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To Fuse or Not To Fuse

Irish55IIrish55 Posts: 17
edited 06/11/2012 - 8:56 AM in Back Surgery and Neck Surgery
To Fuse or Not To Fuse...That is the Question!
I'd like to get some feedback from folks about a decision I'm facing concerning surgery to fuse a broken vertebra. Short background: I have a 10 year history of severe osteoporosis which has caused fractures of my vertebra from T2 thru S1 with fusions at the same levels. About 2 months ago I experienced a new fracture at T1 which has left me with pain, some numbness and tingling going down my right arm, especially on the inside aspect of my forearm. The CT scan shows the fracture that has a "wedged" appearance and looks like it may be close to the spinal cord. My surgeon is sending me for an MRI of my back/neck today. He says that if the fracture looks like it is impinging on the spinal cord he would recommend surgery sooner rather than later. If it looks like the fractured bone is only compressing the nerve(s) he would advise waiting 4-6 weeks to see if the pain goes away and if it does he would leave things alone. If the pain doesn't resolve in 4-6 weeks he would recommend a fusion that would include levels T1 thru C4.

First...I certainly am extremely nervous about just waiting around to see if this fracture moves toward my cord. In addition, with my history of breaking bones that are above and/or below a current fusion what are the chances that leaving the fracture alone will only encourage my cervical vertebra to break in a domino effect?

If you were in my position, what would you be concerned about and what would you do? I really appreciate and and all suggestions and responses. Thanks!!


  • fusion at t level aren't as bad as lumbar levels as the T section of the spine is not as flexible and the lumbar section .just get a top consultant to do the surgery and good luck
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • I fully get the 'iffy' position you feel in presently. Tomorrow I find out the date to which I will be fused C4-T2. Mine is due to instability thanks to a failed fusion. My decision was sort of easy due to that stability issue.

    From what you have posted, I think I too would wait a few weeks to see if the vertebra might 'self resolve', but too in the interim, I would probably get one or two more opinions given the Osteoporosis you've had for years. Osteoporosis is a wild card that can change the game of treatment vs normal strong and supportive bones. Sorry to hear you may be facing surgery. Gentle *HUGZ* of support.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I would get a second opinion STAT and get it taken care of (what ever you decide) so you don't end up with permanent damage and in chronic pain for the rest of your life.

    I have been always of the thought "if" I can fix it and get on with my life "GREAT"...

    Hang in there,


  • Hi Irish55. My situation is different - I was just fused 3 levels C4-C7 on August 29, 2011. But I had bone spurs completely compressing my nerve root. Even with that, I had 4 opinions. Some orthopedic, some neurosurgeons. Take the time to reseach it all, and of course the mri will tell much of what is actually going on. I'm gad i did the 4 opinions, one that sounded really good (to only fuse 2 instead of 3) after researching it, would only have ended up with more surgery and continued pain within a year.

    If you do go for a fusion, they will likely put in the titanium plate like they did me. That will definitely make one part of your spine very strong after it fuses...

    For me, I was scared to death right up to when they put me to sleep in the hospital. But looking back just 10 days I am soooo glad I had it done. I'm already amazingly better!! A few rough days, but take the pain medication and sleep thru it. Let me know if you have any questions.

    Sending you a hug and a prayer that the right answers will come your way.

