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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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@nlback22
Thank you Nadine for your wisdom and best wishes. I'm getting excited/nervous, day-1 surgery is in the morning. Hope everything goes well, I will post when able after day-2 surgery.
Best wishes to you all!
Darold.
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4 Reactions@daddydar
🙏🙏🙏🙏🙏🙏
@daddydar
Harold
I had my t10 to pelvis fusion done 3 months ago at UCSF. It is correct in saying "if you surgeon has done many of these surgeries you are in good hands."
All of my severe pain is gone and have not had any of the sciatica stingers I had in the past.
It will take a lot out of your and the long amont amnistesia will also take some time to get the mind back in action.
Plan a trip 9 months post operation to give yourself something to look forward to and get ready for.
Good luck and God bless.
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3 Reactions@curvedspine Hi! My recovery has went pretty well, all in all. As Nadine said above, we have posted a lot about our surgery and healing along the way. If you type different keywords in the search bar, it will provide a lot of great information that other people have posted. It really helped me find information prior to my surgery. Like all the things to get that will help you after surgery.
In preparation for surgery, I recommend doing squats or lunges every day to build up your legs. It will really help you with getting out of the bed and using the toilet. You don’t need to do a lot, just a few every day and it will really strengthen your lower body.
I remember feeling starved for information on what to expect after surgery so I made it a point to post as much information as I could, starting with while I was waiting in the pre surgery room after they had put IVs in my arms.
I am now 21 months post-op and doing very well! I remember feeling much more “normal” at the one year point. Unfortunately, my body grows scar tissue more than most, so as I’ve been healing, I’ve been dealing with scar tissue from the surgery sticking to my facia and creating inflammation and nerve pain in my skin across my back. There is another gal on this site, Karen, who is experiencing the same thing. I’m so glad it’s not a common thing for others! That being said my physical therapist is working to break the scar tissue free and it’s getting better every day, it’s just a slow process. I do like to share this information in case it helps someone else. I did not realize what was happening because I was healing and doing so well and then, as I started getting the nerve pain, it took a little while to figure it out.
My pre-surgery pain is completely gone. My surgery was necessary because I had a significant scoliosis curve.
Wishing you the best,
Sherry
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10 ReactionsSometimes it's yet another opinion that helps. Or find out what your Hounsfield units (HU) are on the CT scan of your spine. That is what really counts for pre-op osteopenia. If it's good maybe your surgeon will proceed without the treatment. If it shows true osteopenia then it's to your benefit to do the treatment.
There's no formal "score," but opportunistic screening of vertebral trabecular density on any CT that includes the spine is now well established, usually measured as an ROI in the L1 vertebral body (first vertebra below the diaphragm, so it's captured on both chest and abdominal CTs).
Commonly cited thresholds, correlating with DXA categories:
>150 HU — generally normal BMD
~100–150 HU — indeterminate zone, roughly osteopenic range
<100 HU — suspicious for osteoporosis; warrants DXA confirmation
≤80–90 HU — high specificity for osteoporosis; some literature treats <110 as the sensitivity cutoff and <80 as the specificity cutoff (Pickhardt's work, Annals of Internal Medicine 2013, is the standard reference)
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2 Reactions@gluchtel
I had a consult with Chief of spine surgery at UCSF this past week and feel very confident about him. As a UCSF alum myself, it’s nice to be back in familiar territory! More tests have been ordered but I’m potentially facing a T8- pelvis decompression lami with fusion. In my case, pain is not much of an issue (knock wood!) but I have severe stenosis (central, foraminal and lateral recess) over multiple levels. Because of compression fractures at T11 and T12 as a teen, I also have a nasty kyphotic curve at T12-L1. All of this is causing neurogenic claudication and issues with walking. Glad to hear you’ve have great results!
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