autofusion

[Maria]

I'm bringing this topic up even though I think I may be the only person here who has waited long enough for this to occur however I'd like to state some of my own personal progress w/"just waiting"...

Since my 1992 failed percutaneous discectomy I've had *chronic low back pain* as opposed to episodic low back pain.


L5S1 had a rather successful open discectomy in '89 followed by more problems at L4 and a percutaneous discectomy in '92.

This was followed by horrendous days/years of pain (nearly 5) and then the advent of starting Neurontin for neuropathies in '98 (which I had since before '92 but chronic since then). In 2001 I started very low dose Methadone for low back pain and ESIs.

In 2001 a 3 level global fusion was recommended. Didn't do it.
In 2003 a 2 level ADR in trials was offered. Didn't do it.
In 2006 an ADR at L4 and fusion at L5S1 was offered. Didn't do it.

By 2006 I had noticed the ability to do more, be more active without such timely recovery periods from my back getting out of whack.

By 2008 I learned that use of injectable Toradol considerably reduced what I had thought was my "back going out" and disc related pain.. perhaps it was only muscle spasms or muscle spasms irritating the disc or vice versa...

By 2009 I've noticed I can sit longer without repercussion, can sometimes sit for 2 hour bus trip, can sit for one hour bus ride into LA, sat and stood recently at the Hollywood Bowl for Sound of Music big screen movie~ box seats and it was a blast. The next day had some tailbone pain that limited my ability to sit or do too much but by Monday I was OK and did usual activities as well as walking an hour at night.

But I digress.. I'd been told a short while back after a lumbar xray that it appears L5S1 has autofused.

My back injury was in 1982. That's a long haul I will admit and I surely don't recommend it to anyone however I do feel that if I have autofused that the lack of motion in that L5S1 segment has greatly helped me to be more mobile actually with less down period time.

Of course I'm still taking the Methadone and getting an occasional ESI that is given transforaminally at L4 and the last 2 times bilaterally.

I've been told my facets at L4 have degenerated as well as at L5S1 so I'd not be a candidate any longer for ADR surgery (by my OSS). That makes me wonder if I were to have surgery some time in the future would it be only a fusion at L4, perhaps with ADR at L3 (has anular tear but so far not concordant for pain on discogram last done in '06).

Maybe if I'm fortunate I'll autofuse at L4 as well..

I also wonder just say I were to have a discogram done again~ if L5S1 is autofused then the disc should be fibrotic or gone I suppose so would it be impossible to or useless to perform discogram on this level? If it were performed would it be possible for it to still be a pain generator (it was the biggest pain generator on my '06 discogram).

I'm experiencing alot of GI difficulty with evacuation and have upper and lower endoscopy scheduled for next Friday tho I am hoping to eventually get off the Methadone and at least switch to Suboxone. I'm not sure how I'd function w/o pain medication.. maybe everything would be killing me and I'd find that I've really not progressed tho I do think I have.

We never know what will happen until we try it and I can look at my own situation several ways like maybe I waited too long for xyz or maybe I tried waiting and it has worked out for me in some ways~ that's the way it seems right now.

[mmglobal]

Maria, this may be an interesting discussion. I've talked about this many times with many of the leading surgeons I deal with. Many of them say that the autofusion process is typically incomplete and that the patients experience continued movement and pain, even when the movement is very small.

I really question the view that they have. Nobody ever comes to them to say that autofusion is complete and their pain is gone. They only see patients that have failed.

There are specific cases of autofusion that I have seen that have had good outcomes in terms of reduced or eliminated pain at the level that has fused. The one discitis case I know autofused into a configuration that mostly resolved the LBP at that level. I'm told that after the debridement surgery, they always autofuse.

Several cases of subsidence I've seen have resulted in autofusion with good result. While the subsiding plate is still moving and changing, it's very painful. It also releases the osteoblasts, osteoclasts, etc... that promote autofusion. After it stabilizes, it's no longer painful and if the disc space isn't too severely collapsed and the configuration is somewhat sound, it autofuses with good result.

Neither of these types of cases have anything to do with autofusion without surgery. Your questions are interesting. I agree that if the autofusion process is so advanced that ADR or other arthroplasty solutions would not be considered at that level, what value would discography be? At the other levels, an '06 discogram result will be of little value in 2010, unless your situation is really the same (which is hard to imagine.)

Did you have the endoscopy yesterday or is it next week? Bummer about the GI issues... I hope you get that solved soon.

Call me when you have a chance... take care... all the best,

Mark

[Maria]

Hey Mark,
thanks for reply. Glad it's a potentially interesting discussion. I seem to have much more ability to sit now (which was very minimal in the past except after ESI) and be mobile. Certainly over the last few years my ability to walk distances and/or be on my feet (not standing in one place tho) has improved greatly. I actually have very little down time most days at least by my own standards over the years re pain. Again, is this real improvement or is it improvement while on pain meds. All I know is I'm on the same amt. of pain medication for 9 years now but can do much more the last 4 years or so.

Dr.Spencer says L5S1 is bone on bone tho appears to have fused. I find it less painful to sit re old tailbone type of pain but then the following day after sitting a bunch I will have some tailbone pain, pain into the sciatic notchs, pain at piraformis area, glutes, slight burning pain in quads so the old pain areas are still somewhat bothered but not so very greatly so as to be totally disabling (in need of total bedrest for even a day).

Clearly I still seem to have pain in same areas but just less. I definately have more range of motion w/o repercussion.

Now my gut function is another story... it's not working very well and I'm worried about something I'm feeling in the lower right quadrant so am scheduled for endoscopy and colonscopy this coming Friday. Have to drink Tri-litely and 4 liters of fluid and be on clear liquids 2 days before this procedure because of the Methadone)... argghhhh....

Will give you call after this~ I'm hoping I can get thru this prep.. I dred it as well as not eating solids for 2 days!