Lumbar laminectomy/fusion patients with osteopororis?

Posted by pyates @pyates, Jul 28 3:40pm

Greetings to everyone.

I'm a 64 y.o. male with osteopororis and lumbar stenosis in L3, L4, L5, and S1. The stenosis is severe in L5-S1, and mild/moderate in L3 and L4. The situation is complicated further because L4 looks especially degenerated, to a degree that may qualify as a VFX.

My symptoms are chronic back and hip pain, left-drop foot, and possible urinary retention. For the time being, I'm still on my feet, can ambulate easily enough, and haven't had significant loss of bladder control. At least for now, that is.

I've consulted two surgeons so far, and they give me mixed feedback. My impression is that they'll do the surgery, but based on the non-verbal aspect of their communication, may be hoping I find a different surgeon. No surprise there, given my clinical picture.

The second surgeon pointed out that I'd need bone regeneration treatment prior to the operation. He didn't say exactly what that entailed, although I've since connected with an experienced endocrinologist/BMD specialist who explained the basics about anabolics and bisphosphonates and how they'll probably be used in my case.

I'm still mapping out my surgery planning. The timing of the operation, nature of bone regeneration treatment, and who the surgeon will be are still unsettled issues. I'm feeling my way forward in the dark, so to speak.

Needless to say, I'm worried about post-surgery instrumentation failure, because of the osteoporosis.

Presumably the surgery will happen anytime in the short-term (three to six months) or intermediate-term (one to two years) future, depending on symptom progression. I have no idea how quickly the neurological disfunction can progress. I'm not getting clear answers from the doctors on this score.

Is anyone here an osteoporotic who's had spinal fusion surgery (particularly lumbar)? If so, did the doctors use bone strengthening medication prior to the operation? Was your bone density indeed improved, and how did the operation turn out?

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laura1970 | @laura1970 | Jul 28 9:37pm

I wouldn’t wait so long to see a urologist to evaluate your urinary symptoms

pyates | @pyates | Jul 28 9:50pm

In reply to @laura1970 "I wouldn’t wait so long to see a urologist to evaluate your urinary symptoms" + (show)

I've been seeing a urologist for the past two years. He diagnosed a mild bladder problem (i.e., urgency, nocturia) which may or may not have neurogenic origins. Urodynamics testing can uncover evidence of such issues, but rarely does it explain the cause.

Either way, the problem's been reasonably well managed by medication. And the urologist is definitely tracking my condition.

But yes, you're correct: if the stenosis gets worse, that could indeed translate into deteriorating bladder functioning, assuming (in my case) there's a casual link between the conditions. I guess time will tell.

Pet Detective | @berniej1 | Jul 30 7:11pm

In reply to @pyates "I've been seeing a urologist for the past two years. He diagnosed a mild bladder problem..." + (show)

I recently intereviewed a doctor for similar surgery only, mine would involve fusion from t-10 to s1. I do not have osteoporosis but have a very low reading of osteopenia in one area of my spine. The Doctor would not proceed with surgery until I went on Tymlos for 3 months then annother bone building medication for six more. If I had osteoporosis, I would have given pause to the Tymlos treatment plan. The most common failure with spinal fusion is screws pulling out. It would be better for you to get on a treatment plan as soon as possible because it takes six months to a year for bene density to improve.
My decision to not go on the Tymlos treatment plan was because my density readings didn't merit any medication and this doctor was the only one who was pushing for it.
The bladder issues may or may not be related to the disc degeneration, your surgeon should be able to connect the dots on that. Good Luck!

pyates | @pyates | Jul 30 8:53pm

In reply to @berniej1 "I recently intereviewed a doctor for similar surgery only, mine would involve fusion from t-10 to..." + (show)

Thank you for the informative reply. You're addressing the nuances that I'm facing, and am trying to learn about from other patients, meaning (especially) their personal experiences.

Fortunately, for me, things have been moving fast these past two days. That's with respect to launching bone regeneration treatment. The doctor is putting me on something for the next year. I'm getting my first infusion a couple weeks from now.

That is good.

Barring any sudden, unexpected, and dramatic worsening of my neurologic symptoms, I won't be getting the laminectomy/fusion operation for at least one or two years. So I've got some time during which, hopefully, my lumbar BMD can be boosted.

BTW: it's possible I'll be taking Tymlos. In a few days I'll know for certain which medication it will be.

Instrumentation failure is a scary thought for sure. I've got a lot of research ahead of me on that count. I definitely want to know the worst case scenario that could occur, assuming I'm unlucky. Knowledge is power, no matter how distressing the facts may be.

I'm curious...what are your specific reasons for rejecting Tymlos treatment? Are you wary of side-effects or medication-induced health risks? If so, which in particular?