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Fusion questions - strength of??

candle99ccandle99 Posts: 279
edited 06/11/2012 - 8:19 AM in Back Surgery and Neck Surgery
I haven't got to have that last talk with my NS, but I knew that some of you have probably discussed this and know the answer.

Is a cage fusion with synthetic fusing material strong enough to hold everything in place if you have fairly bad degenerated facet joints?

My NS has said that he wants to use cages with synthetic material to fuse my L4/L5. All of my tests have shown that I have badly degenerated facets and movement. I'm concerned that just the cage and fusion won't hold things well enough and I'll still have problems. Don't I need more stability to fuse?


  • I can see why you'd ask this question. It is sometimes confusing to see so many different kinds of surgeries for what we think is the same problem.

    That being said, I'd read here and heard from my surgeon that the cages make the spine stiffer so there's less movement.

    Also, when I asked for BMP instead of a bone graft from the iliac crest of the hip, I was told that your real bone fuses better. I was asking for the synthetic so I could avoid the pain of the bone graft. He took it through the same posterior incision, but the hip did ache for awhile, but it wasn't awful.

    My facet joints at L4-L5 are all but gone too, and you can see in my signature which procedure my surgical team chose.

    Good luck to you! Is your surgery scheduled yet?

  • I was told the opposite - that BMP fuses faster than your own or cadaveric bone, but is alot more expensive (some insurance companies don't authorize it). Shouldn't affect recommendation, but the surgeon can bill more if he does bone harvest. I know some that have had much more chronic pain from the harvest post-op than the actual fusion.

    Any fusion that works should stabilize facets - although my understanding from one surgeon was that if facets are an issue, you should have either posterior fusion or 360 fusion. If the facet joints themselves are your pain generator, that needs to be addressed surgically as well.
  • I heard the same thing. My NS will use my bone that he cuts away for access and mix it with the BMP.


  • Thanks to everyone for the responses. I have had the general surgeon consult this Monday that will open/close, but I haven't gotten the call from my NS about a scheduled date for surgery yet. They must be sliding through the holiday and taking their time. I called yesterday and they'd gotten the report back from the general surgeon Tuesday evening, but the reception sounded like she still had it at her desk. I don't know how they do things, but seems awfully slow. Most of my appts. with the NS, I've had to wait at least 1 1/2 hours to get back there to a room, then he's usually on the ball.

    The anticipation is killing me though. I have kids, 9 and 14, and still working, so I would love to know when. I've bought a few things that I will need, but have been waiting on the other stuff until I have a date. I got a grabber and a couple of new sleep shirts to lay around in.

    I've read some internet stuff about the cages and how they sorta bond in with the vertebras since they have those slits in the top and bottom (like screws?), but I wasn't sure if I would still have problems with my facets on the side-to-side movements.

    This NS won't even do Posterior fusions unless he absolutely has to. He says the anterior is so much more complete and easier to get the disc out and do the work. I'm mixed on my feelings, the anterior fusion surgery for L3/L4 and L4/L5 sounds massive and very scarey with the arteries, the kidney ureters, and all the things they have to shift over to expose the spine. I was scared stiff walking out of the general surgeons office. Lots to consider, until that knife pain hits again and the horrible aching and the white/hot feelings come down my right leg. Then, I'm ready to do it NOW!

  • I have a date! Not sure why I put the exclamation point on that. July 11th, next Friday. He said that we should do only the L4/L5 disc fusion. He said the bulge at L3/L4 wasn't a pain generator so there would be other alternatives later (posterior) to handle it with if it blows later. He said it may never do anything more. Somehow I'm not sure about that. Seems if the disc above is already progressively bulging out, it would be better to fuse it also at the same time, but he's the doctor.

    He confirmed that the facet joints wouldn't be a problem, since over time they will fuse also and the lumbar vertebras are so much larger than the cages plus the synthetic stuff will hold everything.

    I'm ready but not ready..oh boy...
  • A 2-level fusion is much more significant than 1-level and if your NS thinks that the one-level is all that is needed for now, that makes sense. You can have bulges that aren't a problem; as long as there is enough room in the canal and no significant stenosis from it, a bulge is really not that important.

    Good luck with your surgery. I had a TLIF for a gr II spondy and was actually pretty happy that my surgeon went in through the back. I can definitely understand all your concerns about anterior surgery, but it is true that it is easier to get to the interbody space and, often, they can jack up the vertebrae better from the front.

    Let us know how you do and make sure you read around the board a bit for more information on how to prepare for surgery. The old forum had many, many threads regarding ideas for stuff to bring to the hospital and stuff to have ready for when you get home. Somewhere here there is a link to the old forum - can't post there anymore, but you can read them. :)
  • One of the best things I took to the hospital was Pain Cat. Some of my students had given it to me to keep me company. The stomach was just large enough for me to put my hand around and squeeze. It could lay under my cheek and my nurses got used to seeing how it was doing. As one of them said
    "If the head is ripped off and is chunked at him. don't come in without pain pills."
    My other favorite was my MP3 and then my pillow. Music helps the pain and my pillow heard me call my wonderful surgeon some pretty foul names - at pain times.
    I also took a clip on fan for my bed. I sleep with one 12 months out of the year, and it smothered some of the hall and roommate noises.
    Take those things that comfort you and you will be fine.
    Get silky, satiny sheets for home. It sure makes turning easier.
  • Hi candle:

    I had a TLIF, L2/3 last Sept. They go in from the back and I had my own bone and synthetic material used with cages and hardware. The doctor harvested my own bone from my hip area and I had no pain from that. I fully fused in 6 weeks. You will get all kinds of reports, good and bad. Get all of the information you can.

