinion as I was doing a lot of firewood type work and knowing what I know now that was totally the wrong thing to do. I blame the doctor for painting a rosy picture and not making me aware that I couldn't go back to my life as it was. After my 3 month post-op visit I never went back and my spine was not checked for a fusion. BIG MISTAKE.

    Hardware can be placed in the back, front and side areas of your spine so you are not out of options in my opinion. Maybe you are one that needs your own bone in the cage.

    I agree you need to find a very good, fellowship trained surgeon and go from there. A lot of us have more then 2 opinions before we find someone that we are at ease with.

    You may get a lot of time from your hardware, also depending on your activity level and bone density, and your age. There is a lot that goes in to this spine stuff so find yourself a good doctor and ask questions.

    Is the doctor saying why you may not have fused? Did you use Advil, or Motrin style drugs during your 11 months of waiting? There are a whole host of things that can prevent a person from fusing.

    I will say this in closing that the more surgery's you have in the same area the harder it starts to become healing correctly and the harder it is to get through the PT process. This is my experience and opinion only. I am not a doctor.


  • At my 6 month postop visit, it was determined that there was little fusion taking place. My 2 month xray actually looked better than the 6 month xray due to the placement of BMP (from what I'm told). My physical therapist recommended a bone growth stimulator, and I've been wearing it for the last 3 weeks.

    There is quite a bit of data that using it up to 9 month postop does grow bone.

    Did you wear a bone growth stimulator?

  • Here are my answers to some of the questions posed:

    - I don't smoke. Luckily that has never been an issue. Aside from occasional use of a pipe, I've never been a smoker. And the pipe use halted over a year ago as a recommendation about the spinal surgery.

    - I was never given the option of a bone growth stimulator. I had an appointment at 3 months out, which showed no growth, but my surgeon simply said "you might not see it until after 6 months, so we'll just wait and see". Well, i got my other testing (MRI, CT, X-ray) done at the 10-10.5 month mark which STILL showed no growth. Up until that point I had heard nothing from my surgeon. And now he simply said, "Well, I don't see any surgical options here so we're just going to have to turn you over to pain management and rheumatology".

    Nobody has really thought it that strange that someone start having serious bone and joint issues in their early-mid 20's... Now I'm just waiting on the referrals to those new rheumatology and neurology specialists to get scheduled.

    I have a lot of pain, but I try to manage as best as possible without going completely crazy. I use a fentanyl patch and vicodin for the break-through pain. It's certainly not close to "pain free", but that dream ship sailed a long time ago. I'd just settle for lower pain and more mobility. If I'm too active, my pain kicks into overdrive (too brisk of walking, too much stair climbing, too far of walking, etc.) I'm sure you all know the deal.

    I'm interested to hear the opinions of these new specialists.

  • Wow, I had to read your post twice because I thought you were me for a minute there. You sound just like me with your experiences.

    I too, had a L5-S1 fusion 11 months ago. An interbody device was used with a DBM protein and two pedicle screws and a rod on the posterior right side. The Surgery was in August of 09, and in October the Orthopedic spine surgeon stated it was "PERFECT", even though I had told him of new pain on my right back side and discomfort in my right leg that I never had before... After PT, 3 ESI's and trigger point injections. I was getting no relief and no idea of what or where the new pain was from. They told me the only thing to do now was a TDR or IDET, neither of which was affordable or insurance would cover, so I left this spine clinic and went to different spine center and they have done a CT Mylegram last month, only to find "no evidence of a solid fusion". The new Orthopedic doctor stated that the DBM protein which was used in the first surgery has a low success rate in lumbar fusions, he also said that "IT WAS A CUTE OPERATION" (clearly a dig on the other surgeon) but it was no where suitable for a lumbar fusion.

