Four level 360 Fusion

[buckeyefan]

Dear Doctor,
I am a 31 year old female,I have severe deg. spine disease, non accident nor trauma.  I have had all the tests, cons. treatments, pain doctors, multiple opinions.  I had a multi-level laminectomies, bilaterially, forminectomies and bilateral facetectomies L2-L5 in Jan. 2001.  This helped the facet hypertrophy, and stenosis on several levels.  However, new bilateral stenosis on L5-L6 (extra lumbar vert). I was also to have a discetomy during this surgery on the deg. discs.  My Neurosurgeon could not do - due to excessive narrowing of the disc space.  Pain has continued.  Pain is so much worse in my back, hips, thighs.  So very unbearable.
I am scheduled for a four-level 360 lumbar fusion on 4/11/01.  This will be done posteriorly with ray cages, rods and pedicle screws.  (Ray cages on two levels only).  L3-4, L4-5 (these two levels with the cages) L5-6, L6-S1 (extra lumb. vert)
I guess my question is:  How much pain relief can I realistically expect from a four-level fusion (my NS said ideally, I could expect the amount of relief I receive while wearing my TLSO with extension).  What type of problems are possible with additional levels etc?  How soon until upper levels effective (guesstimate) Also, so far, no docs have been able to tell me what caused this...I have never been in any type of accident nor sports related, nothing.  However, so many doctors, both Neurosurgeons and Ortho spine docs say I am much too young for this severe of Spinal Degeneration.  

Thank you so much for your time and consideration.

Beth

[CCF Neuro[P]-M.D.-RPS]

Dear Beth:

I am so sorry to hear about your spinal problem.  I am not sure what to tell you.  Without an etiology I am afraid prognostication is vertually impossible.  It sounds like the neurosurgeons are correct and the pain issue will not go away with surgery.  It sounds like they are just trying to stabilize things, which sounds like a major effort.  With devices, there are always hardware problems.  We put alot of structural strain on our spines and mechanical cages have a difficult time holding up to this strain over time.  However, they are usually the only modality to be effective.  Have they used any of the bisphosphonates yet?  I am sorry that I am unable to help.  Without more knowledge of your case, your history, family history, lab studies, MRI studies..... it is impossible to give you much information.

Sincerely,

CCF Neuro MD

[buckeyefan]

Dear Doctor.

Thank your for your prompt reply.  However, I have another question.  You asked the following in the reply to my post:

"Have they used any of the bisphosphonates yet?"

What is bisphosphonates?  What are the possible benefits.

Thank you again,

Beth

[Steph47]

I'm a 47 year old female diagnosed with DDD, Osteoarthritis in the spine only, osteoporosis.  I'm had a titanium cage fusion at L5-S1, L4-L5.  Prior to the fusion I had become wheelchair bound.  The fusion gave me back most of my life although not completely pain free.  I can live with 4 to 6 level pain though.  I had the fusion Oct. 21, 1998 and still doing great in that arena.  Unfortunately I now am looking at a cervical fusion because my cervical disks (all 7) have degenerated at varying levels of bulging, herniation....etc.  Over the last year I've been having more and more migraine headaches and end up in the ER a lot now.  I've gotten to the point of "do anything to relieve me of this."  My left arm is in constant pain and my neck and shoulders feel like knives stabbing me.  I work in the computer industry and that has allowed me to continue to work a fulltime job although lately it's been difficult.  I have been living in chronic pain for years now and used many means to live with it including massage therapy, meditation, minimal drug therapy (which they say is probably more dangerous since my tolerance is so high now), reliance on a "Higher Power", positive attitude, laughter, vitamins, healthy diet.  My greatest challenge are educating doctors on how to deal with people with chronic pain.  Most of them seem to want to wash their hands of us.  It is a powerless feeling by all.  I am researching everything I can about cervical fusion so any input on that would be greatly appreciated.

Thanks for listening.