Incomplete Spinal Fusion

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Viewing 6 posts - 97 through 102 (of 108 total)
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  • Dr. Corenman
    Moderator
    Post count: 6086

    Your hips are not perfectly normal (“There is mild prominence of the anterior femoral head neck junction bilaterally. There is fibrocystic change at the anterior right femoral neck”). This could be femoral/acetabular impingement and could cause some hip pain. See https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/ to understand this syndrome.

    Where is your leg weakness? Is it all in one myotome (the muscles that are innervated “connected” by one nerve) or are multiple myotomes involved? Is there pain inhibition present (the muscle when activated “hurts” preventing you from contracting that muscle fully)?

    A simple way to rule out the hip is to inject some numbing medication into the hip and look for temporary pain relief.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    sperryguy
    Participant
    Post count: 68

    Hi Dr. Corenman

    The doctors (as a team) are now quite confident that the source of the hip pain is coming from the back. I went through presurgical testing, and was sent for a neuro consult as per the surgeon. Very thorough exam. Thank goodness no nerve damage, the doctor said mechanical in nature. Any last minute instructions?

    Thank You!

    Steve

    ps: The procedure will be an open revision TLIF L4 through S1

    Dr. Corenman
    Moderator
    Post count: 6086

    A positive selective nerve root block (numbing of the nerve with temporary relief of hip pain) will confirm that your back is the cause of your hip pain.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    sperryguy
    Participant
    Post count: 68

    Dear Dr Corenman

    Update on my surgery

    Summary: I had a Open Tlif revision, L4-S1 (l5/s1 was new). The surgeon found “No Fusion whatsoever. Severe compression at the L5 level. He also decompressed the L3 without a fusion. I received excellent care and spent 7 days in the hospital due to severe pain and excessive drainage. The first 2 days there was a discussion with the doctors regarding being sent to a facility since I was unable to move my legs without assistance. I was very adamant in PT and never allowed the staff to miss sessions. Things improved. Constipation was a severe issue. At some point I asked for “Movantik” for the issue which did help. Still hospitals “Do Not” give the correct meds to help the patients. Patients must be there own doctors. I have been home for about 3 months. Recovery has been a challenge but I am improving quite nicely. I am fortunate to be working from home until I’m strong enough to travel to my office. To anyone going for such a surgery, beware that it is difficult and exhausting. Quite different that a MI operation. The older one is the greater the challenge. Go for PT with a therapist with extensive spine experience. My PT started in house and after 6 weeks started in office therapy. One very important finding regarding avoiding nausea post op. I was given a scopmaline patch. I was Rx it for almost 4 weeks due to other meds causing nausea(even Tylenol). The withdrawal from this drug is horrific!. Avoid it if you can, find alternate treatment. I found not doctors, PA, Nurses, and remarkably Pharmacist were aware of the withdrawal effects. My pain management doctor was aware and said he never Rxs med. Im sorry for the long report. The journey continues, 60-70% of my pain has been relieved. I hope it continues. Thank you Dr C for all your help!

    Steve

    Dr. Corenman
    Moderator
    Post count: 6086

    OK-so the L4-5 failed fusion level was obviously not fused. The L5-S1 level sounds to have been nerve compressive (but that should have been known by the imaging-CT or MRI). Your statement “regarding being sent to a facility since I was unable to move my legs without assistance” worries me unless you had previous weakness that was the same as previous to surgery. You should not have had increased weakness after this surgery.

    The recovery from this surgery should have not been too difficult and certainly not any more than an MIS surgery. Did you have a dural leak?

    Glad you have had at least 60-70% relief. Have you regained your strength?

    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.
    If this forum has helped you, please let Dr. Corenman know!

    sperryguy
    Participant
    Post count: 68

    Hello Dr Corenman

    Just checking in with you and the forum. These are the latest xrays from my l4-s1 revision TLIF
    Study Result
    Impression

    IMPRESSION:

    Status post L4-S1 posterior and anterior column fusion with further incorporation of the dorsolateral L4-5 bone graft and no evidence of hardware failure.

    There is no subluxation, normal alignment with neutral, flexion, and extension images.
    Narrative

    History: Lumbosacral spinal fusion follow-up

    Technique: XR LUMBAR SPINE AP AND LATERAL WITH FLEXION AND EXTENSION 4 VIEWS

    Comparison: 8/15/2017 lumbar spine radiographs

    Findings:

    There has been posterior spinal rod and pedicle screw fusion from L4 through S1. The pedicle screws are intact with no evidence of pathologic surrounding lucency. The spinal rods are intact. There is no subluxation, normal alignment with neutral, flexion, and extension images.

    Dorsolateral bone graft is visible at L4-5 bilaterally. It appears to have undergone further coalescence since the prior examination.

    There has been interbody cage placement at L4-5 and L5-S1. There is bone graft within the L4-5 interspace, visible anterior and to the right of midline without definite incorporation into the adjacent vertebral bodies. The L5-S1 interbody graft appears to have resorbed.

    There is mild intervertebral disc height narrowing at L3-4. L1-2 and L2-3 disc height is preserved. There is no fracture. There are no osseous destructive lesions.

    I am post op 6 months. I still some issues, and occasional groin pain, nothing like previous to the surgery.

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