    The new clinic is now suggesting that I get it repaired with a 360 FUSION which is a dual approach surgery where they enter from the front (anterior) to the left and below the navel and go in to remove the existing device, then they add their hardware and then the roll me to my posterior side and go in there to remove the 2 screws and the rod, then they add 4 screws and two rods. This Orthopedic doctor said to plan on 8 weeks out of work and that it would be a harder surgery to recover from, supporting what others have stated in previous posts.

    I got my images and reports and now will go see a NeuroSurgeon to get his opinion on which way to proceed because I want to make sure that I do not repeat this pain any time soon, and others had warned me before not to use an Ortho Surgeon on my spine, but what did I know then.....hind sight is definitely 20:20. I have done so much searching and talking to people that I am so ready to get this over with, but I want to be sure that I am making the correct decisions at this point.

    I agree with everyone posting here, each person is a bit different for sure, and the points about the pain meds are so true, i am still working, but find it more and more difficult each day. I am a 48 yr old male, pretty average build, non-smoker. I medicate when i wake up, then mid day, then evening, then I take Ambien-CR to sleep.....it is getting old...or is that just me...LOL....
    I did start taking the Cymbalta and it has a component that works with on the brain signals for pain management, but it makes me feel a bit to blah blah...so I am debating on whether or not to continue it or not. I will probably have the "re-do" salvage operation in September (12 month mark) and hopefully will be much better than I am now.

    I do wish you the best in whatever decision that you make, it does suck to be in pain, and hopefully your doctors will get you back in shape...best to you all and thanks for the support that you all give each of us in our lives.

  • Non-fusion (pseudarthrosis) is what we fusion spineys dread. Do you smoke? It is much more common in people who smoke.

    I would imagine that the time that the hardware will last must vary with different individuals. I am sure that how you move must make a difference. So, I expect you can put off having problems with the hardware by avoiding bending, lifting and twising. Using good body mechanics will probably help, and also I would imagine that doing approved exercises, particularly to strengthen your core stability will help.

    Whether or not there is any chance at all that it might still fuse, I don't know. (I would think unlikely after 11 months) It is still probably worth stopping smoking (if you do) and really eating healthily. Lots of calcium rich food, and lots of green veggies and fruit.

    Are you having constant pain?
    I really hope that your hardware lasts for a long while yet. I have read of some whose hardware has needed to be removed at about 12 months, but others go several years before their hardware causes problems.

    All this is just guessing though!!
    None of us posting here are medically trained.
    You need to follow your doctor's advice.
    I can really understand that you want to talk to people who have been through this and have experienced some sort of hardware failure problems.

    Do let us know how you get on, and what the solution is.
    We will do all we can to support you through this :-)
  • I don't believe anyone going through a 360 could go back to work full time in 8 weeks. It just ain't gonna happen. You may be able to talk to people on the phone but as far as going to your workplace and lasting a day it just isn't going to happen at the 8 week mark. This is my opinion based on having a 360 revision done. I am a few years older but not by much. A 360 revision is a big surgery.

  • Hi there everyone, I'd like to find out who has had revision surgery for failed L5-S1 fusion. I had laminectomy L4,L5 & S1, diskectomy L5-S1, PEEK w/bone graft inserted for stabilization, lumbar interbody fusion for anterior column support w/bone graft, posterolateral fusion and of course 4 screws with rods...you know the story. My surgeon says he doesn't see much bone growth at this point, so he may want to go in and put some of my own bone to see if it fuses that way. I am having excruciating pain and it is getting more difficult to go to work daily, and even do day-to-day activities.

    Have any of you had the revision surgery to correct this problem? I am reading that it can be a difficult and long healing process. How was it to go through this, and has it helped with the pain once there is an actual fusion?

    Oh my, some of you have been through so much more than I have and my heart goes out to you.

    Thanks to any who respond.
  • How long ago was your surgery and were you required to wear a bone growth stimulator?

