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T10 to Pelvis Fusion. Experience, Comments Appreciated

Posted by LongLumbarFusion @jbesr1230, 1 day ago

I would like to hear from others who had a, or something like a, T10 to ilium fusion with multiple interbody support. How long was the surgery? What is a brief description of the surgery? How long was the hospital stay? Were the results what you expected? How long before you were up and walking as much as you were before the procedure? Did the procedure improve the length of time you can walk? Were you offered any other possible procedures? Any other thoughts/comments?

I have been evaluated and found to have severe Degenerative Disk disease, progressive kyphotic deformity in my lumbar spine, and significant sagittal balance deformity due to a complete loss of lumbar lordosis. This results in my inability to maintain normal posture. In 2018 I had an L5-S1 ALIF for lumbar stenosis, sciatic pain, and a left-sided foot drop. This procedure improved my sciatic pain significantly; however, it did not improve my left-sided foot drop. I spent one day in the hospital. I wear an AFO on my left foot and ankle, an LSO brace, and use walking sticks. I do not have radicular or myelopathic symptoms at present.

I often must use my hands and available furniture when ambulating to keep from stumbling and/or to straighten up my posture. I cannot maintain an upright posture without assistance for more than a few moments. My most comfortable position is while pushing a grocery store cart. I am relatively asymptomatic at rest. I can lay flat without pain or difficulty. I have consulted with several spine surgeons who have discussed thoracolumbar corrective surgery that would include multiple interbody support and fusion from my thoracic spine down to my pelvis. However, one surgeon opines that the risks of the surgery would likely outweigh any potential benefit. Another surgeon recommends the surgery, which has a high probability of improving my quality of life.
Imaging and Findings

GENERAL: The patient is a male in no acute distress. He ambulates with the use of bilateral walking sticks.
BP 129/70 | Pulse 64 | Temp 36.4 °C (Temporal) | Ht 6' (1.829 m) | Wt 83.4 kg (183 lb 12.8 oz) | SpO2 100% | BMI 24.93 kg/m²
FINDINGS:
Alignment: Rightward lumbar spine curvature measuring 9 degrees from L2-L4. 4 degree leftward thoracolumbar spine curvature measured from T12-L2.
Coronal balance: C7 is 3.1 cm to the left of S1 (normal less than 3 cm).
Thoracic kyphosis angle: 10 degrees (normal range 20-50 degrees)
Lumbar lordosis angle: 19 degrees (normal range 20-60 degrees)
lumbar kyphosis 2 degrees
Sagittal vertical axis: 2.2 cm (normal range -2 - +2 cm)
Pelvic incidence: 64 degrees
Pelvic incidence - lumbar lordosis: 45 degrees (normal less than 10 degrees)
Pelvic tilt: 39 degrees (normal less than 20 degrees).

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orloffjr | @orloffjr | 18 hours ago

Hello
I was told by one doctor in 2020 I needed a T12 to the sacrum fusion. I consulted 4 other doctors who had different opinions. I ended up with an L4-S1 fusion immediately as I was having severe foot drop. A year later I had a minimally invasive decompression surgery on T12/L1 that helped somewhat. 2 weeks ago I had a decompression at L3/L4. The disc at L2/3 has a bulge. I'm 58 and as active as possible so odds are good I will have the whole lumbar fused. I have 12 degree scoliosis that apparently doesn't concert the doctors at all. Your case is obviously much different. I have read where many doctors prefer going up to T10 when fusing the lumbar. I have a friend who has been fused T2 to the sacrum. He is 80 yrs old. He is now in a wheelchair because he broke both his hips. He was doing ok with a walker before falling. I would cross post this in the scoliosis group as there will be more people likely to have had a fusion this long. Lastly, if possible I would get at least 4 opinions(Including Mayo) on such a complex case as yours. I'm sorry you're having these problems.

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sassytwo | @sassytwo | 4 hours ago

This is a very hard decision. Keep talking to people and doctors until you reach a place where YOU are comfortable moving forward.. I have been consulting with numerous surgeons and pain specialists for three years now... deciding how and when to move forward with surgery. I am electing to have a fusion from T12 - S2 in a few weeks. I had a micro diseconomy on L2/L3 ten years ago. Very nervous for the long healing time and permanent restrictions. I have gone through my house room by room, drawer by drawer as I will not be able to bend to access, especially the 1st year. My WD are raised 22", purchasing a bidet, etc. I am looking today to purchase a small SUV with all the safety additions, as I will be relying on back up camera, lane assist etc. much more than before and for ease of entry. (I am sad to say goodbye to my old convertible ) I too was told I may never need the scoliosis corrected ( I am 67) however mine curve has progressed from 18 to 30 in the last 10 years. However, it has not changed in the last 3. I really wanted to move forward with a cage from S1/L5 and L5/L4 as I believe this is where the majority of my pain comes from. (Sciatica ). However, my nerve blocks and epidurals did not alleviate this pain so maybe not. I might suggest you try these as a diagnostic tool with or without the steroids. I have stenosis, scoliosis, and spondylylosis . Part of my decision was based on choosing the lesser surgery and then having to go back for more surgery if it did not help and adjacent disk disease, (that is what all spine surgery patients risk to varying degree. ) My age plays a factor in this decision. Will I be healthy in 5-10 years for more surgery. Osteopenia? other issues as we age. Too many surgeries creating scar tissue Will I be in a constant state of healing and surgery. You are 10 years younger, so you have more time on your side. I share my thought process and decision making, not because I think it is the right surgery for you, rather to possible assist you in your decision. Good luck, I will try and report back on my surgery etc. from time to time. Tam

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LongLumbarFusion | @jbesr1230 | 3 hours ago
In reply to @orloffjr "Hello I was told by one doctor in 2020 I needed a T12 to the sacrum..." + (show)
@orloffjr

Hello
I was told by one doctor in 2020 I needed a T12 to the sacrum fusion. I consulted 4 other doctors who had different opinions. I ended up with an L4-S1 fusion immediately as I was having severe foot drop. A year later I had a minimally invasive decompression surgery on T12/L1 that helped somewhat. 2 weeks ago I had a decompression at L3/L4. The disc at L2/3 has a bulge. I'm 58 and as active as possible so odds are good I will have the whole lumbar fused. I have 12 degree scoliosis that apparently doesn't concert the doctors at all. Your case is obviously much different. I have read where many doctors prefer going up to T10 when fusing the lumbar. I have a friend who has been fused T2 to the sacrum. He is 80 yrs old. He is now in a wheelchair because he broke both his hips. He was doing ok with a walker before falling. I would cross post this in the scoliosis group as there will be more people likely to have had a fusion this long. Lastly, if possible I would get at least 4 opinions(Including Mayo) on such a complex case as yours. I'm sorry you're having these problems.

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I would cross post this in the scoliosis group- How do I do this? I don't find a group specific to scoliosis. TY.

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