@annie1 I suggest you ask your bone specialist for an opinion. I don't know how to gage the risks or what your bone scores are, and only a specialist can interpret the information and advise you on your choices. I also don't know how much bone is removed. Surgeons have to gage the risk and they may be concerned not only for you, but for their reputations if something goes wrong. Are you treating the osteoporosis with any bone building drugs? I suggest contact your bone specialist asap.
I have an appointment with her next week actually, so I think I will have to postpone the surgery until I get these questions answered. I was on a yearly infusion of Reclast for 3 yrs but apparently they can't do more than three years. What does spine instability mean actually ?
I also agree with everything Jennifer said. Make sure you check the Dr's track record and the hospital infection rate also. Each patient is different and until the surgery is completed they can't specifically comment and be held to it. For instance what if they told me 6 weeks and for me it turned out to be 9 weeks because it was more severe than the usual cases. A walker can also be arranged by the hospital social worker. Do you have family that can come assist you in the beginning? I had to make sure I had easy clothing and everything at my finger tips. No shoes, only slipons. I could not even think of taking a bus ride, changing my sheets or even grocery shopping. My bedroom and bathroom were all prepared ahead if time . I had a L4 microlaminotomy and microdisectomy. Don't want to scare you, just caution you to be prepared and have a friend or family member to help you. I would have had to go to assisted living if not for a family member helping. Everyone's case is different. Prayers for less pain and a speedy recovery
I don't have family that can help. I am probably going to reschedule the surgery actually because of new information. Do you have Osteoporosis ? Another surgeon said I should not have any surgery because I have Osteoporosis in two places on my spine.
It is very important to keep all activity to a minimum for the required six weeks to insure proper healing. This includes no swimming. You don't want to get an infection. Taking very short walks to begin with is usually prescribed. I needed a helper in the beginning. I was not even allowed to begin PT for 9 weeks after. You may require some home health assistance for ADL,especially if you live alone. The social worker in the hospital arranges for that. The RN and PA will be answering your questions on this, not the surgeon. After the six weeks they will let you know if you are cleared to begin just pool walking. DONT OVERDUE. Good Luck!
I had a hemilaninotomy and a microdiskectomy at L4 . No I don't have OsteoP. It will be up to each surgeon and your bone specialist to concur what to do depending on your level of bone degeneration. I have read some folks take special meds to build bone before a surgery but each patient is unique. Was merely trying to advise on how difficult it was for me afterward.
I have an appointment with her next week actually, so I think I will have to postpone the surgery until I get these questions answered. I was on a yearly infusion of Reclast for 3 yrs but apparently they can't do more than three years. What does spine instability mean actually ?
@annie1 Annie, Instability is usually described as listhesis which means a vertebrae is slipping past another one because the integrity of the spinal disc is not good enough to prevent that movement. If it slips forward they say anterolisthesis and if it slips backward, retrolisthesis. If you have stenosis that has already narrowed the spinal canal with spinal cord contact, and slipping happens, that will put more pressure on the spinal cord. Imagine that like a string of beads, and the string is your spinal cord. If you pull beads away from the string in different directions, you can see what happens when the string gets taught.
It makes sense to postpone surgery until you get all the answers you need. Your surgeon should be agreeable to waiting for you to solve other issues. My mom has severe osteoporosis and has had a spontaneous spine compression fracture. That healed itself, but put a curve into her back. She was not a candidate for a bone cement procedure because of the severe osteoporosis. That cement may be harder than her bone and possibly cause issues. After you get information from your bone doctor and when you start consulting spine surgeons again, I wonder if there is another way to do the laminotomy, but also add some bone as a bridge over the hole they will make. If there is a way to add bone that fuses to existing bone, there will not be hardware or screws. Issues with spine hardware and osteoporosis would create pressure from hardware and screws on the bone. I don't know if this is a workable solution, but something to ask. Your bone doctor may also want to try to build more bone strength before any spine repairs.
