2 discs bad and Osteoporosis

[oldtimegrrl]

Hi.
I've been lurking for a little while, this is my first post.

I'm a computer programmer & professional dancer & dance teacher. Or at least I was. March 2008: Ruptured L4-L5 disc while dancing & moving sound equipment. Severe sciatica, muscle atrophy in left calf. Microdiscectomy performed May 2008 relieved sciatic pain, but lower back pain remained. Many months of physical therapy, walking, etc. and I still can't walk or stand for longer than about a half hour without pain. An hour on my feet and it gets pretty severe.

Discograms, MRIs, CT scans confirm ruptures at L5-S1 (bone-on-bone), L4-L5, and possibly L3-L4. Insurance approved me for fusion at L5-S1 and ADR at L4-L5. But DEXA scan just came back at -2.5, which is borderline osteoporosis.

I go to see my surgeon tomorrow. He's one of the top people in the country for ADR. I suspect he will say no ADR due to the bone density issue, and will recommend 2 level fusion.

I'm reluctant to get the fusion just because I'm pretty certain it will mean no more dancing and/or certain problems at L3-L4 in the near future. I will probably go with whatever he recommends, I'm just wondering if anyone has any other bright ideas for suitable treatment?

thanks, and best wishes to all out there living with pain, and a big thank you to the care-givers.

[dshobbies]

Hi OTG and welcome to the forum,

Been there, done that - we all understand your problems and pain. Your insurance company approved as ADR, a miracle unto itself but your bones are a no go.

If you're completely against a double fusion, I see two possibilities. You can try an osteoporosis drug for a year or so to build up bone density. You can also have surgery in Germany or other country where bone 'glue' is legal. I do doubt that your insurance company would pay for an out of country elective surgery but is worth investigating.

I realize these aren't the best solutions and you must decide for yourself which way to go, it's food for thought.

I wish you the best, Dale

BTW, what insurance do you have?

[fuzzy]

I was T -2 dexa when I had 2 level lumbar surgery. The surgeon was stunned that a 40yo male could have lousy bone like that. From what I was told the cut off in Germany is about -2. After that they suggest fusion. My surgeons comment was that my bone was "pretty soft". I ended up with 1 of 2 levels fused and the other was a close call but got a ADR. It worked out good and I am more flexible then I was for years before. I used to dance in ballroom competitions but had to give that up long ago due to these problems. Today I sometimes feel I could do it again but I think I am getting to old

[oldtimegrrl]

Well, we're going ahead with surgery next month. My surgeon said that he'll see how bad/soft my bone is when he opens me up. If it's hard enough, he'll go ahead with the ADR, but it's greater than a 50% chance that it'll be 2 level fusion. I'm happy with that - at least he didn't totally reject the possibility of ADR. I have 100% confidence in this doctor - he's very good, and very honest, and very experienced. I realize no one's perfect, but I know he'll use his best judgment.

He did say that he'd phone his "colleague in Germany" and discuss options with him, so that made me even more confident.

The big lesson that I've learned is how fast Osteoporosis can set in. He said it's surprising how fast we lose bone density with inactivity. Catch 22- my back hurts too much to exercise, but without exercise, my back's going to get even worse. So if there's anyone out there wondering if they should bother to get up & walk, since it doesn't seem to be doing any good, my message is: do it. Your bones need the exercise, even if it isn't helping your joints/discs.

Oh, and my insurance is Aetna. They apparently accept ADR as fairly standard treatment.

[fuzzy]

Good news about Aetna. I wish you the best for surgery. I hope it works out to your best. The comment about calling the german colleague is interesting.

Exercise for me has been oh so important to keep my bones from hurting even worse. It is true that exercise can reduce pain unless things are mechanically trully wrong. I would exercise pain away and than "bang" back to square one. After my lumbar surgery 2 years ago no more "bang" and my low back has been continuesly improving. I hope it stays that way.

Worst thing for me is bad posture in front of the computer...

[Maria]

Good luck with the surgery.. I had a fusion at L5S1 and ADR at L4 authorized by WC back in '06 but started feeling better even tho on same pain med regime for nearly 5 years at that point.

