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Fibrous Non Union & micro motion

virginiapvvirginiap Posts: 508
edited 06/11/2012 - 7:52 AM in Back Surgery and Neck Surgery
Hi All!
Well I made to my, lets see, what to call it, I guess my 2nd opinion today with an amazing Ortho Spine Surgeon. As you know I had an ALIF L4/5 on 8/24/10 and have been a mess every since. My wonderful NS who performed the surgery discharged me at 4.5 months and said sorry. Sorry your not better, sorry your worse, sorry you can not work or even function. I don't blame him for my outcome but right now, I am PO'd!

I did find another NS to follow me for the past few months, who had recommended bilateral decompression foramanotomies & posterior screws. After all I've been through I had to confirm his thought process and get another opinion.

Today, I had ext/flex x-rays (all the mri's, ct scans, myelogram...post op - no one took plain film???) The ortho spent a good 20 min reviewing all the film I brought in plus the x-rays he took and provided me with a very comprehensive consultation 45 min worth. I feel validated - strange & odd but true. I had begun to doubt myself lately and started thinking I am a freak and hopless.

The deal is, I have not fused he called it fibrous non union (if anybody is familiar please reply, couldn't find much online)he said there is a fault line??? and on top of that I have significant micro motion within the segment and this is causing a lot of my back pain.

He also feels that the nerve was stretched a little too much, my wedge & cage are perhaps just a little to big for me. Which may be why my emg/ncs are now positive. This issue is one that only time will tell if the nerve pains will ever fix! He said could take up to 2 years. Again, if any of you have heard of this, please share.

I had met this surgeon prior to my fusion, my NS actually sent me to see him for an opinion... So he knows my surgeon and has worked with him on many cases. Obviously he was cautious with his words.

He seemed to genuinely care on finding a solution for me. He will present my case to some other board certified surgeons and brainstorm, finally an advocate!

he did offer me surgery but did not push. He said if I wanna wait a few weeks a couple of months... ok.

He wants to do a plate behind the spinous process (sort of where they place an Xstop device) with little screws fixed into facets and add bone grafts posteriorily also widen up the foramans. Due to my build (I am very small, he would not use regular screws, which is one of the reasons I went the ALIF route) He said its not radical and although it sounds like a lot it's not, said 1-1.5 inch incision & 2 small screw cuts.

While I consider this he has placed back on NO BLT's and wants me to wear my brace throughout the day. He is debating a bone stimulator but isn't sure at this point if it will help. He said every time I move, slight bend or twist I am causing trauma to that level and aggravating the nerve.

The other NS said I was ok to do light swimming with a kick board as I am unable to do much of anything else, the Ortho today said NO do not swim, if you want to walk in the pool that would be ok but no swimming or exercise at this stage. SO Confused!

Part of me wants to just get her done! but the rational side of me is in defensive mode! He was clear that due to the two issues, he could not give me more then 50% success rate, the nerve problems might not fix with this. but he can stabilize my spine.

He has ordered my records from pain mgmt, neurologist and blood work from rheumatologist. He is keen on getting my SED rate??? I am not sure if that had been tested last week with all the other blood work.

Overall I am pleased with his assessment and his plan but I am scared to death to go through this again! But I cant continue to exist like I am either.

We did review my cervical issues, but will post that in a later thread... too much info, sorry for the long post.

Thank you for reading and please any input is greatly appreciated!

V
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Comments

  • i like the sound by what you have posted of this ortho surgeon, he seems really thourogh, non rushing and on top of things and realistic

    i think it seems he noes whats what

    wish i was close , wouldnt mind seeing him

    well im still very freaked with my prognosis, so im fluctuating in my capabilities mentally and emotionally to respond in a timely fashion , as my stuff is consuming me , so im a bit all over the place responding
    please bear with me

    will look for your cervical post and will get back to you
    hugs and im so pleased your consult was really productive
    hugs flower

  • Mistake??
    Talk to me. .. I want to hear your thoughts. You've had my surgery, I value your input.
    He said 10% of stand alone ALIF surgeries have this micro motion issue, he is the 2nd surgeon who has told me that they will NEVER do ALIF without "backing it up" with posterior fixation.