@annie1 Annie, Instability is usually described as listhesis which means a vertebrae is slipping past another one because the integrity of the spinal disc is not good enough to prevent that movement. If it slips forward they say anterolisthesis and if it slips backward, retrolisthesis. If you have stenosis that has already narrowed the spinal canal with spinal cord contact, and slipping happens, that will put more pressure on the spinal cord. Imagine that like a string of beads, and the string is your spinal cord. If you pull beads away from the string in different directions, you can see what happens when the string gets taught.
It makes sense to postpone surgery until you get all the answers you need. Your surgeon should be agreeable to waiting for you to solve other issues. My mom has severe osteoporosis and has had a spontaneous spine compression fracture. That healed itself, but put a curve into her back. She was not a candidate for a bone cement procedure because of the severe osteoporosis. That cement may be harder than her bone and possibly cause issues. After you get information from your bone doctor and when you start consulting spine surgeons again, I wonder if there is another way to do the laminotomy, but also add some bone as a bridge over the hole they will make. If there is a way to add bone that fuses to existing bone, there will not be hardware or screws. Issues with spine hardware and osteoporosis would create pressure from hardware and screws on the bone. I don't know if this is a workable solution, but something to ask. Your bone doctor may also want to try to build more bone strength before any spine repairs.
Thank you again for the voice of reason ! I guess I was sort of rushing into this because I wanted to be "all better" by the Summer to travel, walk on the beach etc. But if anything were to happen to destabilize my spine, obviously I wouldn't be able to do any of that. As I am now, I can atleast ride my bike and swim(without using my legs.) So I haven't lost those things atleast. So if i have to postpone until later until I have the Important Questions answered that's a bigger picture decision.
But I've read that if you put off this surgery I might end up in a wheelchair. I don't understand if I am in that category. My gait has changed, and I don't know if the surgery would address that.
This is a message I got from the more conservative surgeon's NP. Much more professional and thoughtful the other one who was answering my questions with one liners !
Based on your dexa scan results it is not ideal for you to undergo surgery. Even if you were to have a laminotomy it increases the likelihood of you needing a fusion because removing a portion of your lamina can cause spinal instability. Increasing your chace of having a fusion is dangerous with osteopenia and osteoporosis. It puts you at risk for screws loosening, and spinal fractures. Ultimately if you were to undergo a fusion you are at increased risk for not fusing appropriately.
Thank you again for the voice of reason ! I guess I was sort of rushing into this because I wanted to be "all better" by the Summer to travel, walk on the beach etc. But if anything were to happen to destabilize my spine, obviously I wouldn't be able to do any of that. As I am now, I can atleast ride my bike and swim(without using my legs.) So I haven't lost those things atleast. So if i have to postpone until later until I have the Important Questions answered that's a bigger picture decision.
But I've read that if you put off this surgery I might end up in a wheelchair. I don't understand if I am in that category. My gait has changed, and I don't know if the surgery would address that.
@annie1 Annie, Spine surgery is something you do NOT want to rush into unless it is emergency surgery for a serious condition. Once done, you cannot undo it. Most spine surgeries are elective and come after years of spine degeneration. You have to make sure that you are picking a solution that is beneficial, and sometimes there are different choices. I have heard of surgeons asking patents to do a year of bone building injections before undergoing spine surgery. You also cannot rush healing and the body takes it's own sweet time.
Have you considered working with a physical therapist? They can't fix stenosis, but they can try to keep the spine aligned and address issues with muscle spasms and that may help reduce symptoms. I also had gait disturbances from spinal cord compression and that was cured by my surgery. One question to ask is are if you are taking any drug prescriptions that have side effects that can be contributing to osteoporosis? I don't know if drinking alcohol contributes, but these are good things to know and ask about if there are things to do or change to improve your chances. I have bioidentical hormone replacement that according to my doctor should help prevent osteoporosis. There is an active group for osteoporosis here too if you wanted to read some patient experience.
