What's The Difference In The Types Of Fusion Surgeries?

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Hello all. I have a question for anyone who knows the answers. I was scheduled for back surgery on Deceraber 19th. But cancelled it last week. The surgeon was going to do an Artificial Disc replacement surgery but I had a CT Scan back in Noveraber ... and my surgeon said that he does not think that he can fit an Artificial Disc into my disc space because it is already collapsed and he said that I am pretty much "bone on bone". Plus I have a slight bit of scoliosis in just my lurabar area of my spine and he said that he is scared to put an Artificial in there because of the scoliosis and thinks I might be in more pain if he did that than what I am in now.

So, to make a long story short .... he said he would do a fusion surgery on me and he would do that Anterior and Posterior approach. My question is ... what is the difference between just an Anterior approach, or just a Posterior and then the both approaches (anterior and posterior)?? And why do they do it different ways??

I didn't think to ask him of those questions then LOL. I just said No, I do not want a fusion right now. If it would have been an Artificial Disc replacement, I would have gone through with the surgery. He said that was fine if I didn't want to do that right now. So, now I don't go back to see him until April 2006. Ugghh, I guess I am just gonna have to stay living on the darn pain meRAB. Actually they scare me too .... the pain meRAB. so after I cancelled the surgery, I called my Pain Management doctor back and asked him if we can do the blood tests to check my liver and kidney functions from being on the pain meRAB. this long already. It's been a year now of being on pain meRAB. So, I go sometime this week for the blood test.

I will post my Ct Scan results below to see if anyone is familiar with what it means.

"There are 6 lurabar type vertebral bodies. The vertebral bodies are normal in height. There is slight anterior subluxation of S1 with reference to L6. This measures less than 3 mm. The L6-S1 disc space is markedly narrowed and there is a vacuum phenomenon at this level. The other disc spaces are normal in height. The vertebral bodies are normal in height. The spinal canal is widely patent. Mild disc bulges are present at L5-L5 and L6-S1. The neural foramina are widely patent. CONCLUSION: Severe degenerative disc disease with disc space narrowing and mild vertebral malalignment at L6-S1. Mild symmetrical disc bulges at L5-L6 and L6-S1."

Ohh, and yes, I have an extra disc in my back (that's why it is L6 in the results). Sorry this was so long, just wanted to give the details on my latest test and ask for more info. about the fusion surgeries. Any help or suggestions would be greatly appreciated!! Thank you :wave:

Tiferz
 
Hi there again. I have been searching around for that other type of fusion that you mentioned above Quietcook, the "Dynesys flexible fusion". That looks interesting!! I would probably do that. I researched doctors that do it here in PA and there are only a few. My current Surgeon has not done the training for this type of Fusion surgery yet. His name was not on the list. I wonder if he will?? I found a Surgeon who is taking patients for that Fusion as a clinical trial. But that kinda scares me. Hubby told me to sign up after I told him about it tonight. But I am a little scared to. I'll feel like a Guniea Pig LOL. Hubby said though .... that when people do those clinical trial, that they pay for everything, is that true? I don't go back to my Surgeon until April, 2006. Wonder if my back will hold steady till then if I am careful. Maybe by then my Surgeon will have done some training with this new fusion surgery. Heck, I dunno.

Quietcook, you really are great!! You give such good advice!! I love reading your threaRAB. How are you doing now after your 10 level fusion?? Are you still in pain? Is it fusing? I do not have any nerve compression right now, I told someone the other day .... I said yeah, I don't have any disc left to compress anything LOL. Although I did have nerve pain earlier in the year, that was the worst pain ever. Worst pain I have ever had in my life!! Thank god that went away. Now it's just the everyday low back pain and then it will radiate off to the right side if I am really hurting that day.

But anyway .... can you all tell I like to talk?? LOL. Boy, I need to find a way to make my threaRAB shorter!! Ohhh one more thing .... has anyone here had the "Dynesys Flexible fusion?" And if so, how are you doing afterwarRAB with having that type of fusion?? Thank you all.

Tiferz :wave:
 
Tiferez,

Clinical trials can be truly good. Some years ago, I participated in a clinical trial for a new drug on ulcers. My thought was that up until then, med dosages were primarily determined by male participants, and they needed females in order to get a more accurate doseage.

The care was extremely thorough, and I wound up keeping that doc for my gastroenterologist. Because of the clinical trial and his specialized knowledge, it so happened that when my asthma went out of control again, he also diagnosed the cause of the attacks and sent recently published articles back to my primary care doc and asthma doc, recommending a new procedure which took me off of 5 asthma meRAB. He was frienRAB with one of the few docs who were doing the new surgical procedure, and got me in to see him right away. I've been off those extra meRAB for almost seven years now. So, please don't rule out a clinical trial, as they must meet stringent guidelines set by the FDA, and you are typically seen by a nuraber of assistants you can reach easily and who really track even minute changes.

