3 level ADR to Autofusion

[dzydvl]

Good Morning Everyone,

I'm new to the forum, but after my Dr Appointment yesterday I will be hanging around a lot more.

So where do I start, I guess the beginning would be as good a place as any.

This all started 2-14-1997, I was 20 working at McDonalds. I was unloading a truck carrying 2 cases of bag in the box soda. Unfortunately someone had spilled some water on the stairs, and failed to clean it up, and I stepped in it. The liquid all shifted, which caused me to ultimately twist and fall and in the process I injured L3-4, L4-5, L5-S1. Fast forward to December 23rd, 2004, after multiple failed treatments, and special approval from the FDA, I had a 3 level disc replacement at Texas Back Institute, my surgeon was Dr Zack E Ziegler. Surgery was uneventful, it took a little under 4 hours, and honestly I felt great, but I’m sad to say that didn’t last as long as I had hoped.
I started having issues in 2008, but it wasn’t the same type of pain, it turns out the generation of disc that I have can cause “Too much” motion (which will really confuse you and me in the next paragraph). As a result my new pain is being caused by the facet joints. (This is common knowledge now, but back when I had the surgery, not so much)

So in terms of treatment we went with facet injections, and eventually RFA, which seemed to help, so once again I was happy and chugging along.
Over time the pain slowly started creeping back in, which I wasn’t too surprised about, since we know over time nerves will heal themselves, and the process of RFA will have to be done again, which isn’t too bad. Unfortunately a new symptom was also developing. This really strange click in my lower back, it wasn’t painful all the time, but it wasn’t right. I saw a DR in WI, and they didn’t see much, so we kept on the same course of treatment, and had the RFA, but this time it did nothing. No relief, not even a little. I ended up back on the pain meds and back into depression. I had really hoped I wouldn’t be in this position again, but I was.

During this time, I ended up getting a new job, which transferred me from WI to TX, so I decided to make an apt with Dr Ziegler, maybe he would have some ideas. I showed up for my appt. and we did the typical set of x-rays, but what we saw still has me confused beyond belief. It seems as though my spine decided to take its own path, and the surgery that was meant to preserve my ROM may have caused the opposite. As of this point it appears that only L3-4 is fused, but the levels below are now out of alignment and most likely causing my pain. The sad thing we don’t know what we are going to do. The plan right now is to try facet injections at a higher level and see if that might help, but I’m not sure if I have much hope. My fear is, if these things are already fusing themselves are we better off fusing the levels below them, to make sure they are fused and aligned?

Now that I’m back and researching it seems other people are having similar issues, but as far as treatment there doesn’t seem to be a standard course of treatment.
I’m hoping some people here may have some experience with something similar and have some ideas. I’m open to ideas so feel free to give me your thoughts. I’m sorry for the wall of text, but I appreciate you taking the time to read by story.

[Jim M2]

Hi dzydvl,

Sorry to hear you are having so much trouble. There are some similarities in our situations.

I had a Charite disc implanted in 2003. The evening of the surgery the facets were screaming. RF treatments gave little relief. The Charite was replaced with a fusion cage earlier this year. Now at five months post-op my post surgery pain is similar to my pre-surgery pain although the pain level has come down slightly and it seems I am very slowly improving. I started back to work part-time this week. I am optimistic I will continue to improve slowly as the two vertabras(sp) fuse.

Maybe do a facet block at L3-4 to confirm that level has calmed down. Then do facet blocks one at a time at each level to get an idea of which levels are the most hosed.

I feel for you. I've had problems with only L5S1 and it has made my life miserable since 2003. Good luck and keep us informed.

[dzydvl]

Jim,

Thanks for the reply... I guess what I hate the most is knowing the treatment I chose that was suppose to be the better alternative to fusion has become a fusion. What stings even more is the financial issues the original surgery ultimately caused (was originally approved by insurance only to be denied AFTER, needless to say the financial turmoil still affects my family today)

Add to it the uncertanty and I feel like I'm stuck in an emotional taffy pull machine.

[Maria]

First off sorry to read that you've had ongoing problems and once again are facing a decision that really probably doesn't even have a definitive answer. By this I mean surgeons can probably tell you what might happen though I'm not sure what might happen will happen and even if it does may or may not impact you as one thinks it will.