I had worries of a wheelchair in my future too. My parents were both in wheelchairs and I took care of them. Having that degree of disability is hard and it doesn't just happen overnight with a gradual spine change. If you can make a plan that can improve bone quality and then address spine issues, it would be the best of both worlds. You need to know what your bone scores mean and how much it may be possible to improve them and how to go about improving things. I have read that laminectomy can cause spine instability. A laminectomy is kind of like raising the roof on a house when you want to build a 2nd floor. They cut through the top side part of the bone that arches over the back of the spinal cord. That leaves the disc intact between the vertebrae and the facet joints supporting the spine. If those are failing as in a bad disc or arthritis in the facets, it creates a problem and that may be why it leads to a fusion. Often with fusion, they screw a plate on the front of the spine and screws can be bad for osteoporosis as they can pull out. I don't have a front spine plate because I requested no hardware and that was possible with a singe level fusion.
@annie1 Annie, Spine surgery is something you do NOT want to rush into unless it is emergency surgery for a serious condition. Once done, you cannot undo it. Most spine surgeries are elective and come after years of spine degeneration. You have to make sure that you are picking a solution that is beneficial, and sometimes there are different choices. I have heard of surgeons asking patents to do a year of bone building injections before undergoing spine surgery. You also cannot rush healing and the body takes it's own sweet time.
Have you considered working with a physical therapist? They can't fix stenosis, but they can try to keep the spine aligned and address issues with muscle spasms and that may help reduce symptoms. I also had gait disturbances from spinal cord compression and that was cured by my surgery. One question to ask is are if you are taking any drug prescriptions that have side effects that can be contributing to osteoporosis? I don't know if drinking alcohol contributes, but these are good things to know and ask about if there are things to do or change to improve your chances. I have bioidentical hormone replacement that according to my doctor should help prevent osteoporosis. There is an active group for osteoporosis here too if you wanted to read some patient experience.
I had worries of a wheelchair in my future too. My parents were both in wheelchairs and I took care of them. Having that degree of disability is hard and it doesn't just happen overnight with a gradual spine change. If you can make a plan that can improve bone quality and then address spine issues, it would be the best of both worlds. You need to know what your bone scores mean and how much it may be possible to improve them and how to go about improving things. I have read that laminectomy can cause spine instability. A laminectomy is kind of like raising the roof on a house when you want to build a 2nd floor. They cut through the top side part of the bone that arches over the back of the spinal cord. That leaves the disc intact between the vertebrae and the facet joints supporting the spine. If those are failing as in a bad disc or arthritis in the facets, it creates a problem and that may be why it leads to a fusion. Often with fusion, they screw a plate on the front of the spine and screws can be bad for osteoporosis as they can pull out. I don't have a front spine plate because I requested no hardware and that was possible with a singe level fusion.
I did have three years of Reclast infusions that did improve my DEXA but I guess not enough according to the more conservative surgeon. I still had Osteopenia and Osteoporosis in the head of my femur on both sides. I was taking Tymlos and Forteo injections for a few years before the Dr put me on the Reclast.
I Have gone to physical therapy many different places it didn't really help with my throbbing calf muscles after walking. That has been the most predominant symptom since this all started in 2016. Yeah as far as the laminectomy actually I would be getting laminotomy, during which they don't cut as much of the bone, they just cut into the lamina. I think you know this, but the other surgeon still thought that could create instability. He suggested I try Ablation again, I had it done once and it didn't help my symptoms, but he wants me to try again with a different Dr.
I'm going to the Surgeon who would have been doing the Laminotomy tomorrow and I will be sure to have him give me very direct answers about the spine instability possibility as well as the probability of needing fusion.
I just am not clear about when I can start stretching and exercising post op. I don't even have a post op visit with the surgeon for a month after because he will be going on vacation!
