3 level ADR to Autofusion

[Jim M2]

Hi dzydvl,

Sorry to hear you are having so much trouble. There are some similarities in our situations.

I had a Charite disc implanted in 2003. The evening of the surgery the facets were screaming. RF treatments gave little relief. The Charite was replaced with a fusion cage earlier this year. Now at five months post-op my post surgery pain is similar to my pre-surgery pain although the pain level has come down slightly and it seems I am very slowly improving. I started back to work part-time this week. I am optimistic I will continue to improve slowly as the two vertabras(sp) fuse.

Maybe do a facet block at L3-4 to confirm that level has calmed down. Then do facet blocks one at a time at each level to get an idea of which levels are the most hosed.

I feel for you. I've had problems with only L5S1 and it has made my life miserable since 2003. Good luck and keep us informed.

[dzydvl]

Jim,

Thanks for the reply... I guess what I hate the most is knowing the treatment I chose that was suppose to be the better alternative to fusion has become a fusion. What stings even more is the financial issues the original surgery ultimately caused (was originally approved by insurance only to be denied AFTER, needless to say the financial turmoil still affects my family today)

Add to it the uncertanty and I feel like I'm stuck in an emotional taffy pull machine.

[Maria]

First off sorry to read that you've had ongoing problems and once again are facing a decision that really probably doesn't even have a definitive answer. By this I mean surgeons can probably tell you what might happen though I'm not sure what might happen will happen and even if it does may or may not impact you as one thinks it will.

I am wondering what the surgeon you saw thinks with regard to the autofusion and/or has advised you with regard to this option or more surgery (fusion)?

I've had 2 discectomies at L4 and L5S1 and was a candidate for a 3 level global fusion, then a two level ADR, the ADR and fusion.. didn't do any of the surgeries because after numerous years of pain post 2nd discectomy it seemed I was starting to feel somewhat better with what at that time was probably related to good response to ESIs, Methadone and Neurontin or at least about 5 years going into all that. I didn't want to be dragged back into the "unknown" re more surgery and response.

Even though my L5S1 area is pretty much autofused L4 is still problematic enough to bug me. I'm not sure what L3 is doing as that had an annular tear for the longest time and it's been so long since I had an MRI (2006) I don't really know what all is happening back there though I know not enough to warrant an updated MRI per WC (work comp).

I'm hoping my L4 will autofuse too and I'm hoping I can get away without anymore spine surgery though I don't know about that so I guess it's sort of always a "maybe" out there for me.

What I'm wondering is would it be possible for you to take pain medication and do nothing else surgically? I did that for the last 14 years. Am just now starting to taper on Methadone which I have to say was a very good drug for me re pain. I'm not sure I'll get off it entirely however that was at least what I have been attempting to do though honestly it did provide me with quite adequate pain relief and also I was dealing with "the devil I knew" vs the devil I didn't re more surgery.

Just food for thought. I mean surgically fusing two levels may help some things and may create some other problems so it's hard to weigh it against the body just auto fusing those levels (the unknown response either way though I tend to put more faith in the body's ability to heal itself than rods, screws and such). I know we all want the Holy Grail when it comes to spine surgery and I'm sure plenty of us get it.. and then plenty don't. I also understand if one might absolutely need surgery to prevent something from worsening.. though I do tend to think what might help one spinal problem might create another surgically so I've held back thus far from thinking along surgical lines myself. I'm sure I have enough going on that something would still be recommended for me like multi level fusion (my low back was so out the last few days ..just outrageously painful to move let alone do anything). And then there are the people I know that have had successful recent spine surgeries or surgeries that actually helped them so it always comes down to each individual weighing his or her own situation and rolling the dice I guess. You know well enough about this given your own spine surgery experience.

