Dynesys removal

[johnb]

I'm a week out from dynesys removal so it is time to update the signature. Six weeks into the dynesys, I started developing bilateral nerve pain down the back of both legs that came on after walking short distances and came on with a vengeance like no other leg pain before. Other than having an MRI 3 months after initial surgery that didn't show anything suspicious to correlate the symptoms, my surgeon was not overly helpful in finding the root cause of what was going on. He said my nerves were irritated because I've had IDET and dynesys. Not a diagnosis that you can really work from. The good news is that my bilateral leg pain has improved with the dynesys removal so the “proof is in the pudding” as they say.

John

[mmglobal]

Were the screws in the foraminal space? What's the explanation? Broken system?

[johnb]

I had an MRI and x rays reviewed by 2 other surgeons (one very well known with authored research) who said screw placement looked great and they even pointed out to me why it was where it was supposed to be (if that makes sense) I did not get a CT scan of the placement which would have been best but that is what I had to work with. The surgeon who put it in was the one who took it out. My surgeon said the screws had not loosened and nothing was broken. Before I had it taken out, I could sit in a good office chair and my pain would dissapear. I could also mash my thumbs up against my back where spacers were and I could feel my leg pain lesson. Its like the spacers had to be against something to straighten out and decompress things. I've read that some industry folks believe that the spacers don't resist well against axial loading once they softened. I'd have left it in but the leg pain I would get after walking a very short distance was multiples worse of what I had pre op. The difference between no leg pain and pain after aggravation was the opposite extremes where before it was pretty steady on the right side hamstring above the knee. It was awful when bad, occured when walking short distances, and was just too life limiting.

One thing I forgot to add. I found some info in of the many research articles that I reviewed (it was a case review) that surgeons sometimes do preventive foraminotomies when lordosis is restored via pedicle screw anchored constructs when disc height is short and facets are enlarged. Who knows. There was a cause and effect reason and it would have been helpful to have a scan while axially loaded but I was just put out with all of it.

In summary, no explanation given.

John

[Maria]

John,
Glad your pain was relieved w/removal. How's the back?
After my 2nd discectomy I ended up with not only greatly increased low back pain but even worse with glute pain bilat, leg pain bilat that was deep burning in nature and debilitating with movement, standing, sitting, anything really even lying down. It was in the front of my legs, back, laterally in calves.. everywhere. No real reason except scar tissue blamed at S1 nerve root.

After nearly 5 years much of this was relieved but enough remained to start Neurontin and fortunately this has blotted out the pain except for on occasion.

I can definately agree w/you re little or no leg pain is awesome and esp. compared to what I felt for so long. Glad you had a short lived time with nerve related leg pain.

[johnb]

Yes Maria, I am familiar with your case and I was worried that it was the decompression that I had when the dynesys was put in that could have been causing the problems but it appears that wasn't the case. I took a leap of faith since my surgeon offered no guidance. I've done more research on the dynesys than you can imagine and talked to so many other dynesys folks around the world with problems that don't show up on any test.

Back pain has been pretty tough and I'll know as time goes by how much is surgical. The back pain is trending better but I'll tell, it has been rough. I've had some really sharp pains that then cause my back to flex up. I'll soon be unde the care of someone else but don't plan on any surgeries anytime soon unless something happens. My mom is elderly and needs my help. These back problems don't occur in vacuums.

I'm off the Lyrica completely.

John

[Maria]

John,
I know what you mean re not planning any surgeries soon. Back when the 2 level ADR was authorized re a trial ('03?) I could have had it done and Dad was fine, I think my Mother hadn't passed away yet.

Now Dad is 87 living alone in Florida and barely getting around. His general health is good but he's quite fragile after his car accident this past Feb and consequent decline in his mobility/outtings. He's dependent on friends that take him to the store, meals on wheels and some other elderly folk in his building that bring by meals.

I'm going to visit him for 2 months shortly but I will fly lying down across 3 coach seats on a nonstop flight. I've found I cannot deal with even the one stop flights well. Exhausting with all that being early to the airport, luggage, super shuttle early and so forth.. I'm dead beat by the time I think about it all!