    V

  • We do have alot in common with the alif's the doctor abandonment and now the non-union thing at least were not alone with it huh?
    I'm glad that you seem to have found a good doctor,that makes all the difference in the world,it took me four tries to find one.
    what ever happened to the avitar you were going to put up?
  • I know what you mean honey about being trapped in your self and feeling like your mind is in a million places. & its okay honey you got a lot going on and I means a lot to me that you took a moment to offer support HANG IN THERE!

    V
  • Oh I forgot. Yes we are twins! god. It just would not size right. I think I will try again thanks for reminding me!
    Yeah of all the the things to have in common! Would prefer something normal like I dunno boating or something like a fav football team, but I'll take the jacked up ALIF as I am glad to know you!
    V
  • a little blurreee but its there!
    thanks Berg for reminding me.
    v

  • Hi Virginia,
    After much searching, I have managed to find your post.

    Well, this surgeon certainly sounds like he is very willing to put lots of brain power to trying to think of a plan to help you (and get other surgeons involved in a plan too).

    I know that the prospect of another surgery sounds very daunting, but what are the possibilities if you just stay the way you are?

    It does sounds like this procedure that he is suggesting wouldn't be so invasive.

    If you have micro motion at this level now, what are the chances that with time, there will be more motion?

    As for the nerve healing, I have read on a spine surgeon's website that nerves can take up to 2 years to heal.

    Could the micro movement be irritating the nerve further and inflaming it? If that is the case then stabilising the level could help the nerve too.

    As you know Virginia, I have no medical training, but I do have experience of pain, have done lots of reading and do lots of thinking! 8}

    Maybe my ideas will stimulate some questions and ideas of your own.

    I'll say a prayer for you. >:D<

  • First, thank you for the prayer! Just came from Good Friday service and praying hard for answers! I really don't want to go through another surgery especially so soon. BUT if this is the answer, I feel foolish not to proceed.

    Yes I really feel this surgeon is a godsend!

    He did say the procedures he proposed even though there are 4 aspects it would be minimally invasive.

    He told me that 10% of stand alone ALIF patients do have this micro motion issue. As such HE does not do stand alone, he always "backs it up" with posterior fixation. Now most ALIF procedures include an anterior plate, which I thought I was getting, but my NS opted not to use the plate, so I have 3 screws,wedge & cage. In the back of mind the plate or lack thereof never sat well. So without anterior plate that 10% increases on the micro motion.

    So yes, he can stabilize the segment, stop the micro motion so that I can fuse. The fibrous non union means non fusion but there is scaring that is occurring where boney contact should be. He believes as long as there is motion it will not fuse. Fibrous tissue is scar tissue. Which is why he has me back in brace.

    Oh yes, the micro motion which is over 7mm on one side and 3mm on other (that's just bending forward, I can't remember the #'s on the bending back, but they were different) is for sure irritating the nerve.

    He said can NOT be fixed by doing nothing. he said it may be possible if I wear my brace for 4-5 months with BGS that I might have a chance of fusion but he believes that the odds are small due to fibrous tissue. He is researching to see if there is any data to suggest that it is even likely.

    He was firm that there is an answer, a surgical fix. I think, my problem is the combo of the movement with the fibrous tissue.

    So I am doing the bracing trial while he researches. He believes I will see pain relief by wearing the brace and following BLT restrictions, which he says will substantiate the micro motion = pain theory.

    Thanks Jelly for your input. I still have questions to ask him before I decide. I can say since wearing the brace since Tuesday my back pain is a bit better. But I think the brace bothers my pelvis and abdomen as well as my leg nerve pain, maybe all the compression???? Also when I do take it off my spine is like a noodle, does that make sense?

    Praying that you wake up refreshed and feeling better. Try not to overdo the unpacking!

    V




  • I am really sorry for the situation that you are in. >:D<

    Reading and trying to understand what is going on with your back, although I am a very long way from being an expert, I wonder if it is possible for this fibrous scar tissue to actually stop your vertebrae from fusing. If it is forming between the vertebrae, which seems likely as the wedge and cage are a bit too big, as I visualise it, this could well hold your vertebrae further apart than optimal, and if there is scar tissue forming between them then the bone is unlikely to grow to fuse them together. Do you think this could be the case?

