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Should I get a new doctor?

B52BB52 Posts: 247
edited 06/11/2012 - 8:48 AM in Back Surgery and Neck Surgery
Morning y'all! Hey, 13 months after my L5-S1 fusion surgery, I'm found to have a non-union (pseudoarthrosis) at the surgery site. So, I guess I'll be going in for repairs. My question this morning is, should I go back with the surgeon who originally did the surgery or a different NS. My insurance will pay either way and I have located doc's who will do salvage surgeries.

This original surgery didn't work out right, but I don't know how much of that was the surgeon. I'm not a high risk pt, I am not obese, no nicotine or any other risk factors. Maybe it was just bad luck or genetics that the bones didn't fuse?

Would I gain or lose anything by getting a new doctor? Any input will be greatly appreciated!

Aloha y'all,


  • Hi Aaron,

    The first question you need to ask yourself do you have complete faith in your Dr? Is he the best in your area? I'm not sure where you live but I can give you some info if you are interested! I live in RI and my Dr is in Boston. I myself had a failed fusion along with loose hardware. like yourself I had no issues that would of caused a failed fusion we are just those lucky ones I guess.

    I have a long history of back complications been to many Dr's and stayed with one because I felt kind of obligated because he tried so much to fix something he caused so to speak. My first surgery in 99 I ended up with staph in the spinal cord and meningitis 5 times. I had my share of Dr's. I learned you need to have COMPLETE faith in a Dr. By no means am I saying he has to be like God because I know there is only one God and He is the great healer but when it comes to Dr's you do need the best!

    My Dr this time was an Orthopedic Dr. all my other surgeries where Neurosurgeons.

    Hope this helps in a way! Remember we spineys are hear for each other for support and encouragement !!

    Maria :)

    spondylolisthesis at L4-5; stenosis,
    Lumbar surgeries 1999 L4-L5
    Lumbar staph infection 1999-2000"
    Meningitis x5 in 1999-2001
    Brain shunt 2000"
    Brain shunt removed 20001"
    ALIF/PLIF fusion 8/5/09
    Failed fusion and Failed Hardware
    PLIF Fusion scheduled for 10/29/10

  • I also would look for a doctor with a top-notch reputation. Someone perhaps at a teaching/research hospital where they are up on the latest methods. I know there have been lots of posts about BMP (bone morphogenetic protein) being a bad thing, but my doc mixed some of that with my own bone marrow, and I was beginning to fuse by my eight-week checkup. By my one-year appointment, I was totally fused. Not saying that would be the best thing for you, but it would certainly be something to explore with your surgeon. I also had an orthopedist, not a neurosurgeon do my surgery, although there was a neuro assisting.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Hey Aaron,

    As the others have said it depends on the faith you have in your surgeon. As someone who has been down that path and had multiple surgeries and did use two different surgeons. I can say I am back with my original surgeon and for myself it was never a issue of trust or faith in him but rather a problem with work comp. Psuedo is one of those things you can't really blame anyone for the happening. If it is true psuedo that is a false joint and not the same as failure to fuse. What is important to me is did he/she recognize the issue or that you were still having problems and they were concerned as to what was happening? I think it is important to understand that there is no perfect world in these surgeries and if the optimal outcome isn't achieved is the surgeon your using going to be willing to explore to find out if something is indeed wrong, be it imaging, therapy or whatever needs to be done at the end of the day. Also of course there is the follow-up care following surgery to think of. Those were all the things that returned me in a long process back to my first surgeon.

    Keep us posted on what you decided to do.
  • Hey guys, thanks for the input. Already I can see a common theme forming as far as trusting in the surgeon. In short, my answer on trust would have to be a resounding "mehh." I do not have absolute trust in him. I mean, I sorta do..cause I lived through the surgery, but I sorta don't cause I almost died and I'm still not healed a year down the road. Tamtam, I'm glad you mentioned follow up care. I have come away from follow up visits with more questions than answers, and I really think the after-care was second class. My NS did not diagnose the failure to fuse. I had to find another doc on my own who sent me for the CT/MRI because I knew that something wasn't right.

    Y'all know, in typing this reply, I may be answering my own question. When it's written out in black and white, it looks like it might be time to hire another doctor.

    Much Aloha,
  • If you have faith in your current surgeon and his technical abilities, there are some advantages to having him do the revision. He knows exactly what was done previously, what cuts were made, what muscles and nerves were moved, etc. So there would be no "surprises" as my surgeon says.

    I would definitely go to another surgeon for a "second" opinion...just in case there might be a different way to do the surgery, or a different technique that surgeon # 1 does not use. He might even have a new idea as to how to address the issues, rather than performing a revision surgery.

    As others have stated, pseudoarthrosis is not the fault of the technique that was used. For me, it would be more how the surgeon treated me in the subsequent months and how willing he now is to address the problem.

