[2Broken]

#21461

Dear Dr. Corenman –
“T10-S1 decompression w/ multilevel TLIF, possible PSO, and bilateral SI joint stabilization” is the description in my neurosurgeon’s office notes of my surgical procedures, as performed on 1/8/2015, at Swedish Hospital in Seattle Washington. I am a 57 year old woman and my recovery has been problematic. Of course, I must be totally forthcoming by admitting that I did not stop smoking cigarettes until 12/1/2015. By then I had drastically reduced the daily number of cigarettes I was smoking, after being informed for the first time on 10/23/2015 that I had advanced osteoporosis; it appears now in my medical records, as the end of 2015. I had always known that if I was ever diagnosed with osteoporosis, like my mother was, that I too would have to stop smoking; my only defense is that the only bone density testing I’d ever had ordered was in 2008, and I passed with flying colors – as I was, of course, pre-menopausal, and I’d fused well in each my previous 5 orthopedic surgeries (a fusion at C4/C5 in 1992, and then four knee surgeries all done on my left knee beginning in 1979, the last of which was a complete joint replacement in 2007).
My back surgeon did not use BMP, although at about 4 months post op, I asked for and received a magnetic bone stimulator and used it faithfully as instructed. Regrettably, I should have done as instructed regarding the smoking cessation without needing to know that my current lack of bone density from the osteoporosis put me at extreme risk for unnecessary peril, as it relates to achieving (or NOT) satisfactory fusions at every level.
Be that as it may, I have been concerned about a hardware failure since 9 to 10 weeks post op; I had rotated slightly while sitting, and heard and felt the audible pop, that was not accompanied by any discomfort – with 2 exceptions. Physically, the exponential effect gravity seems to have on one with scoliosis could be felt, slightly, and has increased with time; mentally, the sound in my ears, and feel of metal hardware rubbing against itself in my back was only irritating at first. It has now become a form of torture that I’m never fully able to rise above and ignore, in order to escape from it.
I was concerned enough to call my surgeon’s office within an hour after this occurred, and was told to let my pain be my guide as far as going to the ER, and that additional imaging would be the only way to confirm or discard a hardware failure question. Additionally, I was told that if the hardware had failed in any way, it would most likely be a minimum of 12 months before any surgical procedure would be performed to correct an issue. unable to ignore the sounds in my ears of metal on metal, I made an appointment about 12 weeks post op, and requested an order for the imaging to discover any hardware problems; I was given referrals for MRI’s of both the lumbar and thoracic region, with and without contrast.
It is my understanding that the hardware can only be imaged on a CT scan, which I’d never had taken, but after the surgeon deemed my fusion a failure, Ct scans were ordered and have been taken. I had anticipated finally finding the answer to my hardware concerns, but the CT makes mention of the hardware only as to whether or not it had obscured the radiologists view of some tissue feature. Asking my surgeon has not been productive; after having my questions brushed aside by him, am I asking the wrong professional? Is it possible for a patient to make an appointment with a qualified radiologist, in order to pose my questions directly to the radiologist?
I apologize for the verbosity of my post, and hope I haven’t left out any pertinent information needed. I’m attaching two photos, including a pre-surgery ex-ray as well as one taken during surgery, that my surgeon shared with me.
Thank you in advance for any information you can pass on to me; I am seriously considering flying to Colorado in order to have receive a second opinion from you; at the least, a film consult. I truly do understand my surgeons focus on my continued smoking as the sole reason for the non-fusion; and, while I am confident in my surgeons credentials wherever his education, training, and surgical skills are concerned, I have many as yet unanswered concerns regarding not only the revision surgery he has proposed, but for the lack of attention and/or merit that has been given to many of my concerns – which may have little if any merit, admittedly. However, without my long standing concerns and questions being met head on with direct answers, I find myself unable to move past them, so that I’m then capable of focusing on the future, and all possible solutions.
Thank You for your time –
C. McCann
PS – I was unable to attach the photos, sorry….

[Donald Corenman, MD, DC]

#21464

First-I will assume that you had the surgery for degenerative scoliosis. If you had osteoporosis prior to the surgery which is highly likely, the success rate of surgery drops due to the soft bone. Pedicle screws cannot easily “hold” an alignment if the bone is the strength of balsa wood.

Smoking also is well known to prevent fusion from forming. It is good that you cut down but the tars and nicotine still cause significant interference with forming bone cells. The fact the BMP was not used is another problem as it is the only substance that can directly counteract the effects of smoking.

Really, the best way to assess hardware is a simple X-ray. This can demonstrate screw displacement, hardware fracture and malposition. The CT scan is great to look at fusion mass and haloing around the hardware.

I have to assume that you do have pseudoarthoses as with osteoporosis and smoking along with a long fusion, the chance of non-union is very high.

I do long distance consults for a fee where I assess you over the phone from office forms you fill out and review all the images you Fedex to me. Otherwise, I will comment at no charge if you can put the radiological consultations here.

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.

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