Back Fusion Surgery

bellehill, RN · Feb 8, 2004

I am by no means an expert, but I am working on a neurosurgery floor now so I see a lot of back surgeries. A fusion is when the disc that is herniated/bulging is removed and the vertebrae above and below are fused together. A lot of people I see have good results with this surgery and are usually d/c from the hospital in about 2-3 days. Sometimes the pre-op symptoms won't disappear immediately and the patient may require a steroid.

From what I have seen, the more disks worked on the harder the recovery. Physical and occupational therapy will be working with the patient on a daily basis. I don't have a website but try a google search, I am sure something will come up. Hope this helps!

Dave ARNP · Feb 9, 2004

My main area of practice is pain management, and I see alot of people who have had these procedures done. In my expeirence, they either work great or they're useless (sometimes making things worse). If she is going to have the procedure done, FIND A SPECIALIST! A good surgeon can make all the difference here. When she sees the surgeon, ask him about his success rates, how many procedures he's done and how often he does them. There are NO procedures in neurosurgery that you want done by a doc who just does a couple a year.

Best wishes to your mother. I commend you for trying to take care of her!

Dave

luckymichelle · Feb 9, 2004

Bellehill & Dave -

Thank you so much for the replies. My mom is sitting here with me, and she thanks you very VERY much. This is such a life-altering experience for her, and so far, she's been discouraged.

Dave - if you read this again, it sounds like you've got experience with pain management - any tips? My mom takes LOAD of narcs currently to function daily. She'd love to work to a point where they're not a part of her life.

You guys are a great help - you all have so much knowledge that can really make a difference to a person. My mom feels like this is a game of Russian Roulette, and she's trying to gain whatever knowledge she can in order to make the best decisions. Are there any viable alternatives? She's facing a fusion of S1, 5, and 4.

Thanks again you guys!

All my appreciation,

Michelle

Dave ARNP · Feb 9, 2004

If you wanna PM me I could perhaps give you some suggestions.

I would need to know what she is taking, and how much as well as how her QOL is with them. Also, what she would rate her pain as on a daily basis, and anything you could tell me about her breakthrough pain.

Would love to help.

Dave

mattsmom81 · Feb 9, 2004

I am sorry for your mother's pain and hope she can get some relief soon.

I had a successful fusion of L5-S1 12 yrs ago and did very well...am working as a nurse in critical care. While I do have some arthritis pain, I am not taking narcs...NSAIDS do the trick.

A good surgeon may be able to help her, if her situation is correctable. Get several opinions tho...and the best surgeon in town (a neurosurgeon did mine)

With 3 levels fused your mom will have some limitation of movement, (I do not) but if it helps her pain she will likely not care. :cool:

Give your mom a hug for me...I know what it feels like to hurt badly every day...it takes on a life of its own.

Cindee · Feb 19, 2004

I am a patient and a nursing student. I have had a fusion on my cervical spine last year. I am refusing the fusion option for my lumbar spine right now, because I have been accepted into a clinical trial at UCSF to recieve Prodisc replacement discs. I have a surgery date for June 1st. This is a wonderful alternitive to the fusion. I have had mutipal problems, to long to list, on my spine. I am sorry your mother has had such a terrible time. I can understand completly. Please check out this web site, it will give you great insight on alternitives to fusion. I dont know how old your mother is, but if she wishes to retain motion, and lessen her pain, this may be what she needs too. http://www.Spinesolutionsinc.com. I dont mean to be a sales person here, but it has opend so may doors for me, I cant wait untill fusion becomes a thing of the distant past. Good luck to you and your mother!

onamission95 · Feb 19, 2004

My mom had her back fused 3 years ago to the month (4 & 5). It was her third back operation. The fusion was the best thing that's ever happened to her. Her back has been in much better condition and she leads a normal lifestyle without restrictions.

If they are recommending your mother get her spine fused, I say go for it. My mom suffered in agony for years. The surgery was fairly routine and she recovered without complications despite having a rare blood disease and Grave's disease. A fusion would most likely give your mother her life back.

Good luck with the decision. I wish the best for your mother. :)

sartell254 · May 26, 2004

Greetings-

I had an L5/S1 surgery a couple of months ago and am now having a considerable amount of pain. They tell me it is a disk degeneration and have mentioned that a fusion may be the only fix. What is the length of recovery time for this/or what is it like?? Thnaks for any input.

moia · May 27, 2004

I just had decompression and discotomy and I am doing pretty good so far.

