Orthopedics Questions? Ask an Orthopedist for Answers ASAP
I am an Orthopaedic surgeon and I would be happy to help you today.
I understand that you and your father are going through a very tough time and my sympathy is with you and your father.
What is his age and what was his functional status before he underwent the surgery?
Does he suffer from any other disease like hypothyroidism etc…?
Can you see what I wrote?
It seems that you are unable to see my reply to your question and request for further information.
I would try to answer your question based on the information you have given in your detailed question.
This complication is a known one and the generic term for this type of complication is adjacent segment disease.
There are several different types of problems associated with adjacent segment disease and vertebral compression fracture is one of them.
In this the vertebra lying next to the fused area faces lot more stress after the fusion and collapses because of the increased stress placed on it. This can happen if the bone structure is already weak due to osteoporosis and elderly patients are prone to this complication.
This is my initial answer and I would be happy to answer any follow-up questions.
Thank you for your detailed reply.As I mentioned above in my reply this is not an unknown complication.In fact the long fusion from L2 to S1 pre disposed him for this complication of adjacent vertebral collapse.
I will try to explain.In an unfused spine the motion and stresses are distributed across all mobile vertebral segments. Most motion occurs in the lumbar spine as it is mobile compared to dorsal spine which is relatively fixed by the rib cage. The motion and resultant stresses are distributed across unfused mobile lumbar vertebral segments.When the major portion of lumbar spine is fused, all stresses get concentrated on the unfused mobile lumbar segment and the dorsolumbar junction because dorsal spine as such is relatively fixed.
In your father's case all stresses got concentrated on L1 vertebral body because dorsolumbar junction is already fixed and all segments below L1 were also fused.
L1 vertebral body being already osteoporotic was unable to take the stress being placed on it and collapsed.
Coming to the treatment part, he does need a revision surgery because this is now an unstable spine and we need to stabilize it.
He does have lot of co morbid medical conditions but his anesthetist and his surgeon are the best people to assess his risk and advise you regarding the degree of risk.
Every surgical procedure has a risk and I have seen patients who have developed complications and who have not made it even with lesser medical comorbid medical conditions but on the other hand I have also seen patients ,actually majority who have tolerated major surgeries with very bad comorbid medical conditions.
Every person and patient is different and we cannot generalize the risk. His risk would need to be quantified by his doctors.
Though an uncommon complication this is certainly a known one. This complication should have been a part of risk benefit analysis before planning the surgery.
Extension of fusion to non mobile dorsal spine is astrategy to prevent similar complication.
Drugs to strengthen the bone like teriparatide should also be started though they may not have any immediate benefit.
His fusion can be protected using external brace postoperatively.
Revision surgery has planned fusion form T10. It means that the fusion is planned to be extended to dorsal spine which is relatively fixed. Because there is little motion in the dorsal spine the adjacent vertebra would not be under so much stress.
I am a practicing surgeon but I am not based in US.You have written in your reply that fusion is now planned from T10 to pelvis.Your surgeon is duty bound to discuss everything with you frankly. You may ask him what measures he is planning to avoid similar complication after the revision surgery and you may make your suggestions during the conversation.
I am going offline now and may not be available for several hours.
Thanks for your consideration.
I empathise with you and your family.
You need to be positive and hope for the best outcomes.
A good surgeon or doctor should not have any problem with answering all of patient's questions and assuaging his concerns.
You are free to ask me if you have any more questions regarding this.
Best wishes from my side.
You are most welcome whenever you need to ask any question.
I hope I have been able to answer your questions well.
Feel free to ask if you have any follow-up questions.
If not do remember to rate my answer positively as this is the only way we get paid and assessed for our time and work on this website.
You may continue the conversation even after you have accepted my answer.
Spine fusion can bleed a lot because bone is decorticated to expose bleeding surface.
Is blood pressure is fine and within normal limits.
Foley's may have been reinserted if he was unable to pass urine by himself. Benign prostatic hypertrophy can produce problems in elderly male patients after surgery.
Prostatic hypertrophy means that the prostate gland which is present in male urinary system gets enlarged.
Enlarged prostate gland can produce problems in normal flow of urine.
Most patients are able to pass urine on their own within few days of surgery.
Oochronosis is a disorder of metabolism where pigment deposition occurs in tissues and bones making them brittle.