My ESIs are just really so I can be there and try to be helpful to him. Recently I've developed a case of bilateral posterior tibeal tendonitis and I hope I've not ruptured the left side. Will be seen tomorrow with an OSS specializing in this area and hope that the Podiatrist's diagnosis was correct and I am just going to be a slow go to heal vs. requiring any more foot surgery (other stuff).

Sounds like you've no need for the Lyrica now and that's GREAT! Hope the low back pain will resolve fairly well on it's own and allow you to be able to tend your Mom Ok.

[fireyangel76]

I am going to knock on wood after reading this one. It will be 2 years in Feb since my dynesys and while I'm still activity restricted my pain is so much less. I do get the pain down to my ankle with walking more than 10 min at a time. Standing is absolutely a killer. I can't stand very long at all without leaning on something. But life is good since I can be mostly pain free when I lay down. No more mega drugs....only on occasion when I over do it.
I guess I'll consider myself lucky.
John, sorry the dynesys didn't work for you and glad to hear you have relief of the bilateral leg pain.

[Eddie G]

Maria, I stopped flying a few years ago. I tried first class but on some planes the seats dont recline and I spent one flight kneeling on the floor with my elbows on the seat and that cost me over $800.

I take Amtrak now and I get a sleeper cabin. I LOOVVE IT! The handicap cabin is big and I can lay down the whole trip. It only takes 20+ hours to get to Florida and it's alot cheaper than flying and dealing with security. I enjoy the food too.

One time I was flying down to Fla. and I was in the security line. I made the mistake of putting my boarding pass into the plastic bin. RED FLAG!!!!
RED FLAG!!! TERRORIST TERRORIST!!!! They pulled me aside and asked me to sit down and raise my legs. I told them I could not because I have severe back pain. That did not go over very well and they made me stand and unbuckle my belt. As it was unbuckled my big baggy shorts dropped to the floor...sans underwear. As I stood there with my twig & berries exposed to everyone, the security guard realized I was not bending over to pick up my pants so he had to do it for me. I thought it was funny but they didn't. They sent me on my way telling me I was lucky there were no police around. I think they were lucky I didn't sue them. That was the last time I flew.

I dont have those problems when I take the train.

Dont wait until your twigs & berries are exposed. Next time TAKE THE TRAIN!

[johnb]

Firey,

Yes, that pain was no fun. The surgical pain I have now is no fun either but I'm getting better every day. I've had some very bad stabbing pains that have been the worst pains I've ever felt. After telling the surgeon's office about it and getting the brush off (that is their MO), I went to the emergency room. I know my body and these were "red flag" pains. Then my surgeon tells me after the emergency room visit that because of the way the dynesys screws are angled out a little bit (see zimmer surgery instructions), he had to split a muscle a little more than he would have normally preferred, to extract the S1 screws. If I had a solid fusion mass there that muscle that has been split would probably been immobolized but my spine is moving again and that muscle that had been split was angry. Those major stabbing pains have subsided. Only time will tell how I'll feel long term but I'm happy to have no major complications considering I've had my back splayed open twice within the last two years.

I didn't have that kind of leg pain before the dynesys. In fact, my surgeon didn't correlate my symptoms with my MRI. He didn't even give me the MRI abstract before doing the surgery. If the surgeon doesn't correlate your symptoms with the MRI, proceed cautiously. In my case, L4/L5 had a bulge on the left that was removed at the same time the dynesys was installed. Before surgery, my leg pains would alternate from leg to leg like it was moving from one side to the other. So what was causing my leg pains on the right? There wasn't any bulge there. My surgeon should have looked into that since my symtoms didn't correlate with the MRI. I've since learned probable causes that have to do with dynamic stenosis. If you are interested in understanding the weaknesses of the dynesys, look at the later generations of dynamic stabalization devices as they look to build on the design of the dynesys but improve on its weaknesses.

Eddie, I like the sense of humor that you keep despite all the crud that you've had to endure. Keep up the good fight. You are an inspiration to us all.

