Update on my spinal degeneration...

[hillarymurphy]

Hello everyone update on my condition...

My previous thread:

New member here and I really need some advice :)

I have decided after 7 months of intense PT that I am going to move forward with the surgery. When I back off the PT even a few days the pain comes back. It isn't unbearable, but it hurts. I am no longer active, and I feel so unhealthy. I am winded going up the stairs and I used to climb 500 foot high mountains. I have decided that this is not the quality of life I want. Thankfully my husband and family are really supportive of my decision.

Now, to find a surgeon. I am looking into the minimally invasive surgery techniques. The surgeons I have seen want to do either a PLIF or ALIF. Any opinions on TLIF? Question I should be asking surgeons about the pros and cons of TLIF vs posterior and interior techniques? I have an appointment with a surgeon at USC who does the TLIF on Thursday.

I also am looking into the BMP used in the fusion. It looks like there are some unknown risks with BMP for those looking to become pregnant. I want to avoid having bone taken from my hip, but I'm worried this may be potentially dangerous when I want to become pregnant. Anyone had experience with this?
Spinal Fusion Surgery & INFUSE Bone Graft and LT-CAGE Device Benefits and Risks

Thanks,

Hillary

[Gilbert P]

Hi Hillary

where do you live? I have a Very bad spine and six months ago I received two Coflex implants those levels are doing good.

Please do all the research possible \

Once you fuse there is no going back.

Gil

[laid up doc]

have you been told that you are NOT a candidate for ADR? if you're a woman still of childbearing age (ie young!)... i would look seriously into ADR.

you're in LA? Dr Regan (i think at Cedars-Sinai) does them there, then there are the overseas options -- I consulted Boeree and Clavel before going with Clavel.

Gilbert is right - there is NO going back... take your time and weigh your options. Spend time the time and $$ to get plenty of input. My situation was not DISsimilar to yours (though i had no "degeneration") - but also L5/S1, younger woman possibly wanting to become pregnant later... and when I found out all of the relevant info, the M6 was clearly the way to go.

good luck, it's tough making all of these decisions.

[Genn]

Hi Hillary

Good luck in your decision re: approach. I was not overly concerned w/ that aspect as I was in deciding on the Surgeon & Team~ to do my surgery.

I also am looking into the BMP used in the fusion. It looks like there are some unknown risks with BMP for those looking to become pregnant. I want to avoid having bone taken from my hip, but I'm worried this may be potentially dangerous when I want to become pregnant.

My Surgeon will be using BMP. He was *insistent* that I would not even think of getting pregnant for 1 year post-op. He went into more detail but, my mind was already racing towards my next set of questions, since I had no problems with a 1 year wait. Sorry
It is a major surgery and I wouldn't want to do anything to jeopardize it. As you can see on here, everyone heals differently. I can only hope I feel that good 1 yr out~ to even consider the changes pregnancy does to the body. Only time will tell...

Good luck

[hillarymurphy]

Thanks guys I have made several appointments in the coming weeks with different surgeons who do the minimally invasive techniques for fusion and ADR. The 4 surgeons I have seen have all discouraged me from ADR. I wonder if it is an insurance thing, or because they are better skilled at fusion? Sometimes I feel like I am running in circles with this stuff. Either way, I just can't take this anymore. I want to start a family and I can't in good conscience do that with my back the way it is now.

As far as the BMP this was my concern, not about the length of time to wait to get pregnant but the unknown risks for a fetus for mothers previously exposed to BMP:

"Women of child bearing potential should be warned of potential risk to a fetus and should discuss other possible orthopedic treatments with their surgeon. It is not known whether a pregnant woman, previously exposed to BMP-2 by implantation with the device, might develop a second immune response to BMP-2 from the developing fetus with adverse effects for the woman or baby."
Warnings and Precautions

This device has not been tested in pregnant women to determine if there is any effect on a developing fetus. This device has also not been studied in nursing mothers.
When tested in female rabbits that received the rhBMP-2, a component of the device, developed an immune response and later became pregnant, the following was seen:

• The antibodies developed by the mother were able to reach the developing rabbit fetus. The effect of these antibodies on the developing rabbit fetus is not currently known.
• Some bone formation abnormalities were observed in a small number of the rabbit fetuses tested. It is not known if these changes would disappear as the rabbit fetus continued to develop or at some time after birth.

This device should not be used immediately prior to or during pregnancy. Women of child-bearing potential should be advised not to get pregnant for one year following treatment with the device. Women of child bearing potential should be warned of potential risk to a fetus and should discuss other possible orthopedic treatments with their surgeon.

BMP-2 plays a critical role during fetal development in humans and other animals. It is not known whether a pregnant woman, previously exposed to BMP-2 by implantation with the device, might develop a second immune response to BMP-2 from the developing fetus with adverse effects for the woman or baby. In a rabbit pregnancy study to investigate this issue, no increase in anti-BMP-2 antibodies was observed.