I am wondering what the surgeon you saw thinks with regard to the autofusion and/or has advised you with regard to this option or more surgery (fusion)?

I've had 2 discectomies at L4 and L5S1 and was a candidate for a 3 level global fusion, then a two level ADR, the ADR and fusion.. didn't do any of the surgeries because after numerous years of pain post 2nd discectomy it seemed I was starting to feel somewhat better with what at that time was probably related to good response to ESIs, Methadone and Neurontin or at least about 5 years going into all that. I didn't want to be dragged back into the "unknown" re more surgery and response.

Even though my L5S1 area is pretty much autofused L4 is still problematic enough to bug me. I'm not sure what L3 is doing as that had an annular tear for the longest time and it's been so long since I had an MRI (2006) I don't really know what all is happening back there though I know not enough to warrant an updated MRI per WC (work comp).

I'm hoping my L4 will autofuse too and I'm hoping I can get away without anymore spine surgery though I don't know about that so I guess it's sort of always a "maybe" out there for me.

What I'm wondering is would it be possible for you to take pain medication and do nothing else surgically? I did that for the last 14 years. Am just now starting to taper on Methadone which I have to say was a very good drug for me re pain. I'm not sure I'll get off it entirely however that was at least what I have been attempting to do though honestly it did provide me with quite adequate pain relief and also I was dealing with "the devil I knew" vs the devil I didn't re more surgery.

Just food for thought. I mean surgically fusing two levels may help some things and may create some other problems so it's hard to weigh it against the body just auto fusing those levels (the unknown response either way though I tend to put more faith in the body's ability to heal itself than rods, screws and such). I know we all want the Holy Grail when it comes to spine surgery and I'm sure plenty of us get it.. and then plenty don't. I also understand if one might absolutely need surgery to prevent something from worsening.. though I do tend to think what might help one spinal problem might create another surgically so I've held back thus far from thinking along surgical lines myself. I'm sure I have enough going on that something would still be recommended for me like multi level fusion (my low back was so out the last few days ..just outrageously painful to move let alone do anything). And then there are the people I know that have had successful recent spine surgeries or surgeries that actually helped them so it always comes down to each individual weighing his or her own situation and rolling the dice I guess. You know well enough about this given your own spine surgery experience.

Good luck with whatever you'll be doing and please continue to update us~ whatever route you choose to take ~ Maria

[Jim M2]

dzydvl,

After some more thought I would thoroughly investigate the situation. What I mean is that I would get as much imaging as possible. I would try a number of interventional pain management procedures in hopes that these might help shed some light on possible pain generators. I would take all of these results to multiple surgeons for opinions. If you found a smoking gun(s) I would certainly consider converting the ADRs to fusion from the front. You need an outstanding vascular surgeon and a spine surgeon to pull this off. The goal is to get proper alignment of the spine. Your spine seems to be unstable. When they go in from only the front a lot of risk associated with spinal cord, nerve roots, tendons and muscle, etc is avoided. This might be bad thinking but I'm afraid you might have pain for many years in your situation.

On the topic of insurance (those sleaze balls) I would start an appeal. Cc your state insurance commissioner on the appeal and all correspondents with the insurance company. Start legal action. It is thievery on their behalf. That's why you have insurance is for these situations. Sorry I am rambling. I don't know how doable these actions are. I hope some of the forum participants can contribute some helpful information. The behavior of the insurance is sickening.

[jsewell]

Hi my spine is really messed up . I just posted about my upcoming surgery in hopes of getting some type of alignment back. My original surgery said there was nothing else that could be done. so after 2 years of more and more hunched over position. I looked for a surgeon who does deformity surgery. I found one . My spine is now in the shape of a C, the lumbar area curving in the wrong direction . I would get lots of opinions. I am going to be financially in bad , bad shape after this surgery. I had to go on Obamacare and not many docs in Ca accept it. I figure from this first surgery I will be paying 7 doctors and I am only sure one of them takes my insurance. If you can fight the decision that is great, but is there a statute of limitations on this? Anyway good luck on getting any pain relief
Judy