    I have had to have revision surgery but not to put in my own bone to try to get the fusion going. What type of bone growth material was used for your fusion surgery? I couldn't determine by the way it was written. Most likely just me.....
  • November 3, 2011 is the surgery date, and my doc used another bone source rather than my own. I wore a bone growth stimulator for 4 mos. I guess it didn't really help. I have severe osteoporosis and I'm wondering if that prevented bone growth.

    For your revision, what levels were affected, what did they do, and how long was your recovery?
  • For the revision on level L3-L4 I had a 360 done. I also hade broken hardware whichwas removed and replaced. This was a pretty big operation for me and it took a long time to really get going again. I was on a bone growth stimulator for 9 months 24/7 and I did fuse this time. Good thing. Now having issues with 2 lower levels I guess from the addded stress put on them. Going to have them done on the 12th.
  • I've read that adjacent levels are stressed. Seems like once a person has back surgery, they are never the same. My dr. said I'll never be "normal", that he aims for 70-80% improvement by the 6 mo. mark. I'm certainly not there yet.

    I wish you the best on your upcoming fusion. It's tough being out of work, and in such pain isn't it? ugh take care.
  • Same here...

    I had a TLIF @L5S1 last June and also did not fuse. I knew something was wrong 6 months ago, but I was just ignored. I must have been stuck on the meds , lots of fighting for adequate care.

    Finally a CT scan was done and my 'new' neuro showed me clearly on it that I was NOT fused.

    Anyhow, original surgeon is looking to have been less through all the time as new neuro had a discogram performed. I now have been diag'd with a bad L3L4 and L4L5 as well.

    (I enjoyed showing those results to old neuro place that day, pain seeker my @ss, they missed two ruptured discs)

    A discogram was no fun, but knowing what I know now, I would have NEVER agreed to spinal surgery without one.

    Anyhow, I am looking at a two stage revision that will be an 2 level XLIF for L3->L5 and another posterior surgery to fix L5S1 by adding new graft (own) as well as instrumentation for all levels then as well.

    To each there own, but knowing what I know now nobody IMHO should consider surgery without a discogram and should not sign off on a supposed successful fusion after until a CT has been done...and read by more than one person.

    Just my .02... well maybe .03 ;-)
    Jun 2011 -TLIF @L5-S1
    Mar 2012 -NonUnion @L5S1
    May 2012 -Multi Level Discography
    July 2012 -XLIF 2Cages @L3L4/L4L5
    Aug 2012 -All New Hardware @L34L45/L4L5/L5S1
    Mar 2013 -FBSS = Pain Management until they figure it out.
  • How did you know that something was wrong, 6 mos post surgery - what symptoms did you have? I think I've heard about discogram and that it's quite uncomfortable. One neuro I saw wanted to perform one before proceeding, but I went elsewhere for a 2nd opinion. The ortho surgeon said we can do one, but it would not change his surgical plans for me.

    I hope your next surgery for the 2-stage revision goes well, and is successful. I have severe osteoporosis which is probably why my fusion failed. Not sure what they would do about that! It gets old being in pain all the time, every day doesn't it? Take care.
  • My diagnosis had always been low back pain that was mostly lower lumbar.

    My diagnosis was also radicular neuropathy in my rt leg. Mostly in my quad, but it does effect the whole leg when it's bad, but quad and inside knee are the hot spots.

    All my MRIs showed a herniated / budged L5S1. It also showed it was in the epidural space.

    L4L5 was only half dark and the rest were white, we asked about but were told "not to worry"

    3 months after my TLIF @L5S1 I went back to work and started PT. I had been coming down from post op meds at a fairly good clip, but suddenly hit a huge wall. At first we figured it was just the new pain from PT etc. After a month though the locking up started again and then the leg. First sore, then constant burning. All classic signs of instability. Like many on here who have been in the spine game for years and years, we know our bodies, I knew all was not well. The next 3-4 months was all out war trying to get taken seriously (read pain mgmt usual BS) and to get a CT. Even after the CT they swore I was fused.

