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Bad Outcome after Fusion Surgery - HELP!

Irish55IIrish55 Posts: 17
edited 06/11/2012 - 9:02 AM in Back Surgery and Neck Surgery
Some brief background. I have undergone about 12 spinal surgeries over past decade involving fusions and repair of broken vertebra, etc. I have severe osteoporosis which causes frequent fractures. Having said that: A previously fused T1-T3 section of spine collapsed and it was necessary for my surgeon to go back in on April 12 and repair the fusion. To allow for more stability he extended the fusion to include C4-T4. This operation has now left me with fusion from C4 thru S1, as well as fusion of my SI joints. Symptoms before this last fusion included pain at the site of the collapse (between my scapula) occasional loss of bowel control and inability to feel the need to urinate and lower back pain. I was told that extending and fixing the existing fusion would most likely relieve me of the pain between the shoulder blades and hopefully give me back better bowel/bladder sensation. Neither happened.

Upon waking from surgery on April 12 I immediately noticed that I had lost complete use of my left arm/hand. It was as if I had a stroke. Although I could get a little movement from the shoulder, I could do little else. When I touched my arm/hand it felt totally numb - as if filled with novacane. Right away I mentioned this to my surgeon (and to anybody else who would listen). I was told that most likely I had been positioned on the surgical table in a way which put pressure on a nerve and that my arm had "fallen asleep" but would wake up just like a foot would that had fallen asleep after being in one position too long. I continued to complain and the doc took one plain film xray and did not notice anything wrong. I was sent home with instructions to attempt to use the arm/hand and it would get better. Ten days later and not only had my arm/hand not woken up, now I was having severe pain on the right side of my neck-upper back and new numbness and tingling in the thumb and index finger of my RIGHT hand. Called the surgeon and went back to Hopkins where a CT scan showed a metal screw directly IN the nerve that controls the left arm/hand. Apparently, as my surgeon put it: It is like putting a nail in the wall to hang a picture....you can't see what's on the other side of the wall, you just put the nail in hoping that there isn't an electrical wire running along the same path!!" I was brought back to surgery and the screw was removed. When I awoke I could tell that things were better. My question to anybody who has had a similar experience with injured nerves: Will I EVER get all the feeling and use of my left hand and fingers again? How long will it take to recover? I always thought that the longer a nerve was left injured (with the screw in it) the worse the chances for a complete recovery. Meaning...if he had done the CT when I first complained about this he could have gone in immediately and remedied the situation and perhaps the recovery would be better. He tells me (the surgeon) that it isn't true - the amount of time that a nerve is under "assault" has nothing to do with the permanence of the injury or the symptoms. Also, am I expecting too much to think that the doc should have been able to avoid this mistake? What would you do if you were in my position.....keep waiting to see if it gets better? Go to therapy? Call a lawyer? Opinions welcome. Thanks!


  • Boy, that is a tough one. Really sorry to read of your journey and its results.

    When ever I've had spine surgery, 4 times, I've always been billed for someone to monitor the electrical impulses from the nerves where they are working. A screw going into a nerve should of sent the alarms off.

    I would certainly be asking the surgeon more about the injured nerve. Maybe he can direct you to some reading material so you can see what is what. He/she may not be interested. Have all your surgeries been done by the same surgeon?

    You ask about seeing a lawyer. That is really a personal thing but from what you have described I would be at least considering it. A lot would depend on what the surgeon said about the monitoring sevice that he used, or didn't use. Once a surgeon gets a idea that you may be talking to a lawyer all lines of communication will be shut off so be sure what you want to do. Not a whole lot of Dr.s will be willing to work on you if you have more needs for surgery.

    Cain't help with how long, or if, the time your nerve may take to heal. I am kind of the same opinion as you that the longer a nerve is compromised that the longer it will take to heal if its going to.

    Good luck.
  • Hi Optimist and Bkins - what can I say but Thank You so much! Both of your responses were exactly what I wanted and needed to hear. You've given me food for thought and I feel much better having read what you have offered here. You are right...I need to give myself plenty of time to get thru this recovery and see how things are working in 3-6 mnths. Nerve damage and repair can take so long - as witnessed by Optimists' year's long wait for nerve regeneration! I shouldn't have said anything about a lawsuit. This surgeon has been with me from day 1 and he knows my anatomy like the back of his own hand. I'm sure what you've both alluded to is true: The screw was where it should be....it was my nerve that had probably moved after 12 surgeries!! I see him in one week and I will sit down calmly and very non-aggresively and ask him what he thinks caused this mishap. Will let you know what the outcome of that visit is. Again..hate to keep saying it but THANKS!! Irish
  • I had a really bad back/pain day today & was really feeling sorry for myself until I saw your post. You just had an eight-level fusion?!? Just had to send a prayer out immediately...