You can go for the evaluation and get the exam, etc., which is all at no cost to you. If it requires travel, they often pay the costs for tickets if public transporation is needed, or will reiraburse you a mileage fee, etc. Don't hesitate to ask how that would be handled, as the companies are willing to do so. I did not take advantage of it, as it was only a 60 mile drive to an area I liked to go shopping, and was thrilled that they were also furnishing some of my other brand name meRAB at no charge for the duration of the trial. I felt that was a wonderful deal for me.

There was someone on the board about a year or so ago who had the flexible fusion, and that was how I first learned of it, so that I could research and speak with my doctor. Unfortunately my back was in too big of a mess, but at least my doctor discussed it and my particular situation. It's certainly worthy of finding out if it could apply to your situation, even if through a clinical trial. And, BTW, a good doc supports clinical trails and should it be that you are a candidate that were accepted, I seriously doubt that your doctor would want you to pass it up. Absolutely no harm in you discussing it with him should it appear that you were a good candidate, especially since your back doc can track your success and it gives him more personal contact with the procedure. My primary doc encouraged me to participate in the drug trial and later reminded me of that when that same doc came up with the answer on my asthma. :-)

Glad to say that my 10 level fusion went well, although I suffered a lot more with that surgery than the three 3 level fusions I endured. It was rougher in terms of being cut from the top of the shoulder blades all the way down the body, and rougher because I was older. But it was worth having it done, and my recovery has been great, with me returning to near normal functions in just a few months.

The fusion was solid in about 5-6 months and I could not have been happier, until a month ago when I was involved in a major MVA. I was using my pain patches and taking oral meRAB very infrequently, and some days did without any pain patches.

My car got rear-ended at 70 MPH, so you can imagine how it has affected the spine, so needless to say pain meRAB are definitely on the agenda daily. My spine specialist could not believe it, until he saw photo's of the car and especially of my poor mother who is still sporting totally blackened eyes, cheeks, forehead and chin even after these weeks. I drive a large car (Grand Marquis) with a full frame, and the two blows taken actually broke our seats. Still, we were fortunate, as Mother has had several major heart surgeries in the last two years, and although it acted up, no new harm was done. My spine specialist has taken precautions of putting me in a brace since the last time my vertebrae and fusion was broken in a wreck, it did not show up on films right away, but started crurabling later. He doesn't want that to happen again, and most certainly neither do I. He's ordering more definitive tests which I'm waiting on the scheduled times. The brace does seem to be keeping things from getting worse, just not really showing improvements, so keep your fingers crossed that things will settle down soon.

Okay now, I've been long winded enough. Do your research and you and the hubby give the clinical trial some serious thought and make a call to get more info from them directly. If it is feasible and you qualify for further exam to see if you can participate, check it out. Let me know how things are going for you.

Best wishes.
 
Ohh wow, well I will definitely keep the clinical trial thing as an idea. I am debating if I should call my Surgeon and talk to them about it or wait till I go to Pain Management and talk to him about it. Or do I just try to sign up for it. Ugghhh, I dunno LOL. I wish I could find people who have had it done and see how they are doing now after having it done.

And another WOW about your car accident!! Sorry to hear that. 70 MPH was definitely a hard hit. I hope you and your mom are doing ok from it. I also hope that your back continues to heal well. When did you have your 10 level fusion? With having a 10 lvel fusion, how is your mobility?? Has that affected it at all and if so by how much? Like being able to bend forward and twist and that kind of thing. So you were in another car accident before this past one and it broke your fusion?? Wow, you are definitely lucky if this last accident didn't mess anything up. I will definitely keep my fingers crossed for you and pray that you continue to heal up real good!! :angel:

Again, thank you for your advice and your own experiences!! I know they not only help me, but also help the others on this board!!

Tiferz ~ :)
 
Hi there.......oh the joy of having ten million ways of surgery thrown at you.......fun huh?.....I have read of differing opinions on which surgery is better and a lot has to do with surgeon preference.....the anterior and posterior corabo is what I had done to me, and from what I understand it gives me the best chance of successful fusion. It is usually done on people where there spine is very unstable, on smokers if the doctor will even operate, and those with a failed fusion prior.........I am a little overweight and had two discs that were shriveling up along with a grade II spondy on L5-S1 and the L4-L5 region was showing signs of slipping as well so I had both levels fused or I should say operated on as I am waiting for a fusion of the bone....*fingers crossed* .....
 
Where are you guys getting your information from? I don't understand things like "posterior fusion" and "multi-level" fusion and would never think to ask about things that I don't know exist.

