5 Years after L5 - S1 fusion, hot sopts on bone study?
I had a spinal fusion at S1-L5 in February 2006. The surgery was to correct vertebral slippage from spina bifida acculta at that level. At the time of the surgery I was in intense pain and had no choice but to have the surgery. In Summer of 2008, I returned to the same surgeon complaining of continued pain in the lower back with radial nerve pain down the right leg. He sent me for steroid injections (a set of three) over the next few months. When that didn't really help, he scheduled another surgery. He removed the hardware holding the fusion and trimmed back some bone at L4 - L5. He also did a lamanectemy at that same level.
This relieved some of the pain but I continued to have low back pain and sciatic nerve pain following the surgery. Over the last 6 months the pain has continued to get worse. I followed up with pain management, trying nuerontin, zanaflex, more injections, and facet joint injections. None of these had any lasting effect. I was referred to another surgeon who ordered a CT Mylogram and a bone scan. The mylogram came back relatively unremarkable. There is disc degeneration at L3 - L4 and L4 - L5 but no stability issues yet. An MRI revealed spondylosis (lots of extra bone) at L4 - L5. Both of these were expected after a 5 year old fusion. The bone scan, however, came back showing a lot of uptake at the fusion site. My surgeon didn't really know what to make of it so she sent me for a second opinion. The second surgeon says he had seen it once before but didn't know the cause. They are showing the films and reports to a spinal group at a meeting in a week, but I would really like some input.
What could be the cause of this ever increasing pain and the hot spot on the study? They all agree that the two levels above will need to be fixed but they don't think they are the cause of my current pain, at least not in total. They mentioned that one radiologist said he noticed minute slippage at the fused level on flexion and extension, but the doctor said he didn't really see it. They took another set of x-rays and are having them looked at again.
Does anyone have any suggestions of questions I should be asking or has anyone run in to a similar bone scan result following a fusion? Any help will be appreciated.
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