    As there is healing still going on, I would imagine that the sooner your spine is stabilised, the better the chance that it will fuse itself.

    If you are getting pain relief from wearing the brace, then I guess that suggests that stopping the micro motion will also give you relief without the brace causing other problems.

    Did this surgeon give you his estimate of the chance that this further surgery will sort out your pain and allow fusion to occur?

    We are having wonderful weather here in the UK - just like summer. I woke with a headache and sore neck, and what is more worrying, pain in my right buttock and pain in my lower back on the right side up to my waist and also in my right shoulder blade. I took pain meds (I try not to use them) and then 4 hours later, was in pain again with the headache returned.

    My husband has been very supportive and made me take it easy. Right now, I am feeling much better, so am very hopeful that this is just a flare and will settle down.

    We have my mum and stepdad coming for the day tomorrow, and my youngest son is here for the long weekend from university. My older son is living here, so we have a nice family gathering for Easter Sunday. We'll see our daughter, husband and granddaughter on Monday as they are travelling back from Paraguay tomorrow.

    I'll keep you in my prayers Virginia, for wisdom of what to do and that there will be a good solution to all of this.

    Wishing you a very blessed Easter. >:D< >:D< >:D<



  • You may not be an expert, but what you've explained you have visualized is in fact EXACTLY what the surgeon has explained.
    So hence my serious contemplation to just proceed & not wait. My family like all of ours, is concerned, as am I, to face another surgery. Again, part of me thinks - just do it, get on fast track to better, even if that road is via surgery. The other part of me thinks well you are only 8 months - maybe you can wait & see, doc said this is on option, but only if I wear the brace, to stop the motion. But is not certain anything will come from waiting, other then letting time elapse, to satisfy, let's say, the 1 year mark.

    Like all of us, I just want to get to some sort of relative pain relief & normalcy, I want to return to work. No longer looking for 100% pain free, just enough to function & work.

    Odds, 50/50, he said he is being conservative, because its a revision, because, he didn't do 1st surgery, failing first time, because of nerve stretch & damage. But then he says this is the FIX.

    Sorry to hear of your your onset of pain, seems so unfair that we need to "pay for" any little normalcy with flare ups & setting off of new pains. :-(
    I hope by the time you read this you are feeling much better head, neck, shoulders, legs and all!

    I hope your English summer time like weather continued through Easter and that you enjoyed your family!

    Remembering you in my prayers Jelly!

    V
  • with the scar tissue being present, stopping the fusion, coupled with the micro motion , which is retarding a union.

    if the back brace is giving you some releif, hence stopping the micro motion, sounds like theres a a nswer there

    another point is hes saying miminally invasive surgery, thats certainly a better option for recovery, however what a horrible decsion to have to make
    as your only 8 months out

    dont no virginia, its a hard decision to make , wear the brace for 6 months and hope for a union or go the surgery soon
    im so sorry you are in this postion

    this spinal surgery that we face just isnt fair as there are never any guarantees of outcome , not like most other surgeries , where they go in , fix the prob and your right

    well you do have time to ask more questions from your surgeon and see what he comes up with the research
    really sometimes i think its allmost like just flip a coin

    wishing you peace of mind and clarity
    hugs flower
  • Hi Virginia,

    Well, yesterday evening and today, I have felt much better and have managed to be pretty busy still doing holiday laundry and preparing food for the family.

    Did an Easter Egg hunt for our 4 year old granddaughter. Made me remember last year, when I hid the eggs using my grabber!! :D

    What does your surgeon recommend that you do?
    He is the expert, and although he doesn't have to deal with the recovery so soon after your other surgery, his perception of this situation is probably the best one there is.

    I wonder if there is a chance that more scar tissue will develop. If so, I would imagine that the sooner that you have surgery the better.

    I am thinking of you and praying for wisdom to know what is the best thing to do.

    'You can do all things through Him who strengthens you'

    Take very good care >:D< >:D< >:D<



  • Yes through HIM all things are possible.

    Keeping the faith.

    My husband told me tonight, he is NOT supporting the surgical fix! I hope its just jitters, and not anything else. He has been amazing the past 8 months, but he was so against the anterior approach fusion.

