[Spinal Fusion / Lumbar] Here to help ready myself and my 87-year-old mom for her upcoming XLIF procedure.

[terrie]

Hey all,

My name is Terrie and my mom has an XLIF procedure scheduled for January 3rd. I'm here to get info so that I can help her through the process. We realize it is aggressive treatment for her age but she cannot live with the pain and has exhausted all other treatment options.

I live in Hawaii and she's in California, so I have not yet met her doctor and don't have complete access to her medical records. I believe she is having a three-level XLIF procedure with screws. For my family leave forms at work the doctor put that I would only need to help for a month but I'm having a hard time believing that. She had a knee replaced in 2009 and rehab took longer because of low blood pressure issues. Hopefully we've got that solved now.

I've been lurking for a week or so and already know that we'll have to have pain and stool management plans. Will appreciate any help, especially from any folks in my mom's age range.

Terrie

[Justin]

Hi Terrie,

Welcome to the Spine Patient Society. It's great that you are playing an active role in your Mother's care. A 3-level fusion is a MAJOR operation at any age. As you are aware, this type and extent of operation is not "common fare" for an 87 year-old. Elderly patients have decreased rates of healing. It's difficult to put a time frame of recovery for your Mother, but it is going to be a "long haul."

I'll just throw something out there--most surgeons do not operate on the spine for pain only, as most spine surgeries do not take away pain. Most surgeries are done to correct anatomical problems and pain relief may accompany surgery.

Does your Mother have any other comorbidities (heart disease, diabetes, COPD, etc) that would potentially complicate her recovery?

[terrie]

Hey Justin,

No, surgeons don't operate just for pain relief. Sharp pain is the symptom of her degenerative disc disease and the pinched nerve that extends down her leg. For years her back surgeon (who had removed a benign tumor from her spine about a decade ago) said there was nothing that he could do, which she misinterpreted to mean that there was nothing that could be done. After going through all of the pain relief procedures from her "pain doctor," she was finally referred to a spinal (XLIF) specialist.

After her initial consultation, the XLIF surgeon sent her back to her GP and cardiologist to get a release for surgery. (He did not expect her to get it.) Her cardiologist ran a stress test. She passed. She knows that there is extensive rehab and that there will be pain after surgery, but she will do the rehab and endure the pain if there is some hope of pain relief. She would like to play golf again but is prepared for the loss of mobility that the fusion will likely leave.

Even with the release, we did not get a call from the spine surgeon with a scheduled date. I ultimately got him on the phone and he assured me that he can fix her spinal problems (and more or less eased my fears that the same thing won't reoccur above and below the fusion). I assured him that she will do the work to be able to walk again. I think his estimate of only one month of my time necessary to assist with her post-op recovery is completely wrong, but we'll see.

Other than blood pressure issues and arthritis (which can be handled with medication), she is as healthy as an 87-year-old can be. She would like to be able to walk upright and without the sharp pain she currently feels. She is also prepared to die during surgery if that is what happens because living as she is now is not an option. So we are going into this with our eyes wide open. She has recovered from both hip and knee replacement in the past five years. If it can be done, she'll do it. My goal here is to make sure we anticipate any problems along the way and have plans in place.

Terrie

[KBear]

Terrie- I'm not familiar with spine surgery in older people, so no advice there. I can tell you I took 6 weeks of doing nothing but healing and had everyday help and I just had a 1 level ADR. I would definitely count on at least 6 weeks of helping her. Generally the restrictions are no bending, lifting, twisting for 6 or more weeks. I didn't even drive for 6 weeks and had round the clock care for my children, chores were completely out of the question. I think you are definitely smart for doing your research and realizing it's going to be a long road.
Best of Luck,
Kathy

[terrie]

Thanks, KBear.

I also think a month is way too short. I had put in my own FMLA forms with request for a 12-week absence. HR called me to the office to point out that the surgeon only said a month (which I had not seen since he sent it direct) and so I was required to change my request, with the caveat that it was an estimate. But I'm pretty safe in believing that it will be at least eight weeks and in a worst-case scenario, I'll have to relocate back to the mainland for a while.