    First of all, I feel really bad for you. Eight-levels! I'm still just shaking my head thinking of it. I know I don't have the support to get through that ordeal- prayers out to those in your family or friends helping you. I'm sorry your outcome was not what was expected. BTDT. When they say "50% chance you will be better" - you count on being in the positive 50%, not the 50% no-improvement or worse group, right? I'm a little surprised they told bowel/bladder sensation might be restored from doing a C4-T4 fusion. That has none of the nerves I know of that innervate bladder & bowel- those are sacral nerves. But I could see why you would thing the shoulder blade pain should get better - and don't give up hope that it still may as a result of this surgery. I don't think anyone here can even fathom the magnitude of your surgery - you are one very, very brave person to be willing to go through that.

    Most of us that have had a "few" back procedures under our belt had at least one time we kept telling a doctor our symptoms only to be blown off - and down the road find out we were right and it wasn't in our "head" and it wasn't "swelling" or whatever.
    Should the doctor have been able to avoid the mistake - my guess with all your prior surgery, difficulty positioning, your anatomy isn't even remotely close to normal or even close to any other patient they have worked on - not necessarily (I'm sure you signed consent that it could happen). Doctors are human, and there's no "perfect" in surgery.

    My first thought was why didn't it "show" on an X-ray? I thought that it was pretty routine or "standard or care" that if there might be a "hardware-placement issue", that usually DOES show up on X-ray. So why didn't it in your case? My guess is that the screw was where they expected and wanted it to be. Problem was, I don't think they were expecting your nerve to also end up in that same place - probably the shift in your whole anatomy from this huge fusion included an unpredicted move of that nerve, and that nerves don't show up on surgery. They weren't supposed to be at the same place at the end of your surgery!

    But should he/she/they have considered that earlier and done more studies sooner? My thought as a patient would be yes, but I'm no spine surgeon, and I'm guessing even among spine surgeons your procedure is so rare that there is not exactly alot of precedent. Also, and I am not trying to shift blame here - but I wonder how much the doctors decisions when to order the CT may have been affected by prior experience with insurance company scrutinizing and denying "advanced" imaging so soon after procedures. I know insurance companies crucify doctors over ordering imaging and doing tests (How can those insurance companies make there huge profits for their shareholders and 200Million+ salaries for each of their CEO's if you use it all up with those tests? - Note sarcasm please, but I consider insurance companies to be the most harmful thing to the health of the patient. You cannot trust a system that relies on limiting patient care for making profit.) There has to be some reason why the doctors didn't want to order a CT sooner. Its already being drilled into their heads to do less - less surgery, less tests, less of everything. Lets face it - ordering post-op imaging is "defensive medicine", so you would think if this surgeon(s) was/were really concerned about a potential problem, it would have been done sooner. The X-ray must have looked OK. You mentioned you had it at Hopkins? If so, it was looked at by probably a dozen doctors. I can imagine that surgeon(s)looking at the X-ray, thinking - "It seems to be where it should be, so lets go down the list of what else can cause these symptoms" and he/she/they elected to wait to do more tests. Still, no doubt they are wishing they had ordered it sooner for your sake. If the screw was greatly out of place from where it should have been - that would have been easily detected on X-ray. I just have to think that your surgery caused such a shift in your anatomy that your nerve wasn't in its previous place, and moved to a place it wasn't expected to be.

    If the numbness is in fact directly from the screw being in the wrong place (I know that sounds odd, but there are other reasons for these symptoms - include a small stroke in the spinal arteries), I think the fact that it was addressed within a month gives a decent probability the nerve will regrow. They usually say it will happen soon, as in 6 months, or not at all. I'm here to tell you that's not true! I had a numb area (non-back) from a surgery for 8 years, then all of a sudden three weeks of awful nerve pain and then the numbness and pain both went away!

    As far as getting a lawyer - if I were in your position I would have to think long and hard about that. Your entire spine is fused - what are the chances that some time in your lifetime you are going to need another back surgery at some point again in your life? Pretty high. Even with just second spinal fusion the odds of a complication are much, much greater than the first, and the pool of competent and willing surgeons drops. And how many surgeons/surgical groups are capable, let alone willing, to provide further surgical care to you as it is now, with 95% of your spine fused? Even in the great northeast - that number isn't huge. Throw in a lawsuit, surgeons will know who you are pretty soon, and not be willing to touch you. With healthcare about to tumble into a greater crisis, you have to ask yourself if you want to be in that position?

    I can definitely and totally understand you being angry, resentful, and even hateful toward the surgeon that did the last surgery. But, after you have a time to heal, and think (but less than the statute of limitations), I would want to sit down and talk to that surgeon. Hear him/her out, and ask them why they didn't see anything abnormal on the X-ray, or why they didn't order the CT scan sooner. Its hard to have any perspective when you are in tremendous suffering like I imagine you must be. As far as what to do? I would ask the surgeon what you should do. I would think any physical therapy short of walking must be done by someone that really knows spine physical therapy well. God bless!
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