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T10 to S1 Fusion Pre-Surgery Medical Treatment Plan
I have been a frequent visitor to this forum for almost 2 years when an orthopedic and neurosurgeon both told me that I was inoperable. I was reffered to physical therepy and pain management.
During this period, I had no relief so I turned my search to surgeons who specialize in spine deformities. My scoliosis is MILD, it says so on the MRI's. But this mild condition has caused a tumbling affect all the way down my spine.
Finally, a year ago I found an orthopedic surgeon who fits the criteria, and he proposed the fusion from T10 to S1. That lead me to a neurosurgeon in the same specialized field who recommended the same surgery with a couple of differences. Neuro Doc wants to perform two surgeries over a two day period that involves three cages and rods, but he also wants me to take tymlos for three months prior to performing the surgery.
This is a lot to comprehend, but please stick with me a minute longer. Prior to Neuor Doc proposing this entire surgery plan, I provided him a copy of my Dexa scan, that was rated very very good with no osteoporosis, and one mention of ostepenia on my femer that barely qualified as osteopenia. I then went to an endochrinologist to review the dexascan and she provided her notes from that visit with the Doctor stating that no treatment plan was necessary and my bone health would not compromise the surgery.
The doctor gave no credit for the endochrinologists report, and insisted that a begin a treatment plan of Tymlos for at least three months before he would schedule surgery.
Has anyone else been confronted with this type of dilema? There have been studies on strengthening bone health prior to surgery that supports better outcomes with this (one was done by MayClinic). But those studies were done on patients who were full blown osteoporosis and would automatically be deemed a very high risk patient for this type of surgery.
I would also like to hear from anyone who experienced failed or revision surgery due to osteopenia or osteoporisis.
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I'm with the neurodoc. Tymlos will hasten healing, and ensure integration of the hardware. But I'm inexperienced and not the responder you are looking for.
@berniej1 Hello Pet Detective! It's sounds like you have done your research about advocating for yourself with your spine. I have 5 rescued shelter cats and have added cat trainer to my resume! (Unofficially I am a spine surgery patient with a cervical fusion of C5/C6 that was done without hardware. I do understand how osteoporosis affects spine care as my elderly mom with severe osteoporosis has had a spontaneous compression spinal fracture. She was not a surgical candidate even for a bone cement procedure so her spine had to heal itself with a brace.
Do you have a lower spine surgery scheduled? Do you have an concerns?
You may be interested in this discussion about spine surgery and osteoporosis.
Spine Health - "Anyone had surgery on spine who also has osteopenia or osteoporosis"
https://connect.mayoclinic.org/discussion/anyone-had-surgery-on-spine-who-also-has-osteopenia-or-osteoporosis/
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1 Reaction@berniej1
How long have you had problems with your spine and been dealing with pain/symptoms? Have you had spinal injections for pain? Are you taking any medications for pain (like Cymbalta/duloxetine, gabapentin, tramadol, etc.)?
What does your MRI show at each level/vertebrae? Do you have disc bulges/herniations, bone spurs/osteophytes, spinal cord/nerve root flattening/compression, end plate damage, abnormal growths, etc.?
Have you seen a neurologist for EMG/nerve conduction studies of upper and lower limbs? Do you have radiculopathy?
Why did the original surgeons say you were inoperable?
@berniej1
You should learn more about the Tymlos medication and its side effects. I think strengthening the vertebrae as much as possible before surgery is good if there is any concern about any bone weakness.
I had c5-c6 and l3-l5 decompression and fusion surgeries and the lumbar spine was the most painful due to cutting through muscle for open surgery. I stayed in the hospital overnight and it took 3-6 months to recover and told a full year to feel the full effects of the surgery. My pain, numbness improved in my lower back/hips/buttocks/legs after surgery recovery and I have no regrets getting surgery.
I do need to continue to work on physical therapy and lose weight to reduce risk for new disc issues above/below spinal levels of fusion since I have degenerative disc disease and congenital spinal stenosis.
@dlydailyhope
There is a trifecta of problems from l5 to s1 with scoliosis at T6, just about everything you listed, I have been fighting this for two years when I woke up and couldn't walk. I have literally spent the last two years interviewing surgeons while seeking relief from pain management doctors and physical therepy. I finally accepted the fact that my spine was not going to heal itself and surgery was unavoidable. I have researched Tymlos and I also follow the Osteoporosis and Bone health forum which has a lot of useful information. Nobody can disagree that Tymlos won't help build bone health, so I need to explore this deeper for one very simple reason, I am not a candidate for Tymlos because my bone health is not diagnosed as osteoporosis. If anyone had a surgeon take you on this journey of building bone health prior to surgery, I would really like to know how that went. If you didn't have any pre-treatment plan like this, did you have to go back for revisions or more surgery because the screws slipped out, the rods damaged the vertebra above or below the fusion? According to a Mayo Clinic research study on this, patients who had osteoporosis showed a 5% better outcome by taking this route, key word "osteoporosis".
If any of this is resonating with anyone reading this post, please chime in. I would love to hear what you experiened. Here is the artical about the May Clinic Research Study:
https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/optimizing-bone-health-before-complex-spinal-surgery/mac-20542607
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1 ReactionBerniej1, I hear there are surgeons prescribe Forteo (similar to Tymlos) before surgery because it helps with the integration of the hardware. You might ask the surgeons you've already engaged with.