I don't really think fusion is a good idea...medscape can give you access to all recent studies and it definitely is looking more and more that conservative care versus surgery are in a dead heat...there is no benefit with surgery unless the patient has cauda equina with loss of bowel and bladder control.

I had my surgery because we tried everything and I was losing more and more sensation and movement so the pressure had to be relieved before I ended up an emergent cauda equina.

Artificial disc replacement is a real option..germany has been doing it for 10 years with good results..the US is still in the middle of trialing..I would recommend finding the neurosurgeon in your area that is involved in the trial and get a consult before you agree to fusion.

Fusion is a big surgery...the doctor won't lie about the risk and you have to know that a lot of people have had fusion with no relief..or a failure to fuse or some of the instrumentation holding the back together can break or move...

Make sure your surgery is done by a neurosurgeon.

Orthapedic surgeons work on bone...remember nothing is wrong with your bone...the nerves are the problem..get an expert on nerves to work on the problem.

Research and get a second opinion and get a consult for the artificial disc...

fusion has been very successful for a very specialized group of people...mostly those with cervical problems .

Good luck and don't get discouraged...come to braintalk.org and go to the chronic pain or spinal injuries forums...we all hang out there and support each other and share all the latest news.

sartell254 · May 27, 2004

MOIA--

Thanks for the input. I'm in the early stages yet, but in a lot of pain, so am trying to gather as much info as possible. Appreciate you input!!

kids · May 28, 2004

Wow, I am surprised I over looked this thread, (many thanks to the person who pointed me toward it).

I am currently recovering from a 4 level (L2-S1) posterior lumbar interbody fusion (PLIF) done on 4/19.

I have a lot of time on my hands and have been composing this for a day and a half so it is long and will probably be way too much information.

I very highly recommend: http://www.spineuniverse.com and http://www.back.com

I have a degenerative process in my spine that first came to light in August 1993 when I bent over to open a narc drawer and herniated 2 disks. Until then, despite previous x-rays, there was no reason to even suspect I was born with spinal defects. I have unusually narrow vertebral foramen and "tight" faucet joints. This coupled with very fragile disks that are prone to herniating (I once sneezed and blew a disk), causes me to be symptomatic with herniations so small that most people would experience minor symptoms if any (3-5mm), the disks also desiccate and collapse on their own. Over the last couple of years I lost 2 inches in height and developed a 28 degree left curve caused by my L5 vertebrae sliding off of S1. When they got me open they found that I actually had bone resting on bone and that the L5 extended 1" past the margin of S1. Why I was not showing symptoms of cord compromise "we" have no idea. My current surgeon describes it as my having a 90 year old spine in a 40 year old body. Given my defects nursing was not the best career choice. There is the possibility that my condition is hereditary so my children (23, 20 & 19) have been cautioned to use good body mechanics, to consider "back healthy" careers and to not smoke ("ages" the disks).

It has been a long and painful journey. Despite being enrolled in a comprehensive pain management program I spent a good portion of the last 2 years in a wheel chair (and working full time until 9/03)

Without going into a lot of boring details this was the latest of several surgeries that started with an emergency laminectomy in 1994 to relieve spinal cord compression. A failed & broken 2 level fusion (L2-L4) done in 1999 was removed with this surgery (replaced steel with titanium). To be honest, this has been the most painful experience of my life and my prior back surgeries did nothing to prepare me for it.

BUT

With the exception of (surgical) back pain, I am pain free for the first time since that day in 1993. This fusion ended leg pain I had been told was the result of permanent nerve damage. I am walking everywhere. I can stand up straight (tho I did not get back any of the lost height) and I don't wet my pants anymore. I am completely confident that I will be able to return to work (Peds advice/clinic) after rehab. If this sounds like some sort of testimonial I apologize, despite a couple of major set backs (a near bowel obstruction and an adverse reaction to Wellbutrin/Zyban that had me vomiting for a month-lost almost 30 lbs.) I feel like I have a future for the first time in years, actually I feel like I have a future I can look forward to.

Every person's surgery and recovery will be different (and depends on the surgeon's preferences).

For ME:

I had surgery on a Monday and came home on Friday. My surgery was done using a posterior approach. Another option is to do an anterior approach which also involves a vascular or thoracic surgeon and requires 2 surgeries (abdominal for cage placement and posterior for rod and screw placement) 1-2 weeks apart.

