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Non Union Talk

Shell74Shell74 Posts: 300
edited 06/11/2012 - 7:49 AM in Back Surgery and Neck Surgery
I have seen tons of posts about non union, never thought I would here that news for myself.

I was going for a SCS, I had my trial done and was ready for placement. The surgeon who did my lumbar fusion dc'd me when I wasnt getting any better, said it was in my head. He said the xrays were good all along too. Now 2 1/2 years later the NS that is to place the SCS did a pre op CT to find I have only a few small pieces of bone and one tiny bridge in my fusion site. Not to mention the screws are coming out the sides of the vertebrae and bent. Either things went poof after one year post op, or the origional dr was full of @@@@ and there was never anything there. Not here to rehash that or complain, sorry. It is what it is, now we just need to pick up the pieces.

How does a doctor determine if a non-union needs to be corrected? I am sure they all have different criteria, but just in general. How much bone do you need to hold things stable?

I am wondering if a PLIF could be fixed with an anterior fusion, I am really not sure I want to agree to another PLIF,lol.

Thanks for any input!
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Comments

  • Donna, I'm so sorry to hear your story. I understand it too. I guess I'm a non union, and I don't know what to do now. Can we go without union and let the hardware hold us together for the rest of our days? I don't know. I've an appt on the 15th to talk to my Ns about this and I sure hope to come away with some answers. If I hear anything useful, I'll certainly post it on here and I hope you do the same. Non union sorta sounds like it might be a problem..I really want to know.

    I wish you (and me) the best!
    Aaron
  • So Sorry That you are going through this! We never want to hear that we have a non union. I myself had a non union and went for another surgery 6 weeks ago. I had a PLIF where as in August of 09 I had a 360.

    You can go on having a non union if the hardware is OK and it's giving you enough stability. I myself had hardware issues as well and all of it was very loose and I was in pain 24/7.

    Hope you get the answers you need!!

    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
  • Thanks Maria and Aaron,

    The NS surgeon and I didnt really get that far on our conversation yet. It was a very crazy appointment, since I was there with my SCS rep getting all ready to schedule SCS placement. I go back on the 28th, what a xmas present thats going to be. He did say something about fixing from the front, but I dont know if that means a full on removal from the back as well. The first OS wouldnt do the anterior because of my weight. For me I had a really bad time with the PLIF. I have issues with muscle relaxers so I couldnt take them. I wouldnt wish my experience on anyone.

    I was going for the SCS since I had worse pain after surgery than before, so the pain is there. He said something about bad screw placement, sticking out the sides, bending screw and being the wrong size. Every doctor thinks his way is the best way so I am not sure what the outcome will be.

    I was supposed to having gastric bypass in June, so If I can hold out for 1 1/2 years that would be great. I dont think we can manage the 2 major surgeries the same summer. The weight will be gone, anterior access will be alot easier. I work in the schools so taking time off during the year isnt so good. Of course emergency stuff is ok. I took a job as an Activty Director with a relatively low physical requirement 9 months after fusion just to get by. This kind of stinks because I just went back to school based therapy in Novemeber after I resigned myself to the idea that this was the pain level I needed to live with.

    One step forward, two steps back, story of my life,lol. I have a pretty bad attitude at this point, hopeing that putting up decorations today will snap me out of it a bit.

    Thanks everyone.
  • Shell,
    Sorry you find yourself in this position. I have just recently found myself facing the same type of diagnosis. After almost 2 years of believing I was conpletely fused and all was fine with my fusion therefore all this pain must be in my head (this from my originial surgeon) another one looked at some images ran a few of his own and said, "ah, I beg to differ!

    So now begins the game of getting opinions and finding out whose right, whose wrong, who do you trust and when is the right time along with what is the right procedure for you. Not fun!

    My point is I do understand you frustration. All along we just want to live our lives. Why is that so difficult for these doctors to understand? Of course at the end of the day they go home and have dinner, play with the kids, enjoy a night of entertainment...

    Good Luck. Please keep us posted. As I said, I'm in the same boat, possible non union, hardware failure, and have yet to get two surgeons to agree on how to proceed so I'm definitely interested in what you find out!
  • Thanks Frog, So sorry you are going through this too.

    All I asked was that my origional dr be honest and open about the issues. Some things just dont work, thats the risk we sign on for when we agree to these types of procedures. We know it "could" happen, but when it happens and the dr ignores it and says it is "in your head" without checking all other possibilities that is just very neglectful.
  • Just a quick update. I finally was able to meet with the doctor. It is confirmed that I have a non union, almost nothing in the vertebral space. On top of that the one screw is sticking out the side/back and is pressing into the illiac artery and nerve root. In addition to the fusion site issues, he found a Syringomyelia in the T level, this could also be causing some of the pain. SCS may be in the future but not for now. OMG, I cant seem to catch a break.

    He wants to do a full on revision with new hardware. We will think about it, but I really have no interest in going thru that again. I now have custody of my grandson and I am not sure fusion and taking care of a toddler mix real well. I will also need to postpone my gastric bypass as he cant do the fusion till your weight is stable and body has recovered, about 1-1 1/2 years afterwards. He also doesnt recommend losing to much weight at this time because of the screw location issue, we dont want to increase erosion of the artery. So the back issue must come first.

    Anyone ever here of the screw eroding/puncturing the illiac artery? I cant seem to remember that being a complication that I had heard of before. Any thoughts?

  • I'm just curious if the doctor is indicating the L5-S1 fusion is the location of the non-fusion? It just doesn't make sense to me that the iliac artery is involved. This seems more than unusual to me...it doesn't seem possible if your surgeon went in from the back. If the iliac artery were punctured, I believe you'd have a major bleeder on your hands.

