[mmglobal]

I spoke to KC a few days ago. It's tough to listen to the descriptions of the limitations imposed by the DVT and the impact that will have on the rest of her life. However, it's wonderful to listen to descriptions of walking longer distances than ever possible without crutches, canes, wheelchairs... and without the RSD-like symptoms that occurred whenever she tried to do this before the surgery. It's been a tough road for KC and I hope that after a few months, it will all seem to be VERY worthwhile.

You may already know that I was able to observe her surgeries. It was planned to be anterior and posterior surgeries on the same day. The surgery started with the anterior procedure to remove both prostheses and replace them with synthes synfix cages. These anterior cages are similar to the STALIF cages that provide big-footprint fusion cages PLUS screw fixation to make them even more stable and rigid than the more traditional style cages.

One thing of note is that the surgeon was somewhat surprised to discover a significant amount of tissue behind the prosthesis, seeming to indicate that inadequate preparation of the disc space was performed in the original ADR surgery. A typical ADR surgery may go very quickly if there is not very much tedious work to do to prepare the site for the prosthesis and to adequately decompress behind the disc if there are osteophytes, calcified remnants of disc herniations, scar tissue, etc.. Inadequate preparation (simply not following the recommended procedure) substantially increases the risk of less than optimum outcomes. That's why the procedures exist.

After the anterior procedure was complete, it was decided that it would be prudent give KC an opportunity to recover some from the first surgery before proceeding with the posterior surgery. The risk of complications from 2 shorter surgeries is far less than the risk of complications from one longer surgery. (I have always wondered about the combined cervical/lumbar surgeries they do in one OR session at Stenum. I know no other facility that will do that. Interestingly enough, my client for my next trip overseas is an MD who needs both cervical and lumbar surgeries. When I started a discussion about the options, she just cut me off... "absolutely medically inappropriate!")

10 days after KC's anterior surgery, they went in posteriorly to explant the existing fusion hardware at L4-5 and implant new hardware at both L4-5 and L5-S1. We had never been able to understand why the revision surgery at Stenum only included L4-5 because there were clearly structural problems emanating from L5-S1 before the revision. There were more surprise findings upon exposing the fusion site at L4-5. Not only was there no fusion mass present, but there was no evidence of any effort to create one. I suppose it’s possible that morselized bone was implanted and was completely resorbed, but the surgeon noted that apparently no effort was made to decorticate the bone before laying down the graft as is typically done during a fusion. It may be the case that the 2006 Stenum fusion procedure did not include an attempt to create a fusion mass. I don’t know the reason for this because in a typical posterior fusion, the hardware needs to function as a load bearing device until bony fusion occurs. After the fusion occurs, the hardware is redundant. Without bony fusion, the pedicle screws will continue to bear the load and the system will be more at-risk for future problems. I’ve never seen another fusion procedure with no attempt to promote bony fusion. I still don’t understand.

In any case, KC is progressing, albeit slowly. I hope to hear more good news soon!

All the best,

Mark