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Neurology (Expert Forum)
Any other option then fusion ?
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Any other option then fusion ?
by Fire/Medic, Dec 28, 2001 12:00AM
My question stems from an ongoing problem,I am a 32 yr old Firefighter/Paramdic and back in 1994 I injured my back at a fire scene. At the time I was unable to walk and was refered to a neurosurgeon. I was told that I had a large herniated disc at L4-L5 and could either try surgery or have therapy instead. I went the conservitive route first until a few days later I was unable to urinate, and at that point I was told an operation was in my best interest. After a sucessful operation I returned back to work for six years without any real problems up until last year. I began to have right sided foot drop and severe leg pains, I was refered to a pain clinic which followed with an MRI. I was told that I needed to have emergency surgery due to impending Cauda equina syndrome. I underwent a right sided laminotomy/microdiscectomy. Following the surgery I have had no problems with my right side at all and was back to work in two months. Since last year though I have had ongoing problems with my left side as far as cramps in the buttocks and calve area. In the last month things have got pretty severe and now I am out of work. I am trying all alternatives prior to going to see my surgeon again. Last year my doctor told me that a fusion was my next step, I am going to see if it is possible to get away a left sided laminectomy since it is only my left side which is causing a problem, but I do not think he will agree.Are one level cage fusions usaully sucessful or are there other alternatives. Don't hear of to many sucess stories.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Dec 28, 2001 12:00AM
To answer your specific question, there are actually many, many cases in the medical literature of successful one level cage fusions.
However, it first must be determined whether or not these cramps are really indicative of spinal problems. Certainly, it is a strong possibility with your history of recurrent back pain and surgeries and the presence of other symptoms you did not mention above. Consider seeing a neurologist to get a formal exam that will help localize the problem to a specific site. Second, an EMG could further pinpoint the exact problem meaning if it is just the left side that is involved. Finally, an MRI of the lower spine may be helpful, although the anatomy may be difficult to assess as there has been prior surgery on your back. If you're reluctant to go back to your surgeon just yet, make sure you have all the info regarding the state of your spine and neurological damage first. Unfortunately, I cannot comment on your surgical options as I myself need more info such as the physical exam findings and the results of any imaging studies. However, a neurologist should be able to get you started in the right direction. Good luck.
However, it first must be determined whether or not these cramps are really indicative of spinal problems. Certainly, it is a strong possibility with your history of recurrent back pain and surgeries and the presence of other symptoms you did not mention above. Consider seeing a neurologist to get a formal exam that will help localize the problem to a specific site. Second, an EMG could further pinpoint the exact problem meaning if it is just the left side that is involved. Finally, an MRI of the lower spine may be helpful, although the anatomy may be difficult to assess as there has been prior surgery on your back. If you're reluctant to go back to your surgeon just yet, make sure you have all the info regarding the state of your spine and neurological damage first. Unfortunately, I cannot comment on your surgical options as I myself need more info such as the physical exam findings and the results of any imaging studies. However, a neurologist should be able to get you started in the right direction. Good luck.
Check it out. GREAT SITE! Very informational. http://orthopedics.about.com you’ll find answers to your questions. Type in “pedicle screw” in search and click on “see more in the blue box” and view animated surgeries of the spine.
I had interbody fusion where they removed the L-4/5 disc replacing it with cages, then the spinal fusion with pedicle screws instrumentation. I came out of surgery with pain and numbness in my thighs and feet. This increasingly got worse and began to effect more areas in my legs.
One of three things will occur. #1 (4) pedicle screws will be properly placed in the pedicle space, which is the narrow bone that bridges the lumbar body where your spinal cord is housed and your nerve roots exit that supplies your muscles and organs. #2 or the screws will be missed place. #3 they can be placed either out of the lumbar vertebra or within the spinal cannel that can pinch and tear the nerve roots. Few cases have reported even broken screws. All of this is done to hold the vertebra still during the healing process. After a year you no longer need the hard ware. It isn’t even necessary to have done when you have an interbody fusion and is in my opinion has far greater risks than benefits. BOTTOM LINE: It’s a longer and more expensive surgery. It allows the patient a quicker mobilization after surgery.
IF YOU ARE A PERCENTAGE OF THE PEOPLE WHO WILL BE MISFORNATE AND HAVE PROBLEMS WITH THE PROCEEDURE OF PLACING THE PEDICLE SCREWS, THIS IS WHAT HAPPENS WHEN YOU DEVELOP COMPLICATIONS: You develop lesions from the instrmentatation of the hard ware. You have a greater amount of scare tissue and can cause a surgical nightmare of symptoms. You have more blood loss and this can build up in the epidural space and cause symptoms as well. You can develop arachnoiditis that also has symptoms and can be severe and is a known complication. Missed placed screws can cause paralysis or pinch at the nerve roots causing nerve symptoms or can be out of the vertebra body causing symptoms.
This is the irony of the instrumentation of pedicle screws.
Most likely you’ll be asked to have a Mylogram/Cat scan (The dye can cause arachnoiditis) to see what’s happening inside. BUT, now they’re having difficulties interpreting the X-Ray’s because of the artifact from the pedicle screws casting shadows that renders the film quality poor and there’s difficulty to characterize the problem. The surgeon will most likely not tell you if the pedicle screws are missed placed. CAUTION: Evidently there’s numerous medical malpractice litigations concerning placement of the pedicle screws. SO you’re left with all these nerve symptoms and you still have back pain and leg pain and you want to know why! Your now disabled and your life is up side down and you wish you were dead. DON’T LET THIS HAPPEN TO YOU. Surgery at times becomes necessary ask questions and if you don’t need the hardware don’t get talked into it. Make sure to say this when you’re registering or your surgeon may feel this is a necessary procedure. Look else ware for alternatives. Get second opinions. The odds may not be on your side and the results are devastating!