    We actually fought over it like nothing else in our 23 year marriage! He did NOT like the procedure & more so he did NOT care for the surgeon I.selected, he was right, that is apparent now. I actually cancelled my first surgery and rescheduled 6 weeks later with original plan.

    Tonight was the first time I got the "I told you so". I know he is just worried and he watched me suffer so much and obviously he has been burdened greatly and he truly hurts for me.

    More considerations.... more prayers.

    V


  • It sounds like your husband needs the chance to speak to your surgeon.
    Was he present at your appointment?

    If he is not supporting the surgical fix, what does he think you should do? Perhaps he is in favour of waiting to see. If things stay the same or worse, what then?

    I can understand if he was really against the first anterior surgery with your first surgeon, and now there are serious problems, that he must feel that his gut feelings were correct. If he still feels unsure, then he is bound to worry that things will just get worse again.

    I wonder if he could speak to the surgeon and voice his concerns and ask the questions that he must have, whether that would help him to know what you should do next.

    His uncertainty is a problem which really needs to get dealt with if at all possible. You really need his support with this. Has he met this surgeon? What does he think of him?

    It must really add to your stress to have this going on as well as worrying about your back and what to do for the best. I am sure that it is his love for you that is causing his anxiety.

    Keep praying (I will too :-))
  • Thanks for your post, yes it does make sense, stopping motion helps with back pain, the scar tissue is a factor in prohibiting a proper fusion to take place, which is why the brace, time & even adding a.BGS may not make any difference in the end result.. But again you are right, doesn't make the decision any easier.

    Hope you are doing ok today.

    V
    In my prayers
  • Best of luck with your decision.
    It's also great that your husband is concerned, and being married 23 years is a long time(believe me i know).
    But in the end your H has to trust that your judgement is sound, and you are in need of the best possible solution and outcome.

    Hoping that in the end that you 2 agree with the procedure and H will continue to support you.
    I've always felt when married what ever happens you are in it together.

    Best of luck, and let us know your decision.
  • My husband was present at consult. He has been to every appointment I've had post op, whether it be with with original NS, new NS, now OSS, as well as PM, each epidural, all MRI & ct scans, countless urologist & bio feed back therapy, PCP, emg, you name it he has been there. He has been through a lot, even had to catherize me for a couple of months.

    Obviously he is frustrated and a bit disgusted by this ordeal.

    He did like the OSS very much, everything he said makes clear & perfect sense, BUT OSS still says we "hope" by fixing the obvious problem that we can alleviate the pain. OSS was clear on nerve stretch issue, NO guarantees, especially with a positive emg.

    My husband would like to wait and give it more time and pray for a miracle.I would too like to avoid another surgery but I its my life on hold, my job will not wait forever, I have a gracious & generous employer who is still holding my position and I want very much to return to work.

    I've called to schedule another meeting with the OSS and see if he can help address concerns, but he is still giving 50/50; he is not going to change that. I need the surgeon to explain to him in more detail the complications of waiting & the benefits of proceeding sooner then later.

    My husband got stuck when OSS said it is possible that bracing & no BLT for 4 months, which will put me at one year mark, may help, albeit unlikely.

    He is scared, I'm scared!

    All of a sudden my ribs & mid T spine are achy I think from the brace, hurts to breath. Took brace off & laying down. :-(

    My neck, shoulder & right arm & both hands are acting up today too!

    Lord give me strength!

    Jelly, I am praying for all of us!

    Thanks for all your support you are a dear sweet person!
  • I can understand your husband feeling the way he does my wife was the same way.
    I think it's the shock of it all for your husband.He doesn't to see you suffer thru it all again. hopefully given a little time he will understand.

    On a side note there have been studies done on fibrous non-unions and from what I've read they all mention useing a bgs with somewhat favorable success rates if you want I can give you the web sites.
  • Jim, yes we were married a long time, I was only 20 when we married; so we grew up together & I know were he is coming from.

    Both you & Berg hit the nail on the head, its hard to watch your partner suffer through so much and then find out, it didn't work, its frustrating for both of us. He wants me well without having to go through another surgery & recovery.

