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LSO brace w/hip extension--post lumbar fusion

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:26 AM in Back Surgery and Neck Surgery
Hi all,

For some reason, I have not been able to log onto spine-health for a couple of months, so I haven't been able to post an update on my situation. (I haven't even been able to open most pages on the spine-health site; but, it seems to be working now!)

After meeting with a total of 6 spine surgeons in Colorado over the past year, I was quite convinced that spinal fusion was necessary, I finally found the right surgical team, and I had surgery on 10/20/08. I had ALIF/PLIF/postereolateral spinal fusion for my grade 3 spondylolisthesis.

But, the surgeon discovered an unexpected mess in my spine, and I was in surgery for more than 10 hours. He found fractures that neither he nor any of the other 5 surgeons (or the radiologists) had seen in any of my images (X-rays and MRI). He found localized osteopenia (weak/soft bone) at L5, so that vertebrae couldn't really hold the screws. He also found lots of bone spurs, completely crushed nerves, a very steep angle at my L5-S1 slip, etc. He ended up fusing L4-L5-S1, not just the planned L5-S1, using 2 cages (with BMP), 5 screws, and some rods. The hardware placement was a bit tricky and is "delicate" because of the osteopenia and the very steep slip angle (they reduced the slip distance by about 50%). Afterward, he said he had no idea how I was even walking with my spine in that condition.

The good news is that at my 6 week follow up, the hardware still seemed to be in place and some bone growth was already visible on X-ray. I go back on 01/22/09 and will have a CT then.

But, because of my complications, my weird anatomy, the tricky hardware placement, and the osteopenia, I was put into a hard plastic and metal LSO brace that has a "hip spica" extension that attaches the LSO to one of my thighs--this greatly limits hip movement. This brace is a major pain to deal with. I'm in it all the time except during sleep. My husband must put it on and take it off, while I lie on my back. It's very uncomfortable. I can't drive, and I can't even get in/out of my SUV without a step-stool and some help, because of the limited leg motion. I've been in this for just over 2 months now, and will be in it for at least one more (hopefully that's all!), if not another 2. Ugh.

This seems to be a rather unusual brace--the physical therapists and the orthotists say it's rarely used and most PTs I've encountered or talked to have never even seen one. I'm just curious if any of you have been in one of these things.



  • I'm glad for you you found a good Doctor and they found the source of your pain. It's a shame you had to wait so long before you found the right Dr. but suffered for so long. I'm sure there are many who are in pain with things unseen. I hope one day scans and MRIs will be better able to see this type of bone problem so people wouldn't have to suffer for so long. I've never seen that type of brace but it's good that something is helping you. I wish you a complete recovery and all the best for the new year. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I wouldn't say the brace is currently helping me--it's kind of like torture! ;)

    But, it is holding my spine stable to increase the chances of fusion and decrease the odds of hardware problems.

    I just got a new brace yesterday that fits much tighter and it's extremely uncomfortable. I'll have to go through a few rounds of adjustments to try to get it bearable.
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  • Heidi, glad to hear you are hanging in there post-op. I have heard of that brace. I remember someone on here saying they were getting one with the leg exension, but can't remember who it was. That must be miserable, but if it works, then it is worth it. Are they treating your osteopenia with any meds? That was an unexpected finding. Boy a situation like yours makes me glad I didn't wait any longer to fix my spondy. I wish you a successful recovery. Glad you made it through to the other side with us. Keep us posted, and I hope SH keeps working for you. >:D< Cali-Sue
  • Oh, my! Just want to give you a big hug, sweetie! You have been through so much! I'm so happy for you that you got a team that was so thorough. Hopefully, you are well on your way to recovery.

    I remember reading on hear about using a plastic bag on the seat of your car to aid in getting in and out. Just might do the trick for you with that wonderful brace you have and limited movement.

    Stay strong dear, and I'm glad you're once again connected to sh.
  • I think Eren (heck if I can remmeber her SH name) was getting one of those, maybe she will chime in at some point. If you do a search on here you may find it, I think she posted about it in the last 2 months.

    I have had a couple patients over the years with these braces and they were mostly used when there was significant hip/SI joint dysfunction as well. I would think this was prescribed because of your weak bone and to make sure movement was more limited. Still with a TSLO, a bit of movement goes on in the lower back. These are just my observations not a medical opinion, blah, blah, blah. You know the drill. If your doctor wants you to stay in the brace another 2 months you could ask him if you can lose the hip part at some point (this should be removeable with a screw driver, but dont do this on your own). Not that you are out of the woods, but the first 4-8 weeks seem to be the most critical. All you can do is ask!

    Good Luck,
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  • I am not on any meds for the osteopenia. We did discuss the osteopenia he found and whether or not this indicates any wider spread bone density problem, concern for osteoporosis down the road, etc.

    My surgeon feels the osteopenia was very localized to L5 and directly caused by L5 basically being non-functional for many years. It was slipped so far forward that it was really not under compression (i.e., not weight bearing), and compression is what makes the bones grow/strong. My body had grown bone spurs around L5 to compensate somewhat, and the bone spurs were actually fairly "normal" bone. The surrounding vertebrae seemed to have normal bone density.

    Also regarding the brace: my surgeon did mention that if he wants me to stay in this brace longer than 3 months, he might have me just wear the LSO part and remove the hip extension. But, that will all be based on what he sees in a CT scan that I'll have in just over 3 weeks.

    I'm a little nervous about coming out of the brace, because it really prevents me from doing much in the way of bending or twisting. I'm wondering if it will be more difficult to keep myself from doing "bad" things if I don't have the brace.
  • Heidi, I had the TLSO brace for 10 weeks (no hip extension), and it very much limited my ability to BLT. It went from above my chest to my hips. Perhaps yours starts lower since it doesn't include thoracic. Just follow your doctors orders, he knows best. >:D< Cali-Sue
  • Cali-Sue,

    My LSO brace comes up to just under my boobs (pushes them up) and down to my hips. Plus the leg extension.

    I'm curious if you slept and/or showered in your TLSO--basically, when did you have to wear it and when did you take it off?

  • Heidi, I wore my brace when up and about. I didn't wear it to shower, go to the bathroom, or sleep. I didn't have any of the issues you have, just level 1 spondy with L4-5 fusion, fairly typical. Good-luck, I hope he lets you out of it sooner than later. >:D< Cali-Sue
  • Joy mentioned in a previous reply the trick of using a garbage bag to help with getting in and out of a car. It reduces friction so you can rotate easier without twisting.

    I had read about that trick prior to my surgery, so I decided to experiment with it. I found that it sort of worked, but the trash bag would wad up under me and/or would slide out and fall to the ground when I got out.

    So, I decided to improve on the idea. I bought a piece of cheap satin fabric, cut it approximately to the size of my car seat, and, sewed some elastic strips to it, and semi-permanently attached this to my car seat. It's been working great. I did a really fast hack job when I created it, so the fit isn't perfect, and it sometimes needs to be repositioned, but overall it seems much better than a trash bag for me.
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