[trkdoc714]

BMP was approved by the FDA for lumbar fusion but not cervical. The complications and associated murkiness of the success rate of BMPII would lead me toward donating my own bone or using cadaver bone. There is an additional surgical site if they harvest bone from the illiac crest and many have reporting that site being more painful than or longer lived pain than the fusion site.

My step daughter had thoractic fusion to correct scoliosis using cadaver bone. It performed terrific but she was 12 at the time. The young age was a large factor in her recovery time/ success.

Good luck. I'm sure you'll make the right choice for yourself.

Bob

[Pbchoclovr]

Hi Hillary,

While I can't speak to the pregnancy issue, I'm quite a few years older.... I can speak to the TLIF approach and the use of BMP. During my consult, my surgeon said that he could use any of the three approaches to fuse my L4/L5 space. His preferred approach in my case was the TLIF. He felt that to approach anteriorally, would make for a much longer/more painful recovery. It was also the more difficult approach due to having to move all the abdominal organs around to reach the spine. The next least invasive was from the side (again having to move organs around, although less muscle to cut through), with the least invasive being the TLIF (posterior approach). I chose the TLIF. I actually only have 3 small incisions ranging in length from 1 inch to about 1 1/2 inches - no external stitches, only medical superglue, which fell off within 2 weeks. My scars are very clean and smooth, some of the best I've ever had. I've read on here about the swelling associated with the surgery. With my TLIF, my swelling was very minimal. I didn't really notice a change in any of my clothing sizes due to the surgery. Sweats and yoga pants were the most comfortable though for quite a while.

I also questioned my surgeon on the use of grafting material. Like others have mentioned, he didn't want to use my own bone from my pelvis because he said it would be cause for a much more painful and lengthy recovery. His exact words were, "I don't want to be the cause of you complaining about hip pain for the rest of your life every time it rains." That left cadaver or synthetic (BMP). His choice was BMP. From my research, I do know that there is more than one kind of BMP, besides the BMP-2. The research I read said that BMP-2 wasn't approved for a posterior lumbar approach. You might want to ask your surgeon which type of BMP he's planning on using. I also didn't have a cage placed in the disc space, but a "brick" infused with the BMP.

I just went in for my 6 month follow up and already I've got bone showing up in my L4/5 space showing the fusion is working. The surgeon said that this was all due to the BMP, otherwise it could be a year or more before it showed up on xrays. I currently have a mix of good and bad days, but the bad days are all part of the recovery process. I'd do the TLIF with the BMP again without hesitation.


Best wishes on your decision.

Linda

[srajan0929]

Thanks guys I have made several appointments in the coming weeks with different surgeons who do the minimally invasive techniques for fusion and ADR. The 4 surgeons I have seen have all discouraged me from ADR. I wonder if it is an insurance thing, or because they are better skilled at fusion? Sometimes I feel like I am running in circles with this stuff. Either way, I just can't take this anymore. I want to start a family and I can't in good conscience do that with my back the way it is now.

As far as the BMP this was my concern, not about the length of time to wait to get pregnant but the unknown risks for a fetus for mothers previously exposed to BMP:

"Women of child bearing potential should be warned of potential risk to a fetus and should discuss other possible orthopedic treatments with their surgeon. It is not known whether a pregnant woman, previously exposed to BMP-2 by implantation with the device, might develop a second immune response to BMP-2 from the developing fetus with adverse effects for the woman or baby."
Warnings and Precautions

This device has not been tested in pregnant women to determine if there is any effect on a developing fetus. This device has also not been studied in nursing mothers.
When tested in female rabbits that received the rhBMP-2, a component of the device, developed an immune response and later became pregnant, the following was seen:

• The antibodies developed by the mother were able to reach the developing rabbit fetus. The effect of these antibodies on the developing rabbit fetus is not currently known.
• Some bone formation abnormalities were observed in a small number of the rabbit fetuses tested. It is not known if these changes would disappear as the rabbit fetus continued to develop or at some time after birth.

This device should not be used immediately prior to or during pregnancy. Women of child-bearing potential should be advised not to get pregnant for one year following treatment with the device. Women of child bearing potential should be warned of potential risk to a fetus and should discuss other possible orthopedic treatments with their surgeon.

BMP-2 plays a critical role during fetal development in humans and other animals. It is not known whether a pregnant woman, previously exposed to BMP-2 by implantation with the device, might develop a second immune response to BMP-2 from the developing fetus with adverse effects for the woman or baby. In a rabbit pregnancy study to investigate this issue, no increase in anti-BMP-2 antibodies was observed.

hey tiff, how old re you btw? you should try to avoid fusion at all costs. generally fusion causes adjacent level to degenerate. you are looking at 5 years down the line where more discs are going to start degenerating. perhaps sooner, perhaps later. i have noticed that surgeons who do fusion vouch for fusion and always say no to ADR while those that do ADRs say no to fusion. Its those that do both that i really like. Clavel and Boeree seem to offer an array of options to patients that include fusion and ADR.