Annie, I started my physical therapy within about a week after surgery. I had my surgeries at Mayo in Rochester so I saw my family doctor for post op visits and had a phone call with my surgeon about 6 weeks after surgery. I had an in-person visit about a year later with the surgeon. You can do your requested x-rays and/or MRI's if needed at your local hospital. My first post-op with my family doctor was about a month after surgery. If your surgery is done at Mayo, they will provide you with a phone number you can call to reach your surgeon's assistant to ask questions or report complications after your surgery. I traveled home the day I was released from the hospital. We stopped about every 1 1/2 to 2 hours on the way home so I could walk with my walker. My orders after the surgery said walking is adequate exercise. You need to have some form of strengthening exercise to complete your recovery process. If you choose not to exercise, less blood flow to the surgical site can prolong your healing process. My physical therapy focused on exercise to increase the core strength in my spine and lower body. I didn't start anything more strenuous until about a month after surgery. I started walking immediately, increasing my distance slightly each day. You will tire easily in the early days after your surgery. I would lay on my bed and listen to relaxing music or nature sounds and take a nap. Patients who listen to music before and after surgery show reduced pain scores, anxiety and need for pain relievers. I found it extremely relaxing, I slept well and I was off pain relievers within about 6-10 days.
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I have an appointment with her next week actually, so I think I will have to postpone the surgery until I get these questions answered. I was on a yearly infusion of Reclast for 3 yrs but apparently they can't do more than three years. What does spine instability mean actually ?
I don't have family that can help. I am probably going to reschedule the surgery actually because of new information. Do you have Osteoporosis ? Another surgeon said I should not have any surgery because I have Osteoporosis in two places on my spine.
What did you have done and did you have any Osteoporosis ?
I had a hemilaninotomy and a microdiskectomy at L4 . No I don't have OsteoP. It will be up to each surgeon and your bone specialist to concur what to do depending on your level of bone degeneration. I have read some folks take special meds to build bone before a surgery but each patient is unique. Was merely trying to advise on how difficult it was for me afterward.
@annie1 Annie, Instability is usually described as listhesis which means a vertebrae is slipping past another one because the integrity of the spinal disc is not good enough to prevent that movement. If it slips forward they say anterolisthesis and if it slips backward, retrolisthesis. If you have stenosis that has already narrowed the spinal canal with spinal cord contact, and slipping happens, that will put more pressure on the spinal cord. Imagine that like a string of beads, and the string is your spinal cord. If you pull beads away from the string in different directions, you can see what happens when the string gets taught.
It makes sense to postpone surgery until you get all the answers you need. Your surgeon should be agreeable to waiting for you to solve other issues. My mom has severe osteoporosis and has had a spontaneous spine compression fracture. That healed itself, but put a curve into her back. She was not a candidate for a bone cement procedure because of the severe osteoporosis. That cement may be harder than her bone and possibly cause issues. After you get information from your bone doctor and when you start consulting spine surgeons again, I wonder if there is another way to do the laminotomy, but also add some bone as a bridge over the hole they will make. If there is a way to add bone that fuses to existing bone, there will not be hardware or screws. Issues with spine hardware and osteoporosis would create pressure from hardware and screws on the bone. I don't know if this is a workable solution, but something to ask. Your bone doctor may also want to try to build more bone strength before any spine repairs.
Keep me posted.
Jennifer
Thank you again for the voice of reason ! I guess I was sort of rushing into this because I wanted to be "all better" by the Summer to travel, walk on the beach etc. But if anything were to happen to destabilize my spine, obviously I wouldn't be able to do any of that. As I am now, I can atleast ride my bike and swim(without using my legs.) So I haven't lost those things atleast. So if i have to postpone until later until I have the Important Questions answered that's a bigger picture decision.
But I've read that if you put off this surgery I might end up in a wheelchair. I don't understand if I am in that category. My gait has changed, and I don't know if the surgery would address that.
This is a message I got from the more conservative surgeon's NP. Much more professional and thoughtful the other one who was answering my questions with one liners !
Based on your dexa scan results it is not ideal for you to undergo surgery. Even if you were to have a laminotomy it increases the likelihood of you needing a fusion because removing a portion of your lamina can cause spinal instability. Increasing your chace of having a fusion is dangerous with osteopenia and osteoporosis. It puts you at risk for screws loosening, and spinal fractures. Ultimately if you were to undergo a fusion you are at increased risk for not fusing appropriately.
