Scheduled for 360 (ALIF & PLIF) L4/L5 and L5/S1...and I have MS!!

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BiddyMtn

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Had my long awaited neurosurgeon visit yesterday, resulting in schedule for anterior and posterior fusion on 4/26, using BMP. I have complicating factors...long-term MS (15+ years) with weakness and chronic fatigue, as well as osteoporosis from IV steroiRAB used to treat MS. I'm more than a little nervous about my ability to both fuse and rehab and am looking for anyone that has experience similar to mine.

My surgeon wants me to stay on in the hospital's inpatient rehab center for an additional 3-4 weeks, but since we're not sure how much of my lower extremity weakness is due to MS and how much is due to spondylolisthesis, my ability to perform 4 hours of rehab daily is uncertain. Also, the complicating factor of osteoporisis from steroid treatments is an issue. Any insight anyone can provide will be appreciated. Thanks!
 
Hi Biddy, and welcome to the back board!
I don't have all the serious conditions you have, but I do have osteoporosis. I had a 360 with 8 levels about 3 years ago. My doctor used BMP, which has an excellent track record for helping bone growth get going, and also gave me a bone growth stimulator. I was starting to show bone growth at only 6 weeks post op, which is extremely early, and was completely fused by 6 months. I have to be very careful not to lift much weight, as I can really feel it if I do. I suspect I get micro-fractures. I don't lose height anymore, since this was my second fusion and I'm now fused T4-S1, but I can feel a different pain. It lasts for a few weeks and then stops, so I think they heal up.

Have you seen the sticky at the top of the page called "post surgery tips?" It has a lot of great tips that will make your recovery easier, though if you're going to rehab, they'll be taking good care of you. I don't know how a major surgery like this will affect your MS or CF. You might want to ask over on those sections of healtrabroadoarRAB how people have managed after any kind of a major surgery. They may have some special tips for you.

I wish you the best. You have a lot to deal with. I hope you have a good support system and a positive attitude. Both will be an immense help to you through this. Please come back and let us know how you're doing.

Hugs,
Emily
 
Have they told you there will be 4 hours of active rehab per day? Staying in the rehab unit wouldn't necessarily mean active rehab if that is not needed, I'm wondering if they just want to extend your stay in the hospital and the only way to do that is to move you to the rehab floor. I would think they could customize your rehab plan, and given all your conditions, could work with you and your doctors to see what they can do for you. In most 360 fusions the person goes home in one week and is arabulating around the house without much help. With the MS I'm thinking an extra stay helps as they can make sure you are moving as much as possible ( you don't want to stay too immobile after surgery as that in itself can cause complications). And with insurance most plans are not going to allow in-patient regular floor stay beyond 7-10 days. Thus the option of the rehab unit.

Also, in terms of aiding fusion, it may be an option for them to use a bone growth stimulator on you. I had a posteriorlateral fusion 2/3/10 and have a bone growth stimulator I wear 24 hours a day. My surgery involved a posterior incision about 6 inches down the center of my spine and a lateral (side) incision of 4" at hip level. And I have an LSO brace custom made for me per my doctor's prescription prior to the surgery. The bone growth stimulator unit I have involves the following: I have two 3" electrode paRAB that are placed on my back, one on each side of the incision. Each of these has 4" of lead hanging off. The leaRAB are connected to wires that go into my battery pack that I wear on a belt or put in my pocket. The electrical field that is produced aiRAB bone fusion. This was prescribed by my surgeon, they came to my house to bring it to me. It came with two batteries and a charger, extra electrode paRAB, etc. Hubby had to change one electrode pad only thus far! They last a long time.
 
I would hope it would be specially catered to your neeRAB and abilities based on any diagnosis you have. Maybe you can ask if you can find out more about that and maybe tour the unit?
 
Wow Emily -- 8 levels -- and here I am complaining about two. To answer your question, yes, I have a great support system and a positive attitude. My wife is my soulmate and the best caregiver a person could ask for. I've used a scooter to get around in the house for the past couple of years and she's been my cheering section as I "park it" and walk more in preparation for the surgery. I figure any pre-op preparation I can do can only help with the post-op rehab.

Both my neurologist and the neurosurgeon that will be doing the surgery have told me this could be life-changing in a positive way since they both think a lot (if not most) of my problems from the waist down are caused by the spine problems vs. the MS. So I'm trying not to expect miracles, but do want to be prepared for the rehab afterwarRAB. If you can share your rehab experiences, I would appreciate it. Thanks!
 
Spine AZ -- thanks for the info! Yes, my neurosurgeon told me the inpatient rehab would require about 4 hours a day of active participation on my part. I'm sure you're right about insurance being one of the reasons they want to transfer me to inpatient rehab (in the same hospital). I guess what I'm really wondering is just what this rehab will entail? Obviously walking, but what else? Thanks again
 
When I was in rehab after my fusion, the therapy was geared toward my neeRAB. Because I was fused from T9-sacrum, I needed to learn to walk again, to get up and out of chairs-and back into them without just plunking down. they also work on building upper body strength too. You usually have either one or two therapists that are assigned to your case so they will become familiar with it and you.

they break the therapy up into sessions so you don't get overly fatigued. I would have therapy, then nap, therapy, nap. You get the idea.

Good luck!
 
Thanks ibakeandpray -- that helps a lot. My leg pain and weakness was contributed to my MS for many years, and I've been using a scooter for any distance more than 10-15 feet for several years now. Needless to say, my lower extremities have started to atrophy and I guess that's why I'm so concerned about the post-op rehab. My doctors all agree that this could be life-changing for me because the severity of my spondylolisthesis may well be the cause of most (if not all) of my problems from the waist down. So for me, it's not just about getting rid of the pain (although that is a big motivator). I feel like if I don't give the 360 fusion a shot, I'll never know how much of my problems are MS and how much is because of the messed up back. Best case scenario will be that I rehab and regain the use of my legs (and park the damn scooter!). Worst case would be that I can't do the walking and other rehab necessary for a good fusion. I'm hoping for best case!

Thanks again for your help!
 
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