    After just about giving up hope I started making inquires on my own time about other neuro's. As mine had left the practice while in pain mgmgt (same place) and their ortho and him both said fused. I got some good feedback on my current neuro. 1st visit he read my op notes (I always get copies of everthing) and he then read my MRIs and CT. Took him all of 5 min to show me on a 27" screen how I was not fused and that my op notes showed techniques he feels show a lessor skillet. Regardless he said he would fix it but not without a discogram as my leg pain would not be L5S1.

    Fast fwd my disco showed 2 more bad discs and the one causing my pain was white on the MRI. It shot off the table during the discogram, hurt like hell, one above it, nothing.

    So in the end 11+ months later I am unfused and have 2 other bad discs I have probably always had.

    So three things, I still had leg pain, instability and I started locking up again.

    I spent many years avoiding surgery with Chiro, Rolfing, PT, yoga balls, etc. etc... I got really good at knowing my body and what did what, how to undo it, etc.

    It's hard to do when we are so closely involved and medicated and frustrated, but without sounding all horse whisperish... Pain is a neurological reaction that protects the body and tells the owner something is wrong. When we listen carefully it will help guide us in the right direction.

    That and I am an info junky. When I have to be involved with something I deep dive into it and educate myself with anything and everything I can get my hands on. I have all my notes, reports, films, etc.

    Education and understanding helps us own our issues and they are ours to own. The more we own it, the better one can self advocate. This knowledge saved me more than once when I had to fight to be heard.

    Anywho, now most likely looking at a 2 stage revision that will also fuse L34 & L45 via XLIF. Probably in June or July.

    My.02.... Well probably .03 :-)


    PS: After all that I woud never advise anybody to go under the spinal knife without a discogram.
    Jun 2011 -TLIF @L5-S1
    Mar 2012 -NonUnion @L5S1
    May 2012 -Multi Level Discography
    July 2012 -XLIF 2Cages @L3L4/L4L5
    Aug 2012 -All New Hardware @L34L45/L4L5/L5S1
    Mar 2013 -FBSS = Pain Management until they figure it out.
  • So, I know this is a slightly old thread but I'm sure some of you would live to know (including the OP) that new options are coming soon!!! TE-IVDs (tissue engineered intervertebral discs). This is a tech I've been keeping an eye on for a few years now and it's finally gaining some momentum (they recently made viable discs for dogs...a step up from the first TE-IVDs made for rats...soon they'll have them for us I hope!!). If all goes well, you can order up a new disc (L4-S1 in my case...) and ideally, after revovery you should be almost good as new since all the mechanics of the original disc SHOULD be maintained. Another tech is from discgenics and they use a combination of tissue engineering and regenerative medicine to repair damaged discs INSIDE your body (using stem cells and other fun stuff...I haven't followed this as much since I'm missing a disc...so there's not much to repair =p) but for those of you with herniations, tears, and possibly even collapsed discs, this may be a new alternative to discuss with your physician/surgeon.

    As for the original poster. If you need a surgeon that is hands down the best around (granted that's opinion, but he's WELL recognized in the field), and if your close/willing to make the trip, if HIGHLY recommend the Spine Center @ Cedar Sinai in Los Angeles, CA. My surgeon was Dr. Anand and as I've said before he's regarded by many as one of the best spine surgeons in the country (the prognosis I received from 3 other surgeons was needing additional surgery every 5-10 years because of my age, 25, and extent of injury...not to mention they all recommended multiple levels be operated on... @ cedars: L5-S1 TLIF w/ BMP, PEEK cage & titanium hardware; L4-L5 microdecompression only... His opinion was the L4/5 was more than strong enough to hold up added stress following fusion assuming I got back into shape...well I did my part of getting back in shape and 1 year post op...my L4/5 still strong and I have a new prognosis...I'm 25 today, I'm not expected to need surgery until my late 30s/early 40s...barring another injury)
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