Rupture at L5/S1/Fusion?

Posted By  CCF NEUROSURGERY MD on August 15, 1997 at 09:46:37:

In Reply to: Rupture at L5/S1/Fusion? posted by Jim Owsley on July 20, 1997 at 17:33:04:

: Dear Docs:
  I have been in chronic pain for approx. 4 months as a result of
  a ruptured L5/S1 approx. 13 year ago that was treated with a
  Chemonucleolysis Injection. Since that time I have been up and down
  with my back until 4 months ago when it "popped" one morning.
  I have been to 2 two neurosurgeons and 1 orthopaedic. I have received
  2 MRI's and 1 Mylogram. The general concensus is that I need a fusion.
  My questions are 1) What are the success rates of a fusion 2)Is it
  common to use titanium plates and screws instead of bone from my hip?
  3)Is a brace common practice w/ titanium plate use (I was told no brace)?
  4)What are the draw backs of the plates v. bone in a fusion? and lastly,
  what is the common recovery time. My surgery is August 12, 1997. PLEASE
  RESPOND ASAP.

[CCF NEUROSURGERY MD]

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Dear Jim,
One indication for lumbar fusion is instability of the lumbar vertebrae.
A common story is often like yours in that a patient has had a lumbar disc
removed and some years down the line experiences unremitting low back pain.
The new radiographic studies were appropriate to diagnose your problem.  
You may have also some new disc herniating into the spinal canal referable
to the 'pop' you heard recently.  If you do indeed have lumbar instability
a fusion procedure is not unreasonable.
There are different procedures a spine surgeon may perform for lumbar
instability.  They generally involve some kind of titanium or stainless
steel fixation construct.  After the spinal segments are fixed in place
it is common to use bone from the patient's hip or other area to lay around
the construct to promote the bony fusion.  The idea is that the metal
hardware holds the vertebrae in place while the new bone grows around the
metal.  It is the new bone forming around the metal construct that allows
long term fusion.  The metal is simply a short term 'holding' device.  
Successful fusion rates are roughly 70% to 90%, and you should discuss
this with your surgeon.
Recovery time from surgery will take a few months.  Progress is monitored with lumbar
radiographs.  The solid bony fusion may take from six months to a year to
form completely.  Our routine at the Cleveland Clinic is to have the patient
wear a brace for three months, at which time the brace may be removed.  Most
people are out of the hospital in their brace within a week.
Good luck with your surgery.