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Can something be done from the posterior to improve a failed fusion?

davidwright242ddavidwright242 Posts: 32
edited 09/15/2014 - 1:35 PM in Back Surgery and Neck Surgery
Here at 10 months I have movement at the fusion site and am facing a revision surgery. I have to go in shortly to discuss the specifics and am terrified of the prospect of a 360 revision since every single person I’ve ever heard of having a revision done has had a 360 done.

Does anyone know what if anything can actually be done from the posterior to improve a failed fusion or is it always from both ?

I'm guessing the answer to that is that it depends on what is wrong, and I assume its because once something is attempted the only way to really access between the vertebrae is from the front?

I so so so so don't want a 360 revision, I’m going to get a few opinions I’m really scared from screwed up from this mentally. . . I can’t f’n believe that my simple L4-L5 fusion has turned into such a mess . . .

--) Dave (--


  • When I had revision surgery, they redid it using the same incision from the posterior of my spine, so it can be done, but it really depends on what needs to be done .
    Fusion can take up to a year or more for the fusion process to complete, and sometimes the reasons for failure to fuse are known, others unknown.
    A second opinion is a good idea, no matter what the reasons for surgery are, to be sure it is necessary and sometimes, you can get other options rather than just one approach. If you do, ask why that surgeon would use that approach, and not the other, and you might find answers that you didn't know you had the questions for.
    Best of luck
  • I will be going for revision lumbar surgery in Nov.- my situation is very similar to David's. I had no risk factors for pseudoarthosis but it happened, and ALIF/PLF ("360" or "circumferential") is what I am going to have.

    I agree with Sandi- on the second opinions and good you're getting those,too, David. I also agree that everyone's situation is different- so it will depend on exactly what's going on in your case.

    Sandi, I assume yours turned out good?

    I know from reading in some of the spine journal articles on revision surgery- it is recommended to the surgeons that "whatever you do, do something different" -which makes a lot sense. In addition to the second opinions i got, I just don't see, in my case, how much more can be done from just a posterior approach for a revision, plus, from what I've read, there is a very high chance of fusion from an anterior approach (ALIF).

    And I would have to say that I think the surgeon (different from the first, by the way) is doing everyhting he can on this next
    surgery so that a third is hopefully avoided.

    Keep us posted, David! Best of luck to you!

  • sandisandi Posts: 6,343
    edited 09/14/2014 - 6:13 AM
    but it was because bmp ( bone morphegenic protein) was used and it migrated from between the vertebra to the canal and has now adhered the covering of the cord to the vertebra........whole other set of problems.
  • Sandi,
    I am so sorry to hear what happened with the BMP. My surgeon is talking about using it in the PLF part of my surgery. I am very well aware (a lot of reading!) of the many adverse effects from it.
    My graft didn't "take" (first surgery) so on this revision surgery, he is planning to use it- I have some mixed feelings about that, having read so many articles on the adverse effects.
    I know he has used it before, and maybe he has not had problems with it- (although that is not a solid line of resoning for it not causing something with me).
    I hope it turns out okay for you, and I hope it is not causing you a lot of pain. I am pulling for you!
  • My last surgery was in 2007, so bmp was relatively new on the market and was not recommended to be used other than anteriorly in the lumbar spine, never posteriorly.
    I , didn't know that , and the adherance of the dura to three segments in the lumbar spine mean a huge dural tear , and it has narrowed the spinal canal down to 3.14 mm at last measurement.....so I have my second round of Cauda Equina Injury, and the highly probably risk of paralysis when surgery is done.....which is why I am postponing as long as possible. The day wil come when I am not left with a choice, but for now, each day that I am able to stand on my own two feet is a blessing for me....
  • I am so sorry to hear what happened. Is there a chance you may not have to have the surgery? if you have to have it done,
    I hope you have the best and most experienced surgeon doing it. I am pulling for you!

    As I mentioned, my surgeon mentioned that he is thinking and planning to use it - posterior. I am going to discuss the use of this with him- I haven't really gotten into any real serious discussions with him on this. Some talk, but I need to really get down to it on this with him. I think he has used it before- but......

    To this day, surgeons are still using it "off label" (posteriorly)- I guess they have the patient sign some type of waiver.

    You hang in there!!! Being new on the forum, and admittedly not having read EVERY word of the rules, I don't know if it's a no-no to tell someone you will say a prayer for them, but I will say that to you now. You can let me know if it is a no-no!
  • No, it's not against the rules to say a prayer for someone....I will take all I can get.
    The chances of my not needing a third surgery are slim to none, I will need it , the question is when. My doctors and I feel lucky that I have made it this far, so each day is a gift.
    BMP was approved for use anteriorly, for patients who were for whatever reason unlikely to fuse on their own. He did tell me he was going to use bmp due the failed first fusion and the screws loosening, but he didn't tell me it wasn't approved for use in the manner he used it......it migrated in my case.
    I also wasn't told the risks about the increased chances of cancer caused by it either......and hope that I don't have to face that down the road. I would love to have it removed completely, and just live with the scaffolding of the screws and rods, but the chances of that are also slim...
    The dural tear is the scary part for me........I had to spend some time in a wheelchair between my first and second surgeries, so that part , while I don't like it is( although I did get very good at popping wheelies) not as imtimidating as spending weeks on my back and not being able to get up.....and hoping that the tear will heal over time.
    If you do decide to go ahead with it, make sure to read the waiver, you don't want to sign all your rights away and not know what you are getting yourself into.....research bmp, it's all over the web.
  • Hey TriGuy (Jack), I had sent you a PM but I don't think you noticed it, I would love to keep up with you since we seem to be dealing with very similar situations. Reply here and we'll coordinate about how to keep in touch in the future.
    --) Dave (--
  • Sorry I missed the PM- I just checked my e-mail again, didn't see it- do you know how those appear as far as how the sender is displayed in one's inbox? ("spine health"? or the sender's actual e-mail? ) other forums I've used the pms are noticed through e-mail... Yes, we should keep up. do you remember when you sent the PM?
  • I'm sorry about the chances of the surgery- what I think, is, if you do have to have it- it is going to have an excellent outcome- and one reason I say that is because I think you've had your run of bad ones- (2?) that's your quota!!
    You are definitely due one with a good outcome!
    Popping wheelies? too funny.
    Yes, there are so many things now about BMP. Adverse effects to some extent from both labeled use (anterior) and off-label- (posterior) .
    I will definitely be asking some questions about my surgeon's experience with it, and the waiver.
    I will have to discuss with him further for sure.- I have to decide if I want him to use it,
  • of pm's..........you get a notice when you log in on the main forum page, in the left hand side of the forum page.
  • Okay, reading them now
  • On the PM info...
  • I just sent you another PM, it should show up right there in your "Inbox" when you clicked "My Inbox" on the left.

    Let me know if you get it or not.


    --) Dave (--
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