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Dr.Sawhney
Dr.Sawhney, Orthopedic Surgeon
Category: Orthopedics
Satisfied Customers: 7171
Experience:  More than a decade of post qualification experience
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I hope someone can shed some light on how this could happen?

Customer Question

I hope someone can shed some light on how this could happen? My father who underwent spinal fusion surgery on 11/16, the areas worked on were his lower lumbar, they put a cage, pins etc...
My father had some compilations due to low blood pressure and was placed in ICU for 7 days and then a step down unit for another 18 days. A surgery that was to take place with a 5-7 day hospital stay and a week at acute rehabilitation center has turned into a complete nightmare.
After 25 days in the hospital my father was transported to a sub acute rehabilitation health facility on 12/10- he did seem to improve as pain was less and he could participate in his daily sessions with plans to be released and off to a better quality of life.
Then soon after the New Year he start complaining of pain in his right side and it seemed to get worse with each day.
Finally I reached out for his surgeon as I truly believed it could only be a pulled mussel , the surgeon set us for CAT scans, MRI a and MRI with contrast. By this time my father was in so much pain he could make it through the testing. I noticed my father's body on a slant as he claimed to be standing up straight , very disturbing to look at.
Finally yesterday we went to see the doctor, the doctor reviewed the DVD's from what images were captured and said my father needed to redo the surgery. He said that the area that he did the surgery was strong and stable but now the above lumbers are starting to collapse on to each other due to my father being top heavy and his age. I really need to understand if this is something that anyone has ever heard of? My father is now in the hospital with a slanted spine in such pain it is beyond heartbreaking to see, while we wait for surgery on Tuesdat? I really need some insight please
Submitted: 1 year ago.
Category: Orthopedics
Expert:  Dr.Sawhney replied 1 year ago.

Hello

Expert:  Dr.Sawhney replied 1 year ago.

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…?

Expert:  Dr.Sawhney replied 1 year ago.

Can you see what I wrote?

Expert:  Dr.Sawhney replied 1 year ago.

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.

Customer: replied 1 year ago.
Dr
On 11/16 my father had a spine fusion L2-S1
On 12/9 he went into an acute rehab and was there till present
Soon after the new year my father started feeling terrible pain to the point he could hardly move.
Soon after we went for CAT and MRI, my father was in to much pain to complete the test by this time I noticed his body was lopsided.
We went to the doctor on 1/26 after reviewing the captured images he said my father needed the surgery all over again as it was starting to clasped above, therefore they plan on going in removing the hardware, clean it refuse but now from T10to the pelvis. We were told sometimes this happens.
My father and I are very scared. Have you ever heard of such an issue or is this completely unheard of?
Presently my father is in NYC since 1/27 prepping for surgery and being cleared by all his doctors to under go this all over again including coming off his Coumadin. As it stands he is due for surgery on Tuesday.
Customer: replied 1 year ago.
Doctor I just want to give you his present medical issuesObesity, Hypertension,Acute ischemic heart disease,Mixed hyperlipidemia, Chronic atrial fibrillation, Gastro - esophageal reflux disease without esophagitis, Sleep apnea, Enlarged prostate with lower unitary tract symptoms, Paroxysmal Atrial fibrillation, Depressive disorder, use of anticoagulants.Past Surgery history:
11/16/15- spineal fusion L2-S1
2009-( left )rotator cuff surgery
2007 - ( right)rotator cuff surgery
2005- Open heart surgery , bypass and a Arctic valve replacement ( pig skin)Family history:
Heart complications
Expert:  Dr.Sawhney replied 1 year ago.

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.

Customer: replied 1 year ago.
In your years of expertise knowing his age and medical conditions, did you ever hear of someone in this medical condition not being able to make it through the surgery? He is convinced he is going to die? I know he is scared and the pain is just awful he is in, even controlled in the hospital with heavy pain Meds. I know you don't have a crystal ball none of us due, but is it common to do surgery with everything else he going on .
Expert:  Dr.Sawhney replied 1 year ago.

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.

Customer: replied 1 year ago.
Let me ask you this Doctor the surgent must of known this was possible given his age, size , diet etc... Was there a way we could of been more pro active against something like this from happening and or how do we prevent this from happening again
Expert:  Dr.Sawhney replied 1 year ago.

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.

Customer: replied 1 year ago.
Can you explain so I can better understand what you mean by extension of fusion to non mobile dorsal spine
Expert:  Dr.Sawhney replied 1 year ago.

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.

Customer: replied 1 year ago.
Dr are you still in practice and if so out of which Hospital?
Is this a question I should ask the surgeon or a suggestion and if so how do you suggest I present that to him with any insult or doubt on my part
Expert:  Dr.Sawhney replied 1 year ago.

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.

Expert:  Dr.Sawhney replied 1 year ago.

I am going offline now and may not be available for several hours.

Thanks for your consideration.

Customer: replied 1 year ago.
Thank you dr for your time this is very hard on us as we just lost our mother and are so fearful of losing our fathert too as he is really all we have left .
It's so hard trying to understand all these big words and terms especially when you aren't educated in the field of questioning. Sometime doctors forget that we little people don't understand their language and are scared to ask questions without insulting them while we are putting our love ones life faith in their hands. I am still confused but I guess my father's outcome is based on the choices I have made in hopefully finding what I believed was to be the right doctor for him, even as his work has shown to fall.
Thank you again for your time, you have been very kind and patient.
Expert:  Dr.Sawhney replied 1 year ago.

Thanks.

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.

Customer: replied 1 year ago.
I think I am okay for now but I just might need to check back in with you after the surgery on Tuesday. Again thank you for such kindness and compassion.
Expert:  Dr.Sawhney replied 1 year ago.

You are most welcome whenever you need to ask any question.

Expert:  Dr.Sawhney replied 1 year ago.

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.

Customer: replied 1 year ago.
Doctor you have been wonderful , so far so good my father had the surgery on Wednesday he spent Wednesday and Thursday evening in ICU and now is in a step down unit where they are monitoring his blood pressure , heart rate , oxygen levels etc... My father still has the blood drains in they call them drain A& drain B. One of the drains is still draining a lot of blood. My father already had 1 blood transfusion on Thursday but they say his levels are fine. Is it common to drain so much blood from a spine fusion? Also his BP is 114/70 is that to low as my father always had high blood pressure.
Oh and one last thing they took out the folly urine tube on Thursday morning but put it back in on Friday morning and it's still in him what would be the purpose of this.
Ps- They did t10 to the pelvis
Expert:  Dr.Sawhney replied 1 year ago.

Thanks.

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.

Customer: replied 1 year ago.
What is Prostatatic hyper Trophy? Is this something bad, will he soon be able to pass urine on his own.
Also very interesting after the surgent came out to speak to us along with telling us everything went well he said my father
Has ochronosis of the tissue and bone??? What is that?? Can you explain??
Expert:  Dr.Sawhney replied 1 year ago.

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.