It sounds like he has had a fusion already at that level and is looking to get a revision??? In which case he might have been told he has a non-union or pseudo arthritis at that level. This can be a painful condition that allows micro-movemtent at that level and can cause discogenic pain. If he has rods and screws, they may eventually come loose or even break.
If there are no signs of loosening or broken rods, they could possibly opt to leave them in. But, to do so they would have to do an XLIF (extreme lateral inter body fusion). This is a newer procedure that is very minimally invasive and allows the surgeon to just go after the cage. It's major advantage is that it allows the surgeon to use a very large cage which improves chance of fusion and best of all you don't have to cut through the back muscles. Recovery is pretty fast as well.
BMP is commonly used these days and works well in the lower back. It is used to encourage the body to make bone. Your surgeon will probably be encouraging its use since he/she will want to do everything possible to make the site fuse properly. It is good to use in the lower back, not good to use it in the neck (cervical vertebra) because it has been show to cause over growth of bone in that region.
XLIF is a procedure that is pretty much limited to just the L4-5 level of the lower back. Great procedure but not all surgeons can do it.
It is worth asking why the last surgery failed to fuse. Sometimes, it just happens. But there are things that need to be avoided. No smoking for several days before surgery and after surgery, definitely no non-steroidal anti-inflammatory (NSAIDS like aspirin and ibuprofen unless OK'ed by the surgeon). Inflammation is needed for the bone to heal. NSAIDS will shut down the process of bone healing if taken shortly before or after the surgery. TRUST me on that one…..I have first hand experience.
One of the disadvantages of going from the back (posterior approach) is that it can be a big challenge to get a large cage into the disc-space. There are a lot of important things that get in the way. To get that thing to fuse, you need strong rods and screws, a big cage (fit tight), make the bone bleed and use some BMP, no smoking and no NSAIDS. The site must be stable and your husband needs to follow post-op instructions regarding activity restrictions closely. Take some V-D3 and some Calcium for good luck. Do a bowel prep before surgery and take stool softeners religiously after surgery until off the narcotics completely.
Sorry if I said to much. Ask me more questions if you need to. I am new to the site. I have chronic pain and need more surgery.
Make sure he takes real good care of that back after it is fixed. Back surgery will never make him good as new. He will be putting additional stress on the levels above and below the fusion site. They will take a beating and may eventually become diseased and you get the picture.
A good fusion is a wonderful thing but you need to baby it regardless of how good you feel. People that think they can go back to labor intensive jobs are fooling themselves. Even sitting for long periods of time will strain his back in ways that normally wouldn't.
Hope I didn't say to much. Peace, Ringo
Quote:
Originally Posted by Sessy
Hi - I am not always able to get on the internet, so I haven't posted more often...
This proposed surgery is a revision of a fusion at L4-5. There is one cage there. For this surgery, they would remove the cage and place a new fusion construct.
Sessy
|