Thought I'd wait a bit because I wanted to see if we'd ever get an FDA approval re use of something to shore up the bone like Dr.Bertagnoli does as my BMD was -2.2 at that time.

Ok a year ago my BMD (lumbar) was -2.6 so I was started on injectable Forteo to build my BMD back up and then was told that I should be maintained on IV Reclast one time a year after the 24 mo. use of Forteo.

I've been on the Forteo 9 months now. My most recent lumbar xray showed that L5S1 had autofused (perhaps why I have less pain) and that I have facet degeneration at L4 as well as L5S1 (why the ADR wasn't going to be done at L5S1 and fusion was going to be).

I'm rooting for you and please let us know how things turn out!

[oldtimegrrl]

Thanks very much.

I thought about going on Forteo or something similar and trying to build the bone up, but I just don't want to delay the surgery. There is always the possibility (knock on wood) that I might lose my health insurance, or develop some other condition, or that my surgeon might move to a different hospital, or that my condition might degenerate even further due to continued inactivity, so I figured I better go for it now, while I'm able.

I realize that there is a possibility I might be worse after surgery than I am now, but it's a relatively small one. And I'm pretty sure that if I don't have surgery, I will just continue to get worse. So this at least gives me a chance of making my life better. That's my thought process, anyway.

I'm trying to prepare the house for the post-op period, setting everything up with my employer, buying satin sheets - recommended by someone to help with turning over & moving in bed post-op.

Maria - do you think the Forteo had anything to do with the auto-fusion?

[Maria]

My original injury was in 1982 and I think the discectomy in '89 at the L5S1 level plus time brought about the onset of autofusion over a long period of time. I actually started to feel better somewhat around 2005 ( 2 level ADR was authorized via WC in 2003 trials but the trial closed and in between 2003-2006 I was in process of trying to get ADR 2 level authorized again. By the time I was seen in 2006 a CT scan of showed moderate facet arthopathy at L5S1 so it was recommended by several surgeons here in US to go with fusion at L5S1 and ADR at L4. I never liked the idea of fusion and had felt much worse in the past so decided to wait. Whether that was an overall good move or not I'll never know tho at least things have been pretty stable over the last few years.

I didn't actually start the Forteo until 9 months ago so it had no actual bearing upon my feeling better that I know of and in fact the first few months I was on it I felt worse with generalized body aches and sluggishness. Hopefully it's doing what it's supposed to~

I strongly feel I'd want vertebroplasty available (by a skilled surgeon utilizing this) if I were having ADR done but it's not available here in the US so that's what I was holding out for more or less.

I can surely understand your reasoning re not waiting and risking the further degenerative changes that will likely occur not to mention worsening of osteoporosis. I've really not wanted fusion done so I'm pleased that it appears I've autofused at L5S1 and feel better than worse~ maybe L4 will do the same in the near future (one can only hope).

BTW~ I walk alot so I was quite surprised that my BMD took such a nose dive in a 2 year period of time. I think it was mostly the estrogen withdrawl being that I'm 55 and postmenopausal since age 50 (and didn't do any estrogen replacement therapy).

[oldtimegrrl]

Maria -
I don't know too much about vertebroplasty, so I asked Dr. Google. I found an article from 2002 from the American Academy of Family Physicians saying that vertebroplasty was totally acceptable for many uses, including "Reinforcement of a pathologically weak vertebral body before a surgical stabilization procedure". Why do you say it's "not available here in the US"? I don't really know much about this.

[Maria]

In the US is used for vertebral fractures I believe and not approved for use with ADR and/or fusion that I know of tho perhaps by now things have moved along and surgeons are able to use this to shore up the levels being worked on to prevent subsidence of implants.

[dshobbies]

Two points - first, i believe studies have shown lifting free weights is the only exercise that improves bone density Walking is said to be the best overall exercise but does nothing for bone strength.

And then we have to talk about satin sheets. True it's easier to move around, but your pillow will not stay in place. As you move, it slides. Anchoring a part of your body, like putting your knees up, forget it. Crawling your way into a sitting position - uh-uh. And if you think it's romantic and might benefit the 'sexual' experience, think again They are good for a laugh.

D