  • Thanks so much Sandy for your response! Only 10 days out of surgery and you are already feeling better? That's pretty amazing. Can I ask how much pain you were in when you first woke from surgery? Did they offer you the patient controlled pump for pain relief? You know..the unit that lets the patient push the button if they need an extra bit of pain meds? I'm really concerned about how much flexibility I will be left with if we go ahead and decide to do the fusion. He (the surgeon) said he would fuse from T1-C4. I've never been fused that high up on my spine and imaging that the pain would be different than my thoracic and lumbar fusions. Thanks! Kath
  • Hi Kath, I feel fabulous. Not perfect. I do have muscle spasms in my neck and I feel like my head weighs 20 lbs sometime. But honest, if I had any idea I would bounce back this quick, I would not have dreaded it like I did. 4 months ago I woke with a feeling like I had a knife in my back and completely numb left arm. SCARY... Do dr, so many Rx including steroids (ugh), did PT which concentrated more on arm numb - no help but the ultrasound and TENS was good (finally bought my own TENS which is wonderful though haven't touched it post surgery. I switched to a pain and rehab doc, he did the 3 epidurals over 2 months. each one helped the left arm come back to life more. Great. But my neck hurt still so very much - using TENS every day to help block pain, and rubbing icy hot and flexall on it literally 15 times a day (no kidding there) working so just did otc pain as the heavy pain pills made me nausea and very sleepy. Then 2 wks after last epidural the pain in my arm starts to come back!! it got worse each day. That is when I looked into surgeons and had 4 different opinions. I am sooo glad I went with who I did.. Day of surgery my left arms hurt so bad, i could barely use it, deep stabbing pain. (epidurals are only temp, and it depends some on how much damage is in there to start).

    And yesterday I went for my wound ck, doc said it looked great - i'm trying not to look (have tape on my mirrors at that level!) not puffy and ugly but it is there. make sure you find a doc who can do this in his sleep. My doc said just before I went in, that he operates on brain tumors all the time, this little spinal surgery was a breeze... What an amazing man.

    he told me i may have a tube coming out of my neck for drainage (I did not). I woke up slowly of course, they had me out for 2 hours to do my 3 levels. no pain at first, the anesthesia blocks most i'm sure. i'd talk and fall asleep mid sentence at first.. my daughter and husband had some good laughs over it. i'd say about 4-5 hrs after i'm awake i could feel it, i was not on a pump. i had told them pain meds make me nausea, so they had me on hydromorphone and a muscle relaxant. NO NAUSEA!!! They had me on 2 mg every 4 hrs and 1 muscle relax. not a problem until I had to go to bathroom - now fun began. I had much help getting there, and i was shaking violently and chattering. and yes in pain. i had a not so nice nurse. I got a bit loud when she said sorry, nothing more we can do for you - WHAT?? She said I cursed (don't remember that part), but I let her know i hurt and needed help! 2 hrs later i was out of bed again going to bathroom, same chattering and shaking. I'm a bit louder! This time other nurses come running in. I made sure they all knew I hurt bad! That time my dearest nurse called my doctor (it was like 2 am at this point). And they doubled my medication. Ta Da - from that point on I took double meds every 4 hrs, i was there 3 days. I could have left earlier but I was very worried about nausea and possibly throwing up the meds. I never did. I stopped taking pain meds Rx on day 8. Doc yesterday said if i need it, absolutely no reason not to have it at this stage. but tylenol is working fine with the muscle relaxant.

    As to movement - here is good news - i have no idea for myself personally. But I went into work quickly to pickup a laptop and met a friend who had this done - like me I'm C4-C7 - he is C5 to T1. his surgery was a year ago may. You could hardly see his scar - he went to a doc in the same practice as mine. And he had incredible movement of his head!!! I was soooo happy to see it, it looked like all the way down, he could look up but not all the way, but certainly high enough to see a bird fly. And he tilted side to side great too!

    I hope these help. How I wish I could have heard all this before my surg. Are you in FL by any chance. if so I could recommend the doctor. Good luck - prayers and hugs coming your way..
  • Is a vertebroplasty an option for you as well as a fusion? I know very little about this procedure, except that a friend's mother had this done due to an osteoporotic fracture. This friend of mine gives the anesthesia for the doctor that does the procedure so I do know that he is getting good results from the procedure. Just another option...

    Several opinions might be a good idea. As you know, a fusion treats the instability, but you may this have lingering symptoms afterward. I went into my fusion thinking that I would be "fixed" and pain/spasms/numbness would be resolved. That has not been that case for me, and for many people who have fusions. You have to adjust your expectations to understand that the ultimate goal of a fusion is stability. If you do have resolution of symptoms...that is just icing on the cake.

    Good luck,
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