    It's hard for him to grasp the amount of uncertainty involved, all the mights, maybes, hopes & thinks.... my husband has a classic car 71 Cutlass and he keeps saying if his mechanic said, I hope or I might, I think I can fix it, well he wouldn't let them touch his car. I am NOT a car, & an engine Is predictable unlike a spine! But I guess its his way of processing. I have to let him go through motions & emotions, I know in the end he will support me, we just have to get there.

    BERG please pm the websites. I am interested in seeing the data, especially if it also includes the micro motion issue, which complicates matters.

    We are seeing the ortho spine surgeon again on May 9th.

    I hope you guys have a good painless night! & a better tomorrow!

    Oh & if all 3 of us could just fuse baby fuse, that would be fantastic, wouldn't it! :o)

    Keep the faith.
    V
  • I have just stumbled onto your thread,& are going through similar stuff.I am 5 months post my first revision.I don't think this has fused either.I still ache all day even though I'm on oxycontin & paracode 4 hourlythrough the day.Gabapentim too for spasam's .
    Over here in New Zealand,they don't use braces after fusion surgery.I find that quite surprising that there is such a difference of procedure in western world countries.
    I am due for a CT scan on the 26th of this month,& then see my surgeon on the 7th july,so not too far away untill we know for Sure.
    All the best mate,may your healing be swift & ezy,which-ever way you go.
    It's really good to hear the incisions would be so small .It sounds like it may not be as tough as full open surgery.
    I know that for me,the second time they operated to do the revision,where they replaced some screws &used a bone compound,instead of taking a graft off the hip.to re-fuse me.It was much less painful this 2nd time.
    The first time ,with the bone graft produced much more intense pain & for much longer.
    Your recovery from what he is discribing could be much more resonable even if you do have to go that way.
    All the best & I look forward to hearing your positive recovery news-Cheers Mike.
  • Virginia, sorry to hear what all you've been through, but I have to admit that I was glad to find someone who is/was in my very same position. Within 1 month of ALIF at L4-5, the same pain I had before the surgery was returning (pain between waist and bra strap, not the usual for L4-5). After 11 months of continued complaints of pain and no empathy from my NS, I got a second opinion from an orthopedic spine surgeon who sent me for a CT which he said showed nonunion and although the plate and screws are still tight, there is a small amount of movement in the back which could be causing some of my pain (he used the analogy of a rock in your shoe) and suggested going in from the back, placing more screws, and removing arthritic facet joints at that level while in there.

    Had original NS review same CT scan as well as his own X-rays taken 1 yr post-op, and his nurse called me and said doc said everything looks fine and for me to return in 6 months for follow-up CT scan. Ended up scheduling an appt for the following week so he could explain what he saw on the CT in detail.

    Initially thrilled that someone had found the problem, even though I wasn't happy about a second surgery but any possible solution sounds better than laying in bed 24/7 at 46 yrs old watching my career go down the sink. If things had gone the way doc had said, he would have performed the second surgery within 10 days. He even took the time to call me at 7:30 p.m. when he saw my CT results knowing how discouraged I was feeling and, like you, was very much questioning myself. Problem now is, second opinion doctor's office sent me away with pre-op orders to be completed while they scheduled the surgery and 1 month later cannot get anyone from that office to call me back. I was leaving messages 1 time a week but have increased to every other day lately with zero response. With the loss of my career, not to mention being able to support myself and losing my personal life (single, self-employed court reporter for 20 yrs), this has sent my depression to a level I've never experienced before.

    Having learned what my original NS said about the CT and everything being "fine," I need to figure out my next step (surgery only if 3rd, maybe even 4th opinion agrees), but I feel so totally abandoned by both docs at this point that I can barely get out of bed due to the depression at this point. I know I can be difficult but have NOT been with either nurse but cannot understand the lack of return calls. Left message for office supervisor to discuss on Fri, and it's Thurs w/ no call.

    Sorry for that un-necessary info. I'm a newbie on this site, found your posting first, thank God, and I'm hoping you have learned something since your last posting on this topic, at least the last I could find being a newbie. Any new info, even sketchy and brief, about where you are now, what you've been through, etc., would be greatly appreciated. Please feel free to email me directly if you're more comfortable with that. I hope you have gotten some sort of relief. At the very least, I hope you're dealing with people who show more compassion than our neurosurgeons did.

    Thanks in advance and sorry for the rambling post.

    LAccr
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