Good luck with whatever you'll be doing and please continue to update us~ whatever route you choose to take ~ Maria

[Jim M2]

dzydvl,

After some more thought I would thoroughly investigate the situation. What I mean is that I would get as much imaging as possible. I would try a number of interventional pain management procedures in hopes that these might help shed some light on possible pain generators. I would take all of these results to multiple surgeons for opinions. If you found a smoking gun(s) I would certainly consider converting the ADRs to fusion from the front. You need an outstanding vascular surgeon and a spine surgeon to pull this off. The goal is to get proper alignment of the spine. Your spine seems to be unstable. When they go in from only the front a lot of risk associated with spinal cord, nerve roots, tendons and muscle, etc is avoided. This might be bad thinking but I'm afraid you might have pain for many years in your situation.

On the topic of insurance (those sleaze balls) I would start an appeal. Cc your state insurance commissioner on the appeal and all correspondents with the insurance company. Start legal action. It is thievery on their behalf. That's why you have insurance is for these situations. Sorry I am rambling. I don't know how doable these actions are. I hope some of the forum participants can contribute some helpful information. The behavior of the insurance is sickening.

[jsewell]

Hi my spine is really messed up . I just posted about my upcoming surgery in hopes of getting some type of alignment back. My original surgery said there was nothing else that could be done. so after 2 years of more and more hunched over position. I looked for a surgeon who does deformity surgery. I found one . My spine is now in the shape of a C, the lumbar area curving in the wrong direction . I would get lots of opinions. I am going to be financially in bad , bad shape after this surgery. I had to go on Obamacare and not many docs in Ca accept it. I figure from this first surgery I will be paying 7 doctors and I am only sure one of them takes my insurance. If you can fight the decision that is great, but is there a statute of limitations on this? Anyway good luck on getting any pain relief
Judy

[dzydvl]

Hello fellow spineys... Well as expected things got worse, this past weekend I lost feeling in my left leg and ankle, and foot drop set in. I did the usual things one would try when you get a flair up, ice, NSAIDS, and rest. Went to the dr Monday, and they ordered an MRI, and a Doppler ultrasound to rule out DVT. Went to the clinic for the MRI, and they did the test scan and immediately pulled me out due to the fact they couldn't see a thing due to artifacting around the Pro-Discs. I was quite surprised to see a clinic that decided it was better to not to do the procedure if it wasn't going to be useful.

Fast forward to today, when my pain Dr immediately sent me to a surgeon. He looked at the X-rays from a couple months back, as well as some past MRI reports, and decided to order a Mylagram. His immediate diagnosis after the usual neuro tests is minimum of a 2 level fusion (L3-l4, L4-l5), but he also said it may be best just to fuse all three levels, to prevent the bottom disc from causing issues.

To make things worse, thanks to my initial ADR surgery, I have an Abdomin full of mesh, so entering through the front is not gonna happen, unless we have an abdominal reconstruction specialist in the room to clean up the mess he's sure to come across.

Fortunately he has experience of dealing with revision surgery for ADR complications, and he immediately said we would not consider removing the discs unless he sees something when he's in there, even then he's not too keen on the idea.

Any who, that's where I'm at today.... Now the long wait until the dreaded mylagram, and the fun that goes with that.

Any and all thoughts are welcome..
Here's to a pain free weekend everyone...

[Maria]

Wow u sure have been having a lot going on! I think there have been some very successful revisions done that I've read about on this forum and some others over the years. It's good that your surgeon has experience with revisions and doesn't have to refer you out even though you may want a second opinion because of the nature of the proposed surgery (revision). I think that's just the norm whenever a surgery of this magnitude is proposed. That being said you may be entirely comfortable with your current surgical choice and confident in his abilities however it never hurts to get one more opinion!

I don't know if you've gone back through some of the older surgical forum material here though I'm sure there are people that have talked about their experience having to go from ADR to fusion in revision surgeries. If not and even if so you may want to talk with Mark Mintzer (mmglobal) about the proposed surgery (or maybe you've already done this). He would likely be the one person here besides those that have had revisions that could give you the most information.

Anyway I guess you'll be having the myelogram soon ( I hated these because I always got spinal leaks afterwards) and then getting your surgical date pending the results?

Please do keep us posted and while I'm sorry to read that you have to undergo more surgery hopefully the surgery will help your current spinal situation out!

Wishing you the best! Maria