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AxiaLif L5-S1 non-union, what now?

Mark88MMark88 Posts: 3
edited 06/11/2012 - 8:53 AM in Chronic Pain
Hey folks, I had Axialif on my L5-S1 in Nov 08, has not gone well at all. My surgeon and I have been waiting out very slow bone growth, used a bone stimulator, but now after 2.5 yrs he is calling this a classic non-union, and recommends revision surgery to re-attempt fusion.
I am seeking a second opinion of course, but curious if others had similar problems with Axialif.
I did see Grahams thread that talked about the facet screws, which I had, now have been replaced w 2 pedical rods. I think that is where my ache is, where the small facet screws are. Pain has worsened considerable, cannot get through the day. Do not want to increase meds, hate taking that stuff.

Wondering if anyone has a surgeon recommendation in greater Boston. I need help fast.
Thanks for reading


  • From what I read up from one of the group of stats taken on 79 consecutive single level AxiaLif(s). Only 1 was a non-union and underwent a redo after 12 months, not 30 months.

    Now that said. If the Axial bolt is in place and stable. Then the L5 and S1 levels are locked and the spacing should be at whatever it will settle too. If you had only the 2 facet screw from the beginning then this would be the most likely culprit. However there are many reasons a body doesn't fuse. If you're an active person then the facet screws only may not be enough to hold you stable and the segment would move. I know with 4 pedicle screws and 2 rods that level was locked regardless of whether fusion takes place.

    I'm actually confused as to why a non union would cause pain in an AxaiLif case. I could understand in traditional fusion where a spacer and cage is used. There is plenty of room for movement.

    Any pain I have is from the damned pedicle screws digging in my muscles. I had good fusion forming at 3 months and it was quite evident. Oh and some bone pain from the rods banging into my facets.

    I'd get at least another opinion and from another surgeon with many succesful AxiaLif surgeries. If you still have leg/hip pain it is not necessarily because of the non union. I still get some hip/leg pain when I sit a lot. And I'm fused 360 degrees.

  • If the hardware is holding things in place then it should be still ok and should not have that level of pain. Unless of course the pain is from the screws. If thats the case then you are screwed cause now you would have to have revision and then posibly have hardware removed later. If the hardware block was to show that its from the hardware.

    Same az Z i also fused by around 3 months or so. Posibly have them do a hardware block on you now so if its not from the hardware then they can maybe find whats the cause and might be able to fix it while doing the revision instead finding it later and having to have another surgery. Good luck
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • thanks to both of you for your input, I really appreciate the advice.
    Alex, I am not sure what a hardware block is, can you elaborate?

    Z, I am curious why you recommend I choose a surgeon that has Axialif experience for my revision. My thinking was that PLIF (if thats what I need) is pretty routine and therefore would not require an Axialif guy. Your thoughts?
  • thanks to both of you for your input, I really appreciate the advice.
    Alex, I am not sure what a hardware block is, can you elaborate?

    Z, I am curious why you recommend I choose a surgeon that has Axialif experience for my revision. My thinking was that PLIF (if thats what I need) is pretty routine and therefore would not require an Axialif guy. Your thoughts?
  • I would want to seek another opinion from someone who has much experience with the Axialif not necessarily for a revision, but to make sure that the original diagnosis of non-union is accurate, then go from there.

    Pain can be from many different generators, not just a non-union. I am fused, but still have severe pain due to other spinal pathology.

  • I agree with Sleepgirl, your 2nd opinion needs to be with someone who has the expertise in your original procedure, surgeon should understand the mechanics of your fusion. Although the PLIF is the gold standard of fusions your case would be a little different as you have hardware in place which may change the dynamics of a PLIF. Surgeon should be astute in revisions.

    Di you have movement at the non fused level? I only ask as I had an.ALIF L4-5 almost 9 months ago and I am not fusing and I have measurable motion in that level, which is causing me pain and I need to decide whether to proceed with my revision now or wait a bit more.

    You mentioned the facet screws were causing pain, how so? One of my proposed fixes would be with interspinous plate & facet screws, so I am wondering if you could share.


  • Mark,

    Take in all these points as they all have merit and should be asking the question. Why? There is quite possibly more than 1 thing going on here.

    So I would want an expert at AxiaLIF. I would want a review of how the bolt and supporting hardware are installed. How stable are they. Is the alignment correct. Is the minimum height still met. There is some settling in the axial system. You do realize not everyone is a candidate for AxiaLIF? Get the consulting surgeon to read the surgical notes from the procedure and make sure that it was all done correctly.

    Next after being assured that the AxiaLIF was originally done correctly. I would want to know how/what the surgeon is going to do the PLIF. While I'm not a surgeon I do know how he installed the bone matrix on me. It is quite simply packed around the Axial bolt. There is no cage. If you have non union issues maybe he will also cage you. Since your L5-S1 is locked up with the Axial bolt. You might get lucky and only need a cage and some bone material installed. If you already had the facet screws changed out for pedicle screws.

    These are all things I would want to know before I let anyone in there. Your second shot is usually your last chance. So this time it must happen.

    Now on mine instead of BMP my surgeon used the Trinity Evolution bone matrix. It is stem cell, but not the latest experimental stuff. It is an older version that has millions of patients. The success rate is very high. While I would be mandating a name brand. I would be pushing that the surgeon is using a matrix that has the highest success rate. Especially in problem patients that do not easily fuse.

    Basically anything that improves your odds for success this time around.

    I'm still confused in an Axial situation how you are having so much pain. Obviously there is a reason. Is it really the non-union? Have other tests been run and more recent MRI or CT scans making absolutely sure you don't have additional disc or nerve issues missed originally?

    This isn't all bad so don't take it that way. I'm just thinking out loud. If it were me, at this point, I would be throwing these out at the surgeon.

    Remember if you are talking to the original surgeon then he may feel you are questioning his skill. If you throw these at a 2nd surgeon who is on a consult. They should be much more receptive.

    Good luck.

  • Let me tell you the truth you all need to know about Trinity Matrix. The reality is this product was never tested! Yes that is what I said. They used (1) a single rat to test the product and then claimed that the product was equally effective as human bone or infuse. The reason well I don't think I have to really say this but I will $.

    Multiple failed fusions have occurred the question is do these people even know that they failed because the product they used is non- FDA approved or tested. Blackstone is the company who marketing this product and then it was sold and now sold again to a UK company. It is time to fight back because many people are suffering because of this.
  • An ALIF cannot be redone because of the risks. The surgery would have to be a PLIF. You need a surgeon that understands that the Trinity Matrix was used because if the fusion did not take place then most likely nerve damage has occurred.
  • I have had severe pain since I awoke from surgery. I live near Boston (Scituate). I tried to get a second opinion in the Boston area and was unable to make an appointment any Dr. here! None would see me. Now, 2 years later I have tried again by asking to an axialiF Dr to "discuss the surgery", I must be blackballed because not a single office has returned my call! If anyone knows of a Dr. who will give a second opinion in Boston please post it here. Now, on to Facet related Pain I have had pain (5-10) at both facet screw locations. when the pain worsens the pain running down the front of my thigh and the hip/groin area worsens too - also the pain in the front and rear calf. While I was getting a cortisone injection in the right sacroiliac joint the Doctor got a good view of the right facet screw and said I should get right to a neurosurgeon and have ti removed. then he lightly palpated the area and i almost hit the ceiling. I have been complaining to my surgeon about the facet and other pains to no avail for 21/2 years. Whatever you do.... don't go to Worcester for a second opinion or back surgery.
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