    Oops, I wrote the above before seeing your comment --
  • SpineAZSpineAZ WiscPosts: 1,084
    For my cervical fusion in 2006 I used an orth spine surgeon who many said was top notch. At first he was great. My hubby and I both liked him. But when I needed more work on my neck in 2008 he almost seemed to have jumped to the "ugh, you again" mentality with me. My hubby says that this doc probably wanted me to move on as he wants only positive outcomes. The new OSS I found is different. He'll take the cases that went bad by other surgeons and work with the patient as long as it takes. He's frank about "this may take a few tries to fix but I believe we can improve it enough to make surgery a good idea". In the Phoenix area most of the "good" doctors are on the East side in Scottsdale. The surgeon I now have is not, he's on the West side at a hospital that's good but not one of those "win every award" places. My faith in him led me to be comfortable with whatever hospital he chose. There's just something about his approach to someone like me, who has tons of orthopedic problems, and how he's willing to work with me. I also ended up changing my knee surgeon to one in the same practice as my OSS. Again, I was with one of the best orth surgeons in the area who does tons of professional team stuff. But I found that I'm beyond the level of getting an athlete (which I never was) functional again. Now my new knee doc and OSS are in the same practice and can coordinate a treatment plan for me. I would still recommend my prior knee doc, but only to those needing minor work or athletes aiming to get back to their sport/activity of choice.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • The fact that your NS did not diagnose your failure to fuse is not a good sign. I hope you find someone who is more competent that can help you. Best wishes for a successful redo and sorry you have to go down that path.
  • get a few opinions.
    You sound indifferent which to me says you need to do some more research to see what else is out there. You may find that you still like your surgeon best and trust him the most either based on his skill, he bedside manners, etc.

    I did switch surgeons b/t surgeries. Why? well, 2-fold. I was out of network and quite frankly, I really wanted to use his partner but it was an urgent situation so I trusted their advice to use the surgeon I did use (the younger partner). The reason I switched was not because I didn't think my surgeon was good. I did. He is very well respected. I switched mostly b/c I was tired of waiting over an hour for every appointment. Who makes a back patient sit that long? the other reason is because while his advice was good, I just felt as if we didn't connect and that I was just a patient.

    I met 6 other surgeons. The last one I met, I had little hopes for b/c he worked out of a huge teaching hospital. I just thought I'd be overwhelmed and really just a number. To my surprise, they saw me at my scheduled time. No waiting, nothing. He spent a lot of time with my husband and I going over my results. He went through my diagnosis, my options, and what his plans were if the revision surgery (microD) didn't work for me.

    If I need more surgery in the future, I will go back to him. He was at a teaching hospital but he did right by me before, during, and after the surgery. The only time I felt a little 'left alone' was at the hospital in recovery BUT I was doing quite well and all of his 'students' checked in on my quite frequently so I knew if I needed to ask his advice I could get him.

  • Changing doctors may be more common than I thought! Hey, thanks a ton for the viewpoints..you guys really have given me something more to think on. I don't really want to be 'doctor shopping', but I kind of feel like DNice in that I don't really want to be a number. And my doc DOES make me wait an hour (minimum) at every single appointment and has horrible chairs in the waiting room. I thought that too, "who makes a spinal pt sit in chairs like this?"

    I'm not sure, but it's looking more to me like I may have to look elsewhere. Can I 'interview' doctors? How is a good way to find out about them?

    Big thanks y'all,
  • Switching surgeons is not that uncommon sadly. I like my NS, but after he basically dumped me with my "complications" - no 12 month follow up, never mind x-rays knowing I have issues. My hubby suggested, and I agree - back to square one, and find a new surgeon.

    It just stinks that there are many surgeons that don't like to go behind another surgeon to "fix their mess." I am so hoping I don't find lots of problems finding a new surgeon. Please keep us posted on what you decide to do. *HUGZ* to ya!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hey, do you mind if I ask how you were in a helicopter crash in CAVU conditions? One of my sisters is a flight nurse with Air Evac and has been for years. That causes us to be quite interested in rotor wing accidents.

    I have so far been able to find several doc's who don't seem to mind picking up where another surgeon left off. Maybe you'll have good luck this time!

    Good luck
  • Aaron,

    Basically (and yes CAVU was the conditions at the time of the crash) I had a fuel govener issue. The fuel flow at low idle (like when you chop the throttle for simulated engine failure) was high. I contacted the company and they gave us the go ahead to still fly. I was the mechanic for this bird as well mind you.

    We did one simulated engine failure to which the applicant failed miserably, but I was in one of those giving days.... I showed him what I expected to see, came around again, chopped the throttle, and when he did the recovery (he screwed up AGAIN) the engine did not respond. Instead of the recommended recovery - it would have killed us or crippled us, I elected in like a .5 of a second to sacrifice the helicopter. Still got hurt, but walking...post crash. I am now paying. :)

    NTSB found that the fuel controller was "over-rich" on its mixture at idle. Dah, I knew that! At any rate, from that day on, when I as a pilot/mechanic had the bells and whistles go off, I did not accept the aircraft.

    I am a trained NTSB rotorcraft accident investigator. Please PM me if you want more details so your sister can feel better. Honestly Aaron, it isn't the emergency itself that hurts or kills you, its' WHEN the emergency occurs and what options you have at that point if that makes sense?