My mother has some informal help now but I am also expecting to arrange for in-home health care for a period if I return to Hawaii. She lives independently and would never consider moving into an assisted living situation or moving to Hawaii, so keeping her independent has to be the goal.

Terrie

[Justin]

Hey Justin,

No, surgeons don't operate just for pain relief. Sharp pain is the symptom of her degenerative disc disease and the pinched nerve that extends down her leg.

I understand...I was just throwing that out there, as I met many (>10) patients this week in the clinic that wanted an operation purely to help with pain.

I hadn't read any literature on the elderly and spine surgery, so your post this morning peaked my interested. I just pulled up a publication entitled:
_____________________________
Journal of the American Geriatrics Society. Volume 56, Issue 7, Pages 1318–1327, 2008.

Complications and Outcomes of Lumbar Spine Surgery in Elderly People: A Review of the Literature

Jordan M. Cloyd, BA, Frank L. Acosta, Jr, MD, and Christopher P. Ames, MD*.
From the *Department of Neurological Surgery, University of California at San Francisco, San Francisco, California.

It was an interesting read to say the least. Below is an excerpt from the publication (I have the full publication, but it is protected by copyright and it is $15 per copy) I found of interest:



I hope this helps and we are here to support you and your Mother.

[Cindylou]

Terrie, You sound like a wonderful daughter and your Mom is very fortunate to have a caring, supportive person such as yourself. She did a fine job raising you. And your Mom sounds like she has still got a lot of "piss and vinegar" left in her. Good for her! It does sound like you are prepared for the worst in this surgical endeavor. Gosh, in all honesty, Terrie, I'm just so surprised she was cleared for surgery to begin with, mostly, given her age. It seems a bit reckless to me, on the part of the doctor who cleared her. I do not mean this in any way as a slight to you or your Mother, but rather the physician's responsibility, so please do not misunderstand me. It just seems that opiate intervention, anti-inflammatory meds (if tolerated), physical therapy, acupuncture, alternating heat/ice, etc., would still be the preferred treatment modalities, as opposed to a majorly invasive surgery. Oh, sorry for the rant. This is just such a rarity. I do get the miserable "can't live with this pain" anymore desperation. No one should have to live in that much pain. I do agree with you Terrie, I think you should conservatively plan to spend all of 12 weeks there, taking everything into account. My best to you as you move forward with this. Cindylou

[terrie]

Hey Justin and Cindylou,

First of all, thanks for the article Justin. It is always good to see some statistics, even though they admit that both their sampling and follow-up are limited. We would have to expect many more complications as the patients get on in years (my mother almost always suffers a pulmonary embolism after surgery) and a 10% increase in morbidity is frankly much better than I would have expected.

We seem to have touched a nerve with you, Cindylou. My mother was given and passed a five-hour cardiac stress test. Why even give her a stress test if she shouldn't be deemed fit for surgery because of her age? It is her physical condition that should be considered in her surgical viability, not her age. There was nothing "reckless" in his decision.

That said, had he not approved her I would have taken around until I found someone who would approve her. What else has she left to do? Her "pain doctor," who had a fit when I wanted to take her to UCLA's pain clinic, proceeded to tell her that she was not going to survive this surgery, that she would "die on the table," that she had too many doctors and that she had had too many scans. When she showed him her most recent films, he had to admit that none of the procedures (including surgical implants) that he had put her through over the last year would have worked to relieve the pain from her current physical condition.

And while I don't downplay the surgery — which we know is aggressive, especially considering her age — XLIF is minimally invasive. They will have her walking on the day of her surgery and proceed immediately into two weeks of in-patient physical therapy. I have assisted her in recovery from both a hip replacement in 2005 and a knee replacement in 2009. She can and will do the work.

My mother can no longer stand up without EXTREME pain. So her choice is to go through risky surgery or lie in bed for the rest of her life. She chooses surgery. If she doesn't live through it, that's OK with her. She can no longer live with her current situation.

