[jericho163]

#21866

Thanks Dr,

That was what I was thinking, a partial fusion or ongoing fusion has alot micromotion and muscles dont like that. I guess it is abit similar to a “bad” disc that no longer offers good support and tends to “move” around.

Technical question: fusion healing is via indirect bone healing(relative stability) that can accept a limited amount of micromotion while healing?

I will go ahead with the static xray since my surgeon wants that and ask about the dynamic one. I am assuming we still can gather some info by comparing that w the 3month xray? Just hoping my early PT didnt screw up anything. My surgeon thinks as long as those hardware are intact, things should be ok, at worst a delayed union. :(

Thanks Dr Corenman, you have been amazing.

[Donald Corenman, MD, DC]

#21870

The reason we use such big screws is that we don’t want motion. Let’s go back to the first intramedullary rods (a long metal rod) in the center of the tibia. Before this invention, the patient was put into a long leg cast and given crutches for 3-6 months. They were asked to “keep off the leg”. About 3/4 went on to heal in 6 months and the rest needed an open operation.

Now, when the rod is placed into the bone, almost all go on to heal in 3 months and many individuals can immediately walk on the broken leg. It is the fixation that allows healing.

This is why for 3 months, I don’t want the patient to significantly bend or twist. The screws will hold without too much torsion but I don’t think this hardware can tolerate major stress (until three months). There are exceptions to this rule.

Delayed union is better than no union.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[jericho163]

#21871

Thanks DR Corenman for this analogy.

I supposed limited motion in the first 3 months have 2 purposes. 1 is to facilitate bone healing.
2 is to make sure screws and rods dont suffer from too much stress and break.

[jericho163]

#21873

Hi Dr Corenman,

In general, is it common to have lower back muscles tightness, achyness, fatigue 5 months post fusion from your experience. Are there patients that need much longer before they feel much better compared to preop.?

I supposed some patients with lower back pain feel much better in the earlier days after op and some feel only better after they are fused solidly? From your long experience, is it easy to tell what kind of patients/symptoms resolve most easily with fusion. I suppose leg pain is resolved easier and back pain can linger around for longer?

[Donald Corenman, MD, DC]

#21874

All your speculations are correct. Most patients have good relief within three months with some feeling great in two weeks (depends upon previous pain levels and instability). In some patients with solid fusion, the muscles can take an additional three months to “regulate” with the unusual patient taking up to a year before they fell “normal” again.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[jericho163]

#21876

Thanks,

Can i also say if we dont use bmp, just own bone plus some grafoton, it usually takes about 1 year for the fusion to solidify. And maybe another few months for the muscles to normalize. And sometimes the “unusual” fellow will complain until around the 1 year mark.

Can I also speculate that those patients who are in alot of pain presurgery normally does quite “well” post surgery because their pain levels have been reduced drastically, while those whose pain levels are low to begin with and not even taking medication are counter-intuitively “harder” to heal post surgery.

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