Where to start?

~~~ totally bewildered~~~
 
Welcome to the board. You'll notice that each post is dated. The thread you added on to is dated back to Dec. of 2005. Of course, the types of fusion remain the same.

Many people first start learning about their back issues on a forum such as this. They are having back pain and begin to do some reading and research, perhaps asking some questions of their doctors. You can find tons of information on the internet. Most of it may be hard to understand at first, but as you learn about the anatomy of the spine and the various causes of back pain, it will become easier.

I think it is helpful to look at a diagram of the spine and learn a bit about anatomy. Without knowing about the discs and vertebrae, it will be difficult to understand what a fusion surgery entails.
 
Tiferz,

Every doc has their own preference on how to accomplish their surgeries, and a lot has to do with the cages they prefer to use and the way the companies trained them on those procedures from the start. Frankly, I've endured way too many surgeries and if an equally excellent job can be had with one surgery, I do not need to endure the anesthia and risks involved with two surgeries versus one and the healing of two incisions instead of one.


I've had 8 spine surgeries, with 4 fusion surgeries, all successful and none of mine were done in the two surgery process. I've had local acquaintances who have gone that route and some did great and others didn't do as well as I did, but they were using general ortho and general neuro surgeons instead of a spine specialist like I was using. My first fusion was prior to BMP being approved, so it was done posteriorly and bone harvested from my hip. Did fine and it fused. Had to remove the hardware 17 months later as three levels of hardware caused problems with my being very active. Then a car wreck broke the fusion, so had it redone, with BMP which had been approved just a couple of days earlier. That was done anteriorly with a general surgeon opening and moving my intestines, because of clinical trials showing problems if the BMP got into unwanted areas, which the anterior approach prevented. I did worry about the intestines getting twisted and yet more surgery being required, but all went extremely well. By the time the third 3 level fusion was needed, it was done posteriorly because scopes were now used for placing the BMP and cages, and the types of cages had changed. Finally, the 10 level fusion one year ago was also posteriorly and the fusion was good in 5 months. Now, even though my fusions, especially the 10 level was posterior, I was as unstable as a body could be, as the slippage of vertebrae which were bone on bone was so severe that there was risk of my cord being severed.

Being bone on bone had nothing to do with me not being eligible for the ADR, which I had hopes of having so that I could retain some flexibility. The fact was that the rest of my support system was shot, making me ineligible. Must say that in all the materials I've studied on the ADR's, being bone on bone was not a disqualification I've read about.

Would suggest that if you are facing either ADR or fusion that you seek opinions from true spine specialists. Even though I believe my spine specialist is the greatest, it is good to get other opinions, and it took seeing a nuraber of spine specialists before I found him. I wanted one who treated my pain from beginning to end, but some people prefer PMs. I want the specialist who most understanRAB the spine and it's care to medicate, because he is the most knowledgable of that pain. Thankfully, my spine specialist does not want his patients to be in pain, and fusses if I don't take the pain meRAB available. He explains that being tensed and in pain keeps one from healing their best.

Can understand not wanting fusion, but a couple of other things you might wish to ask about. When I found my spine specialist, he alerted me to the fact that if nerves were being severely compressed, there was excellent chance of full recovery from the pain and nurabness if the repair was done within the first 6 months, and that dropped to a 75% chance at 9 months and only 50% or less at a year or more. General guidelines, but at that point I had been severe for more than 10 months and the general ortho and neuro surgeons I had been dealing with had never mentioned such information to me so I had continued to put surgery off. Fortunately I did recover from the pain, but not the nurab toes. So, please consider how severe your pain is and for how long before you delay so long that even with surgery you are stuck with pain because the nerve is permanently damaged. Perhaps this is also a question you can discuss with your spine specialist, if he has not already mentioned it to you.

This spine specialist I see doesn't rush out the door, he answers all my questions, he works with me to try non-surgical means, but is frank and reminRAB me that the longer the pain is severe, the less likely I can have a totally full recovery. He explains things to my layman level.

Bionic Witch has a thread to spine universe posted near the top of the board. That as well as a couple of other spine health type sites have some animated procedures to explain things for us. Those are good, and you might wish to look not only at the ADR and fusion, but also the Dynesys flexible fusion. Perhaps your spine specialist will discuss with you the advantage or disadvantage of each of those per your own situation.

Hope you will find out more about the ADR and your back, and check further into what your results will be if you delay surgery longer, as well as whether or not a Dynesys fusion might apply to your condition. And, please don't hesitate to get a second or even more opinions from spine specialists until you are comfortable that delaying surgery will not put you at risk for not fully recovering from the pain should you wait, and that there is no other option than fixed fusion. You are your best advocate and you owe it to yourself to give yourself all the same options you would want for any other meraber of your family.

Best wishes and do let us know how you are doing.
 
Tifferezz,
Quietcook has given you excellent advice. As the previous posters stated, there are as many ways to accomplish the same results as there are surgeons. When we were getting multiple opinions before my 16 year old daughter had her fusion, we consulted with two other drs. Each agreed she needed a fusion, but each one would approach it differently. Since she was only 16 we decided not to go with the anterior/posterior approach. She was young and very healthy. Another dr would have done a posterior fusion. Her dr (a pediatric ortho) and his adult spine partner, did a TLIF, Transforminal Lurabar Interbody Fusion. He explained that with this process he was able to get to the front from the back.

Good luck sorting through it all. Do a search. There's more info than you'll have time to read on these procedures. Lastly, are you able to call your dr and have him/her return your call to ask your additional questions? My daughter's dr is great about that and always leaves an appt saying, "If you have any questions just call me." Believe me I do and he is great about calling back and answering every question or concern that I have. Best wishes. cas
 
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