So here's my suggestion: Pretend that I haven't said she is 87. That seems to be the sticking point. My participation here is not to determine whether or not she should have the surgery. My goal is to find out the pitfalls and hiccups of the procedure so that I can help her through the process.

I took my 83-year-old father from a 28-day induced coma, massive organ failure and 10 weeks on a ventilator to living independently in five months. I am an expert health-care advocate. I'm just here for the information.

Terrie

[Justin]

Hey Justin and Cindylou,

First of all, thanks for the article Justin. It is always good to see some statistics, even though they admit that both their sampling and follow-up are limited.

Sure thing! I know you wanted to know the "pitfalls and hiccups" of surgery at an advanced age, and provided peer-reviewed literature was the best way I now how to share information in this case (as in many others).

We would have to expect many more complications as the patients get on in years (my mother almost always suffers a pulmonary embolism after surgery) and a 10% increase in morbidity is frankly much better than I would have expected.

Just to clarify one point, the study demonstrated a 10% increase in mortality (death).

We seem to have touched a nerve with you, Cindylou. My mother was given and passed a five-hour cardiac stress test. Why even give her a stress test if she shouldn't be deemed fit for surgery because of her age? It is her physical condition that should be considered in her surgical viability, not her age. There was nothing "reckless" in his decision.

I'm not trying to speak for CL here, but I do know that her intentions are "pure." Personally, she's been through some major surgeries and, I believe, is just talking out of concern about the aggressive procedure your Mother is going have. I will let her chime in, as I don't want to put words in her mouth.

That said, had he not approved her I would have taken around until I found someone who would approve her. What else has she left to do? Her "pain doctor," who had a fit when I wanted to take her to UCLA's pain clinic, proceeded to tell her that she was not going to survive this surgery, that she would "die on the table," that she had too many doctors and that she had had too many scans. When she showed him her most recent films, he had to admit that none of the procedures (including surgical implants) that he had put her through over the last year would have worked to relieve the pain from her current physical condition.

From your statements above, it is evident that you would have taken her to any surgeon, as long as they said "yes, we can do the operation." This is totally fine and it is a decision between your Mother and her surgeon to move forward with surgery (and, of course, the input you give as a concerned loved one).

And while I don't downplay the surgery — which we know is aggressive, especially considering her age — XLIF is minimally invasive. They will have her walking on the day of her surgery and proceed immediately into two weeks of in-patient physical therapy. I have assisted her in recovery from both a hip replacement in 2005 and a knee replacement in 2009. She can and will do the work.

An XLIF does play in your Mother's favor, so that's definitely a plus.

My mother can no longer stand up without EXTREME pain. So her choice is to go through risky surgery or lie in bed for the rest of her life. She chooses surgery. If she doesn't live through it, that's OK with her. She can no longer live with her current situation.

The above statement is powerful. She has the ultimate say about what she wants / does not want done to her body. It sounds like she has been made fully aware of the complications of this surgery. Personally, I see patients in the hospital daily, and we ultimately have to respect the patient's wishes regarding treatment.

So here's my suggestion: Pretend that I haven't said she is 87. That seems to be the sticking point. My participation here is not to determine whether or not she should have the surgery. My goal is to find out the pitfalls and hiccups of the procedure so that I can help her through the process.

I took my 83-year-old father from a 28-day induced coma, massive organ failure and 10 weeks on a ventilator to living independently in five months. I am an expert health-care advocate. I'm just here for the information.

We are glad you here, and the excerpt posted above was posted in an effort to better understand the possible "pitfalls and hiccups of the procedure."

In the excerpt above, 35% of patients (or 7/20 patients) at an age ≥ 80 had major complications during / after spinal fusion.

I wish you and your Mother the very best.

[ajj1001]

One of the pitfalls of having surgery to end pain is if that doesn't come to pass then the psychological effects can be huge. Have you been able to discuss this possible outcome with her?

My father has had a few spine surgeries and a knee replacement so I know that talking about possible outcomes prior to surgery when he is more coherent has been very useful rather than being left to make decisions for him regarding his care without knowing what he thinks.