On my way to a potential 3rd back surgery

///On my way to a potential 3rd back surgery
On my way to a potential 3rd back surgery
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  • Avatarnetburgas
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    Hello Doctor Corenman,

    I’m Marta, from Barcelona, Spain. I live in Portland, Oregon. I am 36 years old and I am a graphic designer. I came to the United States to fulfill my American dream 7 years ago and here I found a place to be happy and grow professionally.

    We connected around 2 years ago when I had my snowboarding accident. I broke my L1 vertebra and you were the doctor who helped me to take the decision to finally get surgery and I’m really thankful for that.

    As a reminder, March 2017 I broke my vertebra L1. After 5 days at the Emanuel Hospital in Portland, Dr. David Adler, he decided not to proceed with surgery (spinal fusion) and to wear a brace for 8 weeks at home. The same thing said a second neurosurgeon in the same hospital.
    With your opinion and seeing that the pain increased and having in mind to go to get it in my country as my family is there, I sent the medical tests to Spain to Dr. Joan Molet who said that surgery was necessary too.
    I got a fusion of T11, T12, L1, L2, L3 with 2 rods and 8 screws.
    Back in Portland and after 6 months, and after receiving MRI, X-rays, bone scans and intense pains, they found that the two screws of the L3 (the lower ones) were loose.
    I was told that the lower part is the one that receives all the stress of fixation and that sometimes happens after an arthrodesis operation. Also, my pedicles are very small which makes it more difficult for the screws.

    This time I visited a neurosurgeon at the OHSU Hospital in Portland who told me that he should NOT have had surgery done since he could have healed by itself.

    But the screws were loose and something had to be done … so I went back to Spain, leaving my job and my life here in the USA to get back to the same neurosurgeon who operated and who took the decision to remove all the metal from the back and return to merge this time one level below T11, T12, L1, L2, L3 and L4. This time he used longer, thicker screws + a bone regeneration paste DBM
    Orthoblast (biological bone substitute).
    After 6 months of recovering from the second operation and being in a lot of pain, I went to Spain this past November to see doctors there and do the corresponding tests. The screws of the lower part, this time those of the L4 are loose again and the prosthesis suffers with the movement.

    Right now I have 4 diagnoses from 2 different doctors in Spain and 2 in USA:

    • Dr. 1, who has already operated twice, has checked with his team and orthopedics and says that the broken vertebra is healed and we could try to remove the metal from the body and see how the column reacts without it. Would it be possible to take everything out? I feel like my body rejects metal being honest and I think this could be the best solution if it’s possible.

    • Dr. 2, who said that the metal does not support the spine and is forcing the whole back since the broken vertebra does not have enough support with the superior and inferior vertebra. Suggests replacing the broken vertebra with a “false / fake” (metallic sheath). Open on the side of the body to replace it and reopen at the back and put 2 rods and screws for 1 vertebra above T11 and two below L2, and L3. He says that it is a very risky operation and not 100% sure that it will work.

    • Dr. 3, at the OHSU Hospital in Portland diagnosed that there might be a possibility to remove the prosthesis/metal as long as BMP was not used in my last operation. If it was used, then it means that my bone does not regenerate and I would have to proceed with the same last operation that I received. First make a test of the quality of the bones (Dexa Scan). If the bones are of good quality, re-fix the 6 vertebrae with 2 rods and 10 screws plus the BMP bone regenerating paste and see if the screws do not re-release. (Back to do the same operation?). If the bones have poor quality, start a bone strengthening treatment with medication for 6 months and then proceed with the surgery.

    • Dr. 4, at Barrow Neurological Institute, said the screws and prosthesis are fine and fixed and I just need to start PT again for the pain.

    I’m only 36 years old. I have been without physical activity for 2 years and living with horrible pains that do not allow me to do normal life.
    I know it’s going to be difficult to be the same active person than before but I need someone to be able to operate and find a solution. Please…
    To have to go through a third operation is to redirect my life back to the unknown and I would like to receive your opinion as a doctor.

    I have all the test I got and I can send you via email to review as I need to take a decision as soon as possible. I can’t deal with this pain any longer…

    I would also appreciate if you could recommend me to the best doctor in Spain and the best doctor at OHSU in case I can’t be on your hands in Colorado.

    Thanks so much.

    I really appreciate.
    Marta

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