It was a long surgery and I did develop some skin breakdown (stage II-III) on the front of my hip bones, chest and chin (yeah, I know...but I still believe they did their best considering the surgery ran 2 hours longer than planned).

I was on PCA Dilaudid for the first 24 hours (yuck, I can't believe people "seek" that stuff).

The morning of post-op day 1 OT had me sitting at the edge of the bed washing up and PT had me walking to the room door with a walker. (Have I mentioned that I think therapists are the devil's spawn?)

I had a drain in until post op day 4 and received 2 units of (my own banked) blood (POD2 & 4).

By the time I came home I was walking 300 feet with a walker. I used the walker at home for about a week tho it was more for my sense of security than for stability.

I had an adult with me 24/7 for the first week and have been OK on my own since with my husband at work and my son at school. It does take some planning as I can't get things out of lower cupboards or lift more than a gallon of milk (12 lbs.).

I needed a toilet riser for about 2 weeks and I still have the bath bench in the shower as a safety/security measure. A grabber has been indispensable (tho lately I use it to torment cats more than anything ).

I have to wear a rigid torso brace (actually a pre-fab TLSO) that weighs about 6 lbs. whenever I am out of bed (which is most of the time) or bathing. I am allowed to sit up to put it on. The brace keeps me from being able to wear most of my clothes so I live in bib overalls (with the buttons un-done) and since I have to wear a snug shirt under the brace I wear shelf-bra tank tops (brace binds up on bra wires). Sometimes I wear sweats, sometimes wear a shirt over the tank top. "Most" people wear the brace for about 2 months...my surgeon "doesn't plan" on taking mine off for at least 4 months.

The surgeon anticipates 6 months before we see good bone growth and I will not have any therapy until then.

By far the hardest part of this is the loss of independence and the boredom. To be frank, I spend a lot of time feeling sorry for myself (OK, I'm depressed). I am not able to sit comfortably for very long at the sewing machine (my favorite hobby) so have had to find other things to occupy myself. I sleep a LOT and think my La-Z-Boy is the greatest piece of furniture ever invented. I recently got my driving privileges back (one month post-op) so I can get out if I want. I hated driving before surgery and that hasn't changed so my husband finds errands to get me out of the house with a couple of times a week. Smoking increases the non-fusion rate and ending my 25 year habit has been a struggle. I've quit several times since January but have not made it more than a week at a time. For me the boredom and time alone time coupled with the anxiety issues that popped up about a month pre-op make it even worse. At this point I am down to about 5 per day. My surgeon feels that while this is not as good as none it is better odds than a pack per day. We are taking some extra steps to increase my odds: I am using a SpinaLogic bone stimulator for 30 minutes a day and no NSAIDS (there is research that indicated they interfere with fusion).

Weather to choose a Neurosurgeon over an Orthopedic surgeon is a personal preference. Spinal surgery is a growing specialty practiced by both Ortho and Neuro surgeons. This article explains this far better than I can: http://www.spineuniverse.com/displayarticle.php/article2471.html I have had both and have been equally happy and feel I received equally good care. The important thing is to ask questions!

How many of these surgeries has the surgeon done?

Has he completed a fellowship or other post graduate study?

What percentage of his practice are spines?

What is his success rate (the standard is around 60%, if the doc quotes a number that is significantly off from this find another!)

Artificial disk is a fairly new technology that can be an option for some however; as I recall it is only approved for single level use and has a specific criterion. At this time artificial disk use in multiple levels is still in clinical trials.

There are several micro and minimally invasive procedures. These are appropriate for many conditions and can offer less pain and shorter recovery times than traditional "open" surgery. While it is new technology and new techniques more and more surgeons are offering this. (Was not an option for me due to previous surgery).

I am very anal about wanting to know exactly what is being done to or put in my body. If anyone is interested, my surgery was done using the TSRH-3D system: http://www.spineuniverse.com/displayarticle.php/article1985.html with 3 cross braces rather than the 2 shown in the picture.

I had cages inserted at 3 levels http://www.spineuniverse.com/displayarticle.php/article1523.html.

The original plan was to graft using my own bone in conjunction with Bone Morphogenetic Protein http://www.back.com/articles-bmp.html . The decision was made intra-op to use my own and cadaver bone and reserve the BMP to use in the event of failure as my surgeon prefers to NOT harvest from previously used areas.

(If it looks like a sales pitch for Medtronic/Sofamor Danek it is because they are the largest manufacturer of spinal instrumentation and is prefered by my surgeon.)