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Corrective Surgery after Fusion

My 15 year old daughter is potentially facing another surgery. Two years ago she was fused from T4 to L4. For approximately one year, she’s struggled with sharp lower back pain which turned out to be stress fractures at L4. After NSAIDs, rest, and PT, she’s no better. Doctor wants to talk surgical options (1) replacement of some current hardware, or (2) fusion to pelvis. He admittedly doesn’t like either option. Some bloodwork also indicates the possibility of lupus or JIA. 


Does anyone have success stories or tips for dealing with this? 

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Comments

  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 318

    I'm truly sorry to hear of your daughter's struggles, especially at her age. My L5-S1 fusion failed after a few years and had to be redone. There are several questions I would ask the surgeon: As your daughter is 15 YO, has she finished growing? If not, how does that affect her prognosis? What is the health and density of her bones. Are her stress fractures related to the cause of her initial fusion or something else? Also, I would ask about risks and consequences of fusing to her pelvis, especially in terms of her long-term prognosis and/or limitations. How was her initial fusion done - back, front, side, etc and does that have any impact on the upcoming surgery approach? BTW, I've learned that scar tissue from surgery can cause and intensify pain and you may want to ask if it is an option to remove some of her scar tissue during the revision. I have no experience with lupus or JIA so I cannot comment. Best of luck and please keep us posted.

  • hvillshhvills Suzhou, ChinaPosts: 971

    Most doctors frown on using NSAIDS after fusion surgery as it is believed to potentially interfere with bone growth.  Please talk to your doctor about this before your daughters next surgery.  Also has your daughter had a bone density test?  She may have Osteoporosis which would explain the stress fractures.  It's not so common in young people but it CAN occur.

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
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  • WLLadyWLLady Ontario CanadaPosts: 1,433

    so i grew up with inflammatory arthritis and NSAIDS were the go to for me, until we discovered that NSAIDS weren't good for my blood pressure and other things....so off the NSAIDs.  they did put me on methotrexate for a while, and while it stopped the arthritis in its tracks that stuff has it's own set of side effects that are not good too. of course.  so i learned to live with the pain from it, and the swelly joints.  looking back, it is clear that inflammatory arthritis had a huge role to play in my scoliosis and requiring my surgery to "fix" me to mostly vertical again-and if i had to go through all this again i would have pushed way harder for a good rheumatologist to help me earlier in life.  do you/does she have a rheumatologist-someone that specializes in juvenile arthritis?  and i also have to wonder about bone density-especially with the stress fractures.....i would stress fracture things though with the IA, because the remodelling of the bone surfaces actually lays down weaker bone on the surface that fractures more easily-one time i stress fractured my leg running....of all things.  my rheumy told me that we had to stop the remodelling so that my bones stay stronger.....so....i still have inflammatory arthritis that rumbles along, but ended up needing my back fixed so i didn't end up in a wheelchair but my bone density was fine to go ahead...it sounds like her L4 is taking a beating, and i can understand that because a lot of the motion happens L4-L5-S1....but i can also say that being fused to my pelvis isn't as big a deal as i had worried about (but i'm not a teenager anymore, alas).  my back was so bad that i instinctively started bending at the hip and not twisting because it just hurt so much, that after surgery there are really only times that i notice-like trying to look over my shoulder.....but the one big thing i would worry about is the pelvic screws, they do limit the walking....so i will never walk "normally" because i cannot stretch my legs out to walk with a longer stride.  and i could see that being very limited to a youngster undoubtably wanting to keep up with her friends!  sounds like there's some more investigations needed first-with the arthritis and the stress fractures/bone density....and of course i hope she can get referred to a specialist for the lupus/IA question-as i understand from my own experience that it's some kind of autoimmune problem but there are treatments for it that do work....just a matter of finding out exactly what it is, and then what works for her to keep it in check.

    good luck, and i'm so sorry she's got so much pain.....hopefully a plan can come together to help her out. 

    Kathy
    Spine-Health Moderator
    ---------------------------------------------------------------
    Dec '16 T10-S2 fusion with pelvic fixation. Laminectomies L2, L3, L4, L5, facet removal, cages L4-5, L5-S1, severe scoliosis, arthritis and stenosis repair. 

  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 318

    camb411, any update on your daughter?

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