    I would think it would be just as difficult to deal with a toddler if you are in a great deal of pain, as it would to have the revision and stand a chance of healing properly and having less pain.

    Are you dealing with the original surgeon or is a different surgeon suggesting there is a problem with the iliac artery?
  • Tetonteri66, The L5-S1 site is the area that did not fuse properly. I am not sure if you were referring to that or something else.

    I am dealing with a new NS surgeon now. The first doctor claimed all my pain after surgery was in my head and caused by an addiction to pain meds. He was unwilling to even consider that there may be an issue. He assured me that I was fully fused at 18 months and discharged me.

    The operating surgeon went in thru the back, instead of the screws going from the facet joint into the middle of the vertebrae they ended up going straight thru the facet, outside of the pedicle and only catching the edge of the vertebral body. The tip/point of the screw is sticking out the anterior/lateral side of the vertebrae (where the iliac runs along). It also hits the nerve root as well since the screw isnt completely within the pedicle space. The placement is just way off. There was been no puncture, but rather the "significant chance" of erosion from the pointed tip of the screw. I am not really willing to take that chance, as that is a major issue if it would ever get that far.

    We cant just remove the hardware since the joint isnt stable either. If I had fusion it would be a simple thing toi just remove the hardware and solve the issues.

    Yes, dealing with a toddler at this point is not very comfortable with the back, but at least I dont have restrictions and can run when need be. He is a real mischeivious little devil at times. We do have a plan for if I do decide to go thru with the revision, thank goodnesss for daycare.

    Not sure what will be the outcome, I only have 3 months this summer that I have off, since I just started this new job I cant really take additional time off. Not sure if that is enough time or not for me. Guess I will just need to wait and see.
  • Yes, I was asking the location of the non-fusion because I was trying to figure out where the iliac artery was being touched by the screw. Thank you for explaining. I am still having a difficult time picturing this happening. It just seems so deep to have the screw touch from a posterior surgery.

    Can you see it on X-ray?

    I hope you'll be able to figure out a way to have a revision surgery.

  • I have seen it on the CT scan that I just had done. The doctor showed me exactly where the issue is. I wish I could copy a picture from the scan for you, believe me I have tried the program just doesnt give you the option. It is alot easier to understand if you can see it.

    I was actually thinking about it last night, I am wondering if he can do a laproscopic removal and refuse from an anterior approach. I just dont even want to think about an open posterior approach. I didnt do well with that. Guess the apprehension makes things even worse.
  • I can't tell you what to do, but maybe my personal experience will shed a little light on things. I had a 2 level PLIF L4-S1 3 1/2 years ago. I picked up all sorts of new issues, but one issue was that I partially fused at the L4-L5 level. All I had holding that level together was the screws and rods and a bone bridge on the left side. I had a revision of that level at the 10 month mark where my surgeon removed the hardware and redid the fusion at that level. Other stuff was done at the time, but that was the major piece of work. They actually did the revision as out-patient surgery and I was back to work within a week. I'm sure my recovery was an aberration but still the second surgery was much easier to recover from than the first one. Last year, I had a stimulator implanted and that surgery was almost as bad as my fusion surgery, go figure.

    My only suggestion is that you should probably sit down with your family and doctors and map out what is the best course of action. Only you can decide the next step.

    Good luck with the decision.

    Dave
  • Thanks Dave,
    I am making an appointment with another NS (the one that did my cervicle fusion) to get a second opinion. I am surprised at how fast you were back up and moving after your revision, that is great. The NS said it wouldnt be as bad as the first but still in need of at least 2-3 months off.

    I am lucky that my husband is very helpful and I have family support as well. My children are old enough that they can help with their nephew, but its a big decision anyway. I think remembering how the first time went is my biggest roadblock.
  • SpineAZSpineAZ WiscPosts: 1,084
    I had an ACDF C5-C6-C7 in 2006. My surgeon at the time said all was fused and I was fine. In 2008 he went in again from the back to take out some bone spurs and do a foraminotomy. He added some bone to the fusion from the back (must mean he saw a reason to do so). I was back in his office with a bunch of symptoms that seemed to be at C6-C7 but he kept saying I was fine.

    Then I decided to go to a new orthopedic spine surgeon when my lumbar problems arose. He did surgery on my lumbar area and I kept mentioning my neck. He did a simple x-ray of me looking down at the floor and that showed him C6 was not fused and was moving a bit which correlated with the symptoms I was describing. So since my symptoms are still there it's likely I'll go for a revision of the ACDF, but in the meantime C4 is not in good shape. It wasn't great in 2006 and I should have insisted it be in the fusion too. So now, due to non union of C6 and due to symptoms related to C4 I may be headed for a C4-C5-C6-C7 ACDF (hopefully ACDF and not posterior)
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • I have been around for many opinions after a surgeon implied I was a non-union. With some types are hardware, esp. certain plates and cages, they give off artifact that make it impossible to tell 100% of the time with any imaging, CT, MRI or X-ray,if your are "solidly fused". The biggest give away is movement of hardware over time; if you are solidly fused, the hardware shouldn't move at all (that's why post-op a lot of surgeons are happy to just see X-rays),if there is a black halo (indicates space or air) around hardware or screws that is a given non-union, as is the screw breakage etc, Another doctor said a series of facet injections with lido only (no twilight sedation or pain meds) that provide pain relief are a strong suggestion of non-union. Yet most say - the bottom line, the only way to know for sure is to open you up (under anesthesia) and yank real hard on your spine. I've found another interesting differention - some surgeons distinguish from a solid "anterior fusion" done by ALIF that still isn't fused posteriorly, and the opposite done by a PLIF.
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