@annie1 Annie, Spine surgery is something you do NOT want to rush into unless it is emergency surgery for a serious condition. Once done, you cannot undo it. Most spine surgeries are elective and come after years of spine degeneration. You have to make sure that you are picking a solution that is beneficial, and sometimes there are different choices. I have heard of surgeons asking patents to do a year of bone building injections before undergoing spine surgery. You also cannot rush healing and the body takes it's own sweet time.
Have you considered working with a physical therapist? They can't fix stenosis, but they can try to keep the spine aligned and address issues with muscle spasms and that may help reduce symptoms. I also had gait disturbances from spinal cord compression and that was cured by my surgery. One question to ask is are if you are taking any drug prescriptions that have side effects that can be contributing to osteoporosis? I don't know if drinking alcohol contributes, but these are good things to know and ask about if there are things to do or change to improve your chances. I have bioidentical hormone replacement that according to my doctor should help prevent osteoporosis. There is an active group for osteoporosis here too if you wanted to read some patient experience.
I had worries of a wheelchair in my future too. My parents were both in wheelchairs and I took care of them. Having that degree of disability is hard and it doesn't just happen overnight with a gradual spine change. If you can make a plan that can improve bone quality and then address spine issues, it would be the best of both worlds. You need to know what your bone scores mean and how much it may be possible to improve them and how to go about improving things. I have read that laminectomy can cause spine instability. A laminectomy is kind of like raising the roof on a house when you want to build a 2nd floor. They cut through the top side part of the bone that arches over the back of the spinal cord. That leaves the disc intact between the vertebrae and the facet joints supporting the spine. If those are failing as in a bad disc or arthritis in the facets, it creates a problem and that may be why it leads to a fusion. Often with fusion, they screw a plate on the front of the spine and screws can be bad for osteoporosis as they can pull out. I don't have a front spine plate because I requested no hardware and that was possible with a singe level fusion.
Jennifer
I did have three years of Reclast infusions that did improve my DEXA but I guess not enough according to the more conservative surgeon. I still had Osteopenia and Osteoporosis in the head of my femur on both sides. I was taking Tymlos and Forteo injections for a few years before the Dr put me on the Reclast.
I Have gone to physical therapy many different places it didn't really help with my throbbing calf muscles after walking. That has been the most predominant symptom since this all started in 2016. Yeah as far as the laminectomy actually I would be getting laminotomy, during which they don't cut as much of the bone, they just cut into the lamina. I think you know this, but the other surgeon still thought that could create instability. He suggested I try Ablation again, I had it done once and it didn't help my symptoms, but he wants me to try again with a different Dr.
I'm going to the Surgeon who would have been doing the Laminotomy tomorrow and I will be sure to have him give me very direct answers about the spine instability possibility as well as the probability of needing fusion.
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1 ReactionAnnie, I started my physical therapy within about a week after surgery. I had my surgeries at Mayo in Rochester so I saw my family doctor for post op visits and had a phone call with my surgeon about 6 weeks after surgery. I had an in-person visit about a year later with the surgeon. You can do your requested x-rays and/or MRI's if needed at your local hospital. My first post-op with my family doctor was about a month after surgery. If your surgery is done at Mayo, they will provide you with a phone number you can call to reach your surgeon's assistant to ask questions or report complications after your surgery. I traveled home the day I was released from the hospital. We stopped about every 1 1/2 to 2 hours on the way home so I could walk with my walker. My orders after the surgery said walking is adequate exercise. You need to have some form of strengthening exercise to complete your recovery process. If you choose not to exercise, less blood flow to the surgical site can prolong your healing process. My physical therapy focused on exercise to increase the core strength in my spine and lower body. I didn't start anything more strenuous until about a month after surgery. I started walking immediately, increasing my distance slightly each day. You will tire easily in the early days after your surgery. I would lay on my bed and listen to relaxing music or nature sounds and take a nap. Patients who listen to music before and after surgery show reduced pain scores, anxiety and need for pain relievers. I found it extremely relaxing, I slept well and I was off pain relievers within about 6-10 days.
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Like -
Helpful -
Hug
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