    I've had 3 tail rotor failures, and NO damage to the bird, or injury to us to give example. It all depends on if "each hole in the cheese lines up" for the accident to occur. :) Hope that all helps. Oh, and your sister probably knows this... WIRES are NOT a helicopters friend!!! I've had other "life threatening" emergencies in helicopters, but that's another day. (G)

    Thanks. I too hope that I can find a surgeon that is cool with prior "actions" in there. :) Thanks for your comments, makes me feel better. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • If my doctor had been straight-up honest with me, "you didn't fuse" and I can do this for you..., I probably would use him again, providing he does a fair number of revisions. Revisions are trickier, there are some docs that claim to "specialize" in them. Now, if your doc said all along you were OK, I would go running to another surgeon.
    And yes to clarify, a "pseudarthroses" is a non-union or non-fusion of an intended fusion of two joints, your vocabulary is correct, although it is one of the worst words to hear.
  • I couldn't agree more! My NS ignoring an obvious crack in my C6 vertebra, and then dropping me for my 1 year check up - how wrong is that? I know that as a professional, I was very proud when things went as planned, but for heaven's sake, when they didn't, I took ownership. Many surgeon's don't like when things go wrong, and hope "it" goes away!

    I've PM'd and chatted a lot with Tamtam about revisions as she has sadly had many, and I highly value her opinion about them. Revisions are a lot harder to recover from, and too the surgery is a lot more involved. Another reason why I agree with my hubby on getting another surgeon should that be needed. So B52, another reason not to feel bad if you want to get another opinion, and if it comes to it, a new surgeon. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • optimist said:
    If my doctor had been straight-up honest with me, "you didn't fuse" and I can do this for you..., I probably would use him again, providing he does a fair number of revisions. Revisions are trickier, there are some docs that claim to "specialize" in them. Now, if your doc said all along you were OK, I would go running to another surgeon.
    And yes to clarify, a "pseudarthroses" is a non-union or non-fusion of an intended fusion of two joints, your vocabulary is correct, although it is one of the worst words to hear.
    I completely agree. The OS that did my lumbar fusion kept telling me I was fusing good and the pain was because I was addicted to the meds. Once I went back to PM at about 14 months post op he discharged me and said I was an addict. 2 1/2 years post op I am getting ready for a SCS implant for pain and the NS wants to check the stability of everything. Bamm! I have a complete non union. I dont think that just happened out of the blue. The operating surgeon couldnt just admit to me that things werent doing what they should. For months he was telling me I was crazy. Not to mention I have screws sticking out the sides of the bones too.

    OK, I am a bit angry, I just had my CT today and got the info within an hour. My mind is just spinning with what to do next,lol.

    Good Luck Aaron.
  • Oh my..yea I can see where you might be just a little angry!! But that's kinda like what I've been hearing. "Well, the xrays look good, so you must be good to go" I'm no doctor (but I did stay at Holiday Inn express once" (Har har) but I could tell something wasn't going right. Then like you said Bam!..non fusion. I don't know about some of these guys. Why don't they want to admit the possibility of non fusion?

    Best of luck to ya....and me :)
  • After much thinking about what to do and some phone calling, here's what I got. My insurance is going to pay to have me sent up to St. Louis to Washington Univ. School of Medicine's Advanced Research Dep't. There, I'm supposed to meet with one of the board certified by everyone on Earth, super duper fellows. This Dr. in particular specializes in revision of failed back surgeries.

    I'm going to put my whole trust in this one, as they don't come much more highly recommended or credentialed. Whatever he thinks, I'm inclined to do. So anyhow, Jan 3rd I go up to get started. Wish luck y'all, and thanks for the advice everyone!

  • I'm a BIG believer in that "our" bodies know a hell of a lot more than we do, and many times our doctors do! Stick to your guns! My favorite phrase is "If in doubt, check it out!!" Good for you for doing that!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Aaron,

    So glad to hear this news. Please let us know how it works out! It looks like you are being a great advocate for your own care. Good for you!!! Proud of ya! :) *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I was wondering how much pain or other symptoms this is likely to cause.

    Anyone else have this problem? If so what are your symptoms?

    You would think that before a surgeon puts in the screws he would take great care to decide what size, particularly howl long they need to be. I can understand that misplacing them can happen, but having them too long for the size of the vertebrae seems to be careless to me!

    On my x-rays taken at about 8 weeksn the screws look rather long, with one appearing to stick out very slightly. The surgeon said everything was fine. I seem to be getting increasing pain and other symptoms in my lumbar spine, legs and feet.

    I know that there are different size screws, which have different colours. The first doctor who looked at my MRI said I have a congenitally small spinal canal, so I suppose I could have small vertebrae too! Surely the surgeon should have noticed that and used smaller screws. ( I have been told that I have small veins too, which is why they have trouble getting blood from me.)

    Aaron, I hope you have a great Christmas, and that 2011 will be the year that your back gets sorted out. :-)
  • That is wonderful to hear. Hope they get to the bottom of the questionable fusion. I will certainly be interested to hear how things go, and how well you like your doctors.

    Wishing you well!!

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