cdebrun2002MemberFebruary 14, 2014 at 8:50 amPost count: 11
I injured my back on 12/10, which led to intense radiating pain down my left leg/buttocks. I had a laminectomy on 7/11, which did not help. On 2/12 I had a fusion of L5/S1, performed by an Orthopedic surgeon. About a month out of surgery I began to have radiating pain in my right leg/buttocks, along with the original pain in my left leg that was unchanged. On 5/13 I had a fusion on L4/L5, and he redid the fusion on L5/S1. This was done by a Neurosurgeon. Immediately after surgery the radiating pain seemed to be gone, but I had what I would describe as “muscular” pain in my lower back. It was the worst when changing position. As the months wore on the pain remained, but it started to hurt all the time, and the pain changing positions was less. I would still describe it as mostly “muscular” pain, as opposed to the “nerve” pain I suffered before my last surgery. For 9 months my Dr. assured me that this was normal post surgery pain. A couple of weeks ago I talked him into an MRI. It showed “L4-L5 extensive Modic type I endplate change in part related to the presence of a new Schmorl’s node.” He then ordered a follow-up CT. It showed “Postsurgical changes from L4-S1 posterior spinal fusion with evidence of bilateral L4 pedicle hardware loosening and no significant bony bridging across the L4 and L5 posterior elements. These findings are suggestive of pseudoarthrosis.” At my follow-up apt with my Dr. he told me it looked like my pain was just caused by the stress of the surgery, and gave me a NSAID. He didn’t mention the loose screws or pseudoarthrosis. Should I be concerned about the loose screws and pseudoarthrosis, and the fact he didn’t mention them? I have read that pseudoarthrosis is a cause for revision. Do you think that it is called for here?Donald Corenman, MD, DCModeratorFebruary 17, 2014 at 3:37 amPost count: 8503
You have undergone a two level posterior lumbar fusion with a pseudoarthrosis (lack of fusion). This will cause lower back pain just as you describe it. I will assume that this neurosurgeon does not understand that your fusion did “not take”.
The good news is that a salvage surgery in your case is not too difficult as the discs of the spine were not touched by the first or second surgery. A TLIF surgery (transforaminal lumbar interbody fusion-see website) will most likely fix most of the discomfort you have and can use the same incision that the first two surgeons used.
Dr. Corenmancdebrun2002MemberFebruary 17, 2014 at 9:28 amPost count: 11
Thank you for your quick response. Should I be worried that he has missed the fact that “it did not take”? He is my third doctor during this ordeal and overall I have been very happy with him, but it makes me very nervous that when discussing my pain he didn’t bring up the pseudarthrosis.
Is the pseudarthrosis also responsible for the Modic Type I changes that showed up in my MRI? I have become very acquainted with the mechanics of the spine that caused my original “nerve” pain, but I can’t seem to find any info on how the lack of bone fusion on L4 is causing the “muscular” pain I currently have. My Dr says the pain is just a “result of the stress of the surgery”. Could you explain this for me or direct me to a resource that could?
After looking up the TLIF surgery on your website it seems, to my reading, that it is pretty much the same surgery that I had originally (L5/S1). Am I misreading? Since all the hardware is already there and the nerve root doesn’t seem compressed, would he just have to repeat the bone graft part of the surgery? My recovery from the last surgery was about 5 months or so till I felt halfway “normal”. Would the recovery for this be similar or shorter?
I just want to really thank you for providing this service for all of us that have these spine problems. Some doctors do a really poor job of explaining things. Even if they are the best, it’s easy to forget to ask a question in the 15 minutes you see them, which means you have to worry about it for the next month. Providing this resource has, I’m sure, saved the sanity of many people. Thank You!!Donald Corenman, MD, DCModeratorFebruary 17, 2014 at 11:37 amPost count: 8503
I do not understand why some physicians do not recognize pseudoarthrosis. Maybe we all want to have the best outcome for our patients and do not want to recognize a failed surgery. Unfortunately, pseudoarthrosis will occur even in the best of hands.
Yes, pseudoarthrosis will cause Modic changes.
Your “muscular pain” is most likely bone pain that “feels” like muscle pain.
I cannot comment on the surgery you underwent without your personal knowledge of what was performed or a reading of the operative report.
All of the hardware might be intact but with a pseudoarthrosis, the screws will most likely be loose and will need to be replaced. Also, BMP (bone morphogenic protein) use is a must in my opinion for a revision surgery.
Dr. Corenmancdebrun2002MemberFebruary 17, 2014 at 11:50 amPost count: 11
Is the typical recovery from a revision surgery easier than the normal fusion? I have a brace that I wore for a couple of months post surgery, would it help my pain to go back to wearing it?
One last question: I know there are many reasons for a failed fusion, but I had a severe post-op infection, and I have read that antibiotics can interfere with a bone graft. Is that that the case? I know in the long run that the cause is not all that important, but when considering whether to go under the knife again, it would provide a little peace of mind if I knew that the pseudoarthrosis was a “fluke” of the infection.cdebrun2002MemberFebruary 17, 2014 at 12:01 pmPost count: 11
I’m sorry, I said “one more question” and I was almost right. Will anything have to be done about the damage being done to the vertebral body due to the failed fusion or will it heal on its own once the spine is stable?
I am taking a muscle relaxer, hydrocodone, and a NSAID. Knowing where my pain is originating, is there anything else I could look into taking to reduce pain? Thank you again.
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