Why Spinal Fusion Surgery?

It has been over two years since my surgery and yet it is so easy to forget how it all began...  This is a "refresher" post to better help you understand what led to my spinal fusion surgery.

What is Spinal Fusion Surgery?

Spinal fusion is a surgical technique used to join two or more vertebrae. Supplementary bone tissue, either from the patient (auto graft) or a donor (allograft), is used in conjunction with the body's natural bone growth (osteoplastic) processes to fuse the vertebrae. This procedure is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the vertebrae themselves.

When I finally found my way to The Orthopedic Surgeon's Office, I had experienced low back pain for over 10 years; that was over 1/3 of my life....

What does Spinal Fusion Surgery Treat?

Certain types of spinal deformity, such as Scoliosis, are commonly treated with spinal fusion. Scoliosis is an “S” shaped curvature of the spine that sometimes occurs in children and adolescents. Fusion is indicated for very large curves or for smaller curves that are getting worse.

I was diagnosed with Scoliosis in 1994. I saw a Scoliosis Specialist for 3 years; however, I was never treated beyond consultations. My primary curve was in my low back – at about 38-degrees – and my secondary curve reached my upper back, in-between my shoulder blades. A curve is considered severe at 40-degrees or greater. The Scoliosis Specialist said that my curve was "moderate" and that it was not severe enough for further treatment....

Another condition that is treated by fusion surgery is actual or potential instability. Instability refers to abnormal or excessive motion between two or more vertebrae. It is commonly believed that instability can either be a source of back or neck pain or cause potential irritation or damage to adjacent nerves.

During my Junior Year at college (2001), I first began experiencing severe back pain that greatly impacted my mobility and lifestyle. I was prescribed 12 sessions of physical therapy. After the 12th visit, the PT explained that I "knew how" to execute the exercises and as long as I "kept it up" the pain would be minimized. The pain decreased, but it never disappeared….

In 2003, I was the victim of a drunk-driving accident. While my car was totaled, my back was "only sprained." The driver did not have insurance. I was young and did not know to pursue appropriate health care. I was treated by a chiropractor for a few weeks then was released. The pain, however, never ceased….

In 2007, a series of x-rays revealed that I had bulging discs along my vertebrae. I was diagnosed with Degenerative Disc Disease and Annular Tears….

The Controversy behind Spinal Fusion Surgery

Spinal fusion is sometimes considered in the treatment of a painful spinal condition without clear instability. A major obstacle to the successful treatment of spine pain by fusion is the difficulty in accurately identifying the source of a patient’s pain. The theory is that pain can originate from painful spinal motion, and fusing the vertebrae together to eliminate the motion will get rid of the pain. Unfortunately, current techniques to precisely identify which of the many structures in the spine could be the source of a patient’s back or neck pain are not perfect. Because it can be so hard to locate the source of pain, treatment of back or neck pain alone by spinal fusion is somewhat controversial. Fusion under these conditions is usually viewed as a last resort and should be considered only after other conservative (nonsurgical) measures have failed.

In October of 2009, I saw The Surgeon for the first time. He sent me to my third physical therapist that year. After working diligently with this PT for months, The Surgeon finally agreed to a pre-operation procedure conducted by an Anesthesiologist called a Discogram. A Discogram is a diagnostic procedure that determined whether I was a candidate for Spinal Fusion Surgery. Lucky for me, I was....

Before my surgery, I made an appointment to get a second opinion from a Spinal Surgeon at my Pain Specialist’s office. This Surgeon told me NOT to get the Spinal Fusion Surgery. Instead, he suggested that I get another type of surgery where he would insert an electrical stem product attached to my spine. This product would help decrease my back pain. When I asked the Second Surgeon if his option would potentially “fix” the problems with my spine (the mobility and bulging discs) he said, “No.” When I asked the Second Surgeon if his surgery was a permanent solution to my chronic pain, he said, “No, you would need to have this surgery again EVERY FIVE YEARS.”

My Decision to have the Surgery

In 2007, the intense pain that was once in mild remission, resurfaced. I saw a chiropractor who asked me, "Do you want to have surgery or do you want to try alternative methods?" Of course, I said, "I do not want to have surgery!" What the doctor failed to tell me was that upon reviewing my x-rays, he saw that I had bulging discs on multiple levels of my spine. He withheld this information so that he could "fix me" himself. I saw this chiropractor for over two years. At my first appointment, the doctor told me that, “Had I seen a chiropractor when I was first diagnosed with Scoliosis, my curve could have been mostly, if not entirely corrected.” However, because I was an adult, we could only hope for some mild correction of my spinal curve. During my two-year treatment with the chiropractor, there were weeks when the pain was so great that I was required to attend three appointments a week; other times, I saw him once every three weeks for maintenance. Despite the appointments and the adjustments, he never "fixed me.” My curve remained the same degree, my pain persisted and my discs continued to bulge out of my spine….

In June of 2009, after a family vacation where my back pain was so severe I was greatly restricted from many of the group activities, my mother-in-law, Sandy, (who is a physician) encouraged me to call my primary care doctor and to get an MRI. The MRI results revealed that I had Degenerative Disc Disease (in addition to Scoliosis) and Annular Tears on multiple levels of my vertebrae.

During the year following my new diagnosis (Degenerative Disc Disease), I saw a Pain Management Specialist in addition to my primary physician. The Pain Specialist started my treatment with cortisone injections. The shots did not work. He then referred me to a Radiologist. At the Radiologist’s office, I received three rounds of Epidural Steroid Injections. I still had no difference in pain. That year, I was also prescribed medication after medication which only masked the pain, never finding a solution to stop the source of pain. The Pain Management Specialist then prescribed another round of physical therapy. I went dutifully to PT every week for months. After no significant changes were made, my physical therapist and my Pain Management Specialist recommended that I finally consult with an Orthopedic Surgeon. They agreed that I had tried ALL appropriate, non-invasive options without success.

Weighing my options I reviewed that: my Primary Care Physician, my Pain Management Specialist, The Surgeon, The Anesthesiologist and three Physical Therapists all agreed that I should have the Spinal Fusion Surgery. They agreed that the surgery could potentially correct the instability in my spine, for at least the next twenty years of my life, if not forever. Alternatively, The Second Surgeon recommended a surgery that would mask the pain and would need to be repeated every five years.

Using the information that we were given, along with a great deal of prayer and consideration, Gage and I decided that I should move forward with the Spinal Fusion Surgery.

I had surgery on June 24, 2010.

Stay tuned... In my next post, I will recap what went wrong with my recovery.


Information from:
WWW.SPINE.ORG
http://en.wikipedia.org/wiki/Spinal_fusion