    My best to you on the 11th.

  • Thank you all for the helpful hints and everything. I'm considering trying to rent a potty chair just for the support arms to pull up and hold on to while going potty. Wasn't sure they rent those? I saw some elevated seats for $30 or so and that was on Kin's list of good things to have post op. After my c-sections (was 9 years ago on the last one) I remember how sitting and getting up was soo hard and hurt so much, as coughing and sneezing. I'm sure this vertical incision will be a lot worse than the one for a csection that is horizontal and very low.

    Other than that, I have tv trays and bed trays. Was thinking about a chair-like cushion for the bed that has arms, but wasn't sure where to get one. Maybe I"ll look at Linens and Things?

    Just not sure how invalid I will be....I'm tough and have a high pain tolerance, but I don't know. I'm chicken, but this pain has got to go. I'm so tired of living with it everyday. It will be weird to not have it with me anymore. I guess everyone goes through that.
  • Hi Candle,
    I dont know about others but I really didn't spend much time in bed except to sleep. I had PLIF L3-s1 done and after the first couple of days in hospital when I was out of it anyway I really only was on a rotation.
    Lie in bed and watch TV or read for a short while, get up and have a walk, sit for a short while (often I arranged this around meal times) then Bed, walk, sit etc.
    I wouldn't go out of your way to buy things and expect to spend too much time in bed. You are better off moving around to get the circulation going.
    Also e-bay can be really good for second hand toilet chairs,shower stools etc.

    All the best for the 11th.
  • Hi Candle:

    You will definitely need help when you get home from the hospital. One person mentioned they were out of bed a lot. I was told not to sit much until about 6 weeks, it puts pressure on the spine and causes pain. I was in bed or up walking. If your insurance pays for it, I would suggest you rent a hospital bed. My insurance also paid for a potty seat. It was nice because you could put it anywhere and it had arms, it also could go over the regular toilet. Salvation Army, Am Vets, those places have good prices on walkers, canes, etc. I got a used walker for about $5. Another important point...you will be on pain medication when you come home and it can cause constipation. This can be very painful and you want to avoid that. Many of us have used stool softeners. You can get the "cheap", generic brand at Walmart. I also ate dried apricots. I hope this helps.

  • If you have a tub shower, a shower bench that extends outside the tub so you can scoot across into the shower, and a hand-held shower head are lifesavers. Before you're able to shower, the no-rinse shampoo is awesome. It's not really a good substitute for a good shower, but the first few weeks, you don't really care about your hair too much. :-) Or I didn't anyway.

    The toilet arms that attach to your toilet are great because as you get better, you can remove one of those, then remove the other one but still leave the frame in place, just in case you need them back. If you're like me, I started getting really tired of feeling dependent on those things at about the fourth week.

    I rented a walker, but the only thing I used that for was helping me get up off the sofa. I never mastered walking with one.

    The reacher is still with me constantly.

    Anything your insurance will pay for, go for, if you have room. You can always sell it or pass it on (my parents are starting to need some of these things now).

    The best thing I've had, that money couldn't buy, have been my friends and family who gave up weeks of their lives to provide 24-hour care for me for these ten weeks. The company is wonderful, the help is so awesome. I just love them all so much. :)
  • for getting potty chairs and other things to help? I'm going to go by one of those homehealth/medical supply places and see what they have. I found a raised potty seat at Walmart for $21.96 so I bought that. I would like to have the frame with arms for the potty too. I have a walk in shower with the hand held shower head/hose already, so I don't think I'll need the shower chair.

    Thanks for all the suggestions again. You guys are awesome! Geez. I'm getting so anxious. I hope by Thursday when I go for preop stuff that I'll be just a go with it and not so nervous.

    One more questions for you post op people that had Anterior surgery.....do you have to drink the laxative drink the night before??? I wondered if they want you cleaned out so that when they move over the intestines, there's not problems or if they just don't want you going to the bathroom right away.
  • I had a PLIF not anterior but as far as I was concerned I would rather have an empty intestine and bowel then risk constipation later when you're in pain anyway.
    I bought a packet of suppositries and used them for several days before and kept to more liquidy meals such as soups and smoothies for the day or two before.

    Blessings Sara
  • You can also rent some of the equipment, and some agencies, e.g, may have a loan closet. Also, if you know anybody who had major surgery in last few years (hip replacement, etc.) they may have some of these items sitting in their garage. That is how I got some of the things I am still using. And as somebody pointed out, some insurance may cover some of these items, you just have to find out.

    As far as the hospital bed, some people really like it, I am perfectly happy using a 3' Memory foam mattress cover.

    Good luck with your surgery,


    Kin ;) :) ;) :)
  • Candle-

    I haven't had my PLIF yet- but I did have the orders that the day before surgery I have to do a bowel prep. Only clearish fluids and I also will have to drink the phoso soda. I bought the lemon flavor- You can mix it with juice (the package says). I had planned on doing liquid anyway- I have heard too many bad tales about constipation :sick:

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