Oh Yeah, I forgot to mention that physician assistant at the ER who initially talked to me has an artificial disc after I asked him if he ever had back problems. I asked him how it was working for him and he sort of shrugged and said he had hoped for a a better resolution of his problems. He was working and standing on a hard floor all day so that says something. He could have been writhing in pain on a gurney like me
John

[fireyangel76]

John,
You mention the angle of your pedicle screws....All 4 of mine are angled different, so much so I asked my surgeon if I had tweaked them. He said it is just the way he had to put them in. I have much more back pain since Dynesys. I mainly had right leg pain before which correlated to my herniation at L5-S1. I also have a buldge at L4-L5 and some stenosis, typical stuff.
So I think you are saying taking out the Dynesys was worse then putting it in. I have asked my surgeon for a new MRI on lumbar spine. I have not had one since Dynesys. He told me it isn't justified even with my continued back and leg pain. I am just tired of dealing with the medical system right now so as long as I can do some basic functions in life I will not push. There is other things to so in life then go to medical appts....really tired of those appts.


I was looking in to amtrack for traveling as opposed to flying. How much does the sleeper cost? I have never been on the train but I have heard the food is good and is included if you have a roomette/sleeper.

[johnb]

Firey,

I was able to locate a zimmer surgical manual online and have it saved on my computer. I can forward it to you if you send me a PM with your email. The bottom line is that the dynesys is primitive like the model T of cars. The evidence supporting the dynesys is scant and not enough to justify using for many surgeons. Another surgeon told me there is "no proof that it works." Other surgeons see it as an extra product to sell. Its no secret that zimmer spine paid the DOJ as a result of someone on the inside blowing the whistle on them for paying doctors kickbacks. I mean, the FDA hasn't even approved the dynesys as a stand alone becuase there is not enought proof that it works. If you still have paperwork, you will probably see that it was billed as a posterior fusion. That was so the surgeon could get paid for putting it in. Insurance companies don't cover it. I'm not even sure there are CPT codes established for it yet. That's great that it can be taken out but there isn't proof that it works and much less of the effect what happens after it is installed, left in for a year, then taken out. So when surgeons say that it can be taken as a "selling point" and yes, we are being sold this stuff in the same manor a used car salesman sometimes operates, they don't tell you that there aren't studies on what happens after it is removed so that selling point is flawed when you dig into the details.

This article written by a Aaron Filler references the dynesys. The study by Grob is on the dynesys though the dynesys isn't mentioned by name. Is There An Ethical Crisis in Spinal Surgery? : OUPblog

Yes, I've had more pain and discomfort with taking out the screws than with putting them in. However, every spine and corresponding symptom is individual to the patient. I'm just glad to have that crap taken out of back to be honest and don't have to worry about screw loosening and failure of an unproven medical device that squeezing my nerves to begin with.

My dynesys installation was good. I've seen the scans, had them reviewed by other surgeons, and the placement was good. My surgeon is very experienced and recognized in my region to have a very high level of surgical skill. All this hardware on the market isn't worth much if it can't be put in correctly by a skilled surgeon. Surgical skill does vary between surgeons. My prediction is the dynesys will go the way of the dinosaur as better stabalization devices are developed. Having a cord that is stiff and allows no flexion and spacers that get soft after being implanted and do not resist extension is garbage. As no reason was given to why I developed the nerve problems after the dynesys I was left to do my own research and it turns out I was right. Once those spacers soften up, they do not resist compression and the dynesys cord is stiff so you can't use flexion to open up the disc space. When you lose disc height, you have to use some spinal flexion to keep the disc space open. You can't restore lordosis or put the spine into too much extension if you don't restore disc space by restoring disc height or hollow out the foramen a bit via decompression. However, remove to much bone and you have instability. Its a tough balance that the surgeon has to follow. My L5/S1 is low but not painful. It has stabalized and was not painful on the discogram despite looking black and crummy on the MRI. My facets have enlarged at that level so I don't have the foramen space I used to but it is still enough for the nerves as long as I'm not locked down into extension.

Good luck Firey, If I had a better support system around me (I'm single and live with my 74 year old mom) I'd maybe considered a fusion but I missed my window when I made the mistake of not being better informed and choosing the dynesys. It would have been irresponsible to have a major fusion surgery and expected my mom to pick up the support duties and god forbid if something had went wrong. MY mom would have had a heart attack.

John