I have an upcoming TLIF with spacers. Why not a BMP cage?

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mamagoose

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Hello all.
New at posting. Sorry if I did it incorrectly the first time. I am a 46 yr old woman who has 4 teenagers, a part time job, supportive husband as well as chronic inflammatory disease(psoriatic arthritis, fibromyalgia) I am scheduled for a TLIF, Aug 28,08. Minimally invasive, grade 2 spondy, no disc left between L-4 and L-5. Moderate stenosis.My Surgeon helped pioneer the Minimally invasive part. He will be placing spacers b/t the vertebrae--instead of cage or bone graph. Good, I think??:confused: Since this is Transverse access to the vertebrae, that means they go in at an angle, virtually break off a part of the facet bone, I think, to gain access. I'm frightened that if the fusion is not a success, will I be more unstable than before? And does anyone understand why spacers vs. cage with bone protein? Has anyone else been through this with "other" active autoimmune disease? Does this slow the fusion and healing? I do have a pre op scheduled with my doc to ask some of these questions but thought it would be helpful to get some input from the tried and true population. Thanks so much for your help and I hope to hear back from some success stories.
Blessings,
Susan from Charlotte, NC
 
Hello mamagoose ~

Welcome to the board. I read your earlier post and thought about it, but didn't respond. But since no one else has responded, I wanted to at least welcome you to the board.

I don't know enough about the type of surgery you are having to be able to respond, but I wanted to ask if you have explored these questions with your surgeon? Your surgeon helped develop this technique so he has confidence in it. With my limited layman's knowledge, I am wondering if you are the right candidate for this particular surgery? The part of your story that confuses me is the grade 2 spondy. If you are having spacers, is the planned outcome that you will be fused?? I will await your answers before I comment further.

Lots of people with auto-immune disease have successful back surgery, so I imagine your chances of success are as good as anyone else's. One of the keys to a successful outcome is having a surgeon who is able to match the correct procedure to the right candidate (patient). Have you gotten any other opinions from other spinal specialists?
 
Thank you so much for your reply. I've seen your earlier posts and I value your wisdom and experience! Yes, I have had several opinions over the years...from an Orthopedic surgeon, a orthopeodic chiropractor(whom I credit my lasting this long, too!--had four children within 5 years with a grade 2 spondy, the the while getting regularly adjusted, :) )as well as my rheumy and radiologist girlfriend. This has been a long time in the works...just had to get to the point where I couldn't stand it (more ways than one!) any longer.
You are correct. The spacers are being placed for 2 reasons I understand it; first to separate the discs(bone on bone is such a lovely feeling:( ) and then to stimulated bone adhesion/ultimately fusion. In my research I've read that "if the fusion should FAIL, spacers are more difficulty to remove than BMP cages. I think they consider artificial discs when more than one level is affected. Fortunately for me. it's just this one. I do not have DDD as my other discs/space looks good. This was from gymnastic injury in adolescence...weird--I remeraber the exact moment when it happened. I was 13-14.
Anyway, my concerns are why the spacer vs. cage and secondly, will mu autoimmune illness slow healing (and most importantly DRIVING!!!) I've been asked :"Is my surgeon rec'ing me for this surgery because this is his technique of expertise, or because it's the best option for me? So, I started researching and realized that MOST post had failed or unsatisfactory fusions. This is very frightening as though in pain and an altered lifestyle because of my pain, I don't want to be worse off than prior to my surgery. Does any of this make sense? Blessings to you for your response. I need to hear from Post TLIF, minimally invasive (just means less cutting of muscle) that have had success!!
Susan in Charlotte
 
Well, Susan...

You raise several good issues. Success. That's a very subjective word when it comes to spineys. Some people's expectations are to come out of surgery able to regain their life as it was, and painfree. Ohers are satisfied to have some pain relief and accept that they will never be totally painfree. And of course there are a million attitudes in between.

I am concerned about you having a TLIF with nothing to stabilize the spondylolisthesis. Hopefully it will work and you will be fine. If I were in your situation, I would get at least another opinion (knowing me, I'd get several more!! :eek:) You are in an area that is blessed with many wonderful doctors, so you should have a good selection from which to choose.

Regarding the artificial disc, in the US, at this point, they are ONLY using it for one level fusions. You have to go to Europe if you need multi-levels fused.

You must remeraber that most have a satisfactory result with fusion. They are no longer on the board, but are out living their lives. The people who continue to post are in the small minority that for whatever reasons had unsatisfactory outcomes.

I would consider my surgery a success. I had a one level PLIF in Jan and am still recovering. All the problems I had prior to surgery were corrected, but I've had a new pain that developed on the 2nd day after surgery. I am just in the process of getting tested to see what's going on.

I can't comment on the auto-immune disease and how that will affect your healing. Hopefully others who know more will comment!!
 
Thanks agan for your input! As I said earlier I have a pre op appointment with my surgeon on Monday and hopefully he'll have answers to all these questions. The one most unsettling question that still remains though is : As I have lived with several chronic autoimmune conditions for over 10 years, I wonder how this will play into my recovery. I was hoping that there might be someone out there that ,in additon to the mechanical/anatomical issues of the spine(unstable spine, spondy, grade 2 due to teenage gymnatics) also suffers from additional conditons...i.e. Lupus, Rheumotoid, Psoriatic arthritis) . I am curious to know if the fusion was successful and if their recovery took longer, or no difference. Seems like a thesis paper in the making, huh? Anyone? Thanks again!
 
Maybe the reason for the spacers rather than using a cage is because of your other autoimmune issues.
 
I am more than happy to answer some of your questions.
I am a person who had 2 spinal multi-level fusions, lami, SIJ fused, decompression, 360 Plif, etc. My first surgery failed, was done 03/06. Second surgery was done 12/07 on higher levels. Both times cages, screws, roRAB (hardware) metal plate and metal clips were used.
I suffer with severe case of RA, MS and Lihcken Planus. I don't mention Fibro, because honestly if I would have Fibro only I would consider myself a very health woman.
My surgery did not failed because I have autoimmune conditions, but because unfortunatelly multi levels fusions have low sucess rate all over the world. Very high risk of nerve damages and this happened to me too: dropped foot and meRAB from nerve pain.

I hate to do it to you, I mean I don't want you to think that every fusion surgery failes
and doesn't bring some relieve to people. To some it works well, to some it doesn't.
If I am right you are not having fusion, so other surgeries, less invasive and major having better outcome and results. So don't worry about it.

Having auto-immnune disease may affect your pain duringrecovery - you may feel more more pain due to your RA than people who don't have it. But it will not affect your results.

I hope I helped you a little. I will be glad to help you if you have any questions.
Best wishes,
Moldova
 
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