Why the fusion failed-Mar G

I have been asked to answer the question why my fusions failed. The reason is different for each fusion so I'll separate the two of them.

The first fusion was done in Nov. 1997 I believe. It was done by a military doctor. Come to find out, after the fact, this surgery was not done correctly. I believe this contributed to why it failed the way it did. Here are the errors:

1. The incision was made in the back
2. No hardware (plates or screws) were used

From what I learned (after the surgery) the best way to fuse the SI joint is on an angle from the front. It usually requires an incision in the abdomen or one starting at the belly button and going around the side to the sacrum in the back. That's a large incision. I do not know why the original surgeon did not do it this way. The SI joint is one of the hardest joints in the body to fuse because of its shape and angle. From everything I've read and every surgeon I talked with afterwards a fusion of the SI joint requires hardware. The use of plates and screws, to hold the sacrum to the hip bone while it heals. These were not used at all.

What broke this fusion was quite simple, I fell. My son, then 2 years old, hugged me from behind. He was just tall enough to hug my knees from behind and when he did my knee gave out (as it will when hit from behind) and I went down. I landed on one of his little wooden alphabet blocks. This resulted in a perfect L shaped bruise and it hit exactly at the base of the incision.

My second surgeon believed that I may have had psuedoarthrosis. This is basically that the body grows a thin bone covering over the area. On x-ray this covering looks like solid bone, but on cat scan the space behind that covering, the original joint, is visible. As no cat scan was done post-op I don't know if this contributed or not. All I do know is that I was 6 months post op and all x-rays showed solid bone (no joint) yet it broke from a small fall that shouldn't have done it.

After the fall the x-ray showed a fracture line in the fusion and my pain, which had been easily manageable, went through the roof.

The second surgery was done in 1999. This surgeon explained the errors made in the first surgery and was not a military doctor. He explained about the possible pseudoarthrosis as contributing to it breaking the first time. He also told me that this was the last time this surgery could be attempted. Due to instability in my lumbar spine he chose to go through the original incision site. He said the risks were too high to do the larger incision. He also made a similar incision on the right to harvest bone from my sacrum on the right to pack the fusion with. He used a plate and screws, one of which is 6 inches long and lays horizontaly from my hip to half way through my sacrum.. (This screw is the reason I can walk today).

This fusion failed for a group of different reasons. I believe that the failure of the first attempt was a contributing factor but I have no evidence of that. I was unable to follow doctot's orders for recovery after the surgery. Then I got kicked exactly on the surgery site and x-ray showed there was a fracture. After that I spent a few weeks in a wheel chair for a month, hoping it would heal anyway as it was still only 3 weeks post op. The surgeon said it might anyway. After that month an x-ray showed solid bone so the surgeon ordered a cat-scan to rule out psuedoarthrosis. With that x-ray result I was forced to get out of the wheel chair and continue activities (such as walking without crutches and bearing weight on my left leg) that I shouldn't have been doing (its a long story). The cat-scan verified pseudoarthrosis. The surgeon told me that it was just a matter of time before that thin bone covering breaks and when that happens I will be walking on a permanent fracture of the SI joint. He also said that it would be a matter of time before the plate and screws break also and when that happens I will be in a wheelchair. (He gave it 5 years till I was in a wheelchair..it's been 9 so far)

So that is why my fusions failed.

I have had bonescans done and bone density tests to see if I have early osteoporosis or some other explanation for the pseudoarthrosis, but those tests came back normal.

Due to another fall where I landed on the edge of a marble topped table, the fracture was made worse (becoming a compound fracture and leaving bone fragments floating around) and I blew a second disc somewhere between 1999 and 2001/2002. With the worsening of the fracture my formerlly indented left hand scar filled in due to swelling. This swelling has pretty much stayed since that last major fall. Prior to landing on the table that scar was indented along its entire length. Now the indent is only visible near the top of the scar and only the width of my index finger (1/2 inch maybe), whereas if I were on hands and knees that indent would hold a small cup (like a cup-holder). When other things cause increased swelling (moving around too much, weather changes, falls, my period) that little bit of indent goes away and if the swelling is bad enough there will be a raised lump the length of the scar that is visible through my clothing. Lately the swelling has increased to form the shape of the letter C with hard nodules/spots at the top and accross the bottom where it hurts to touch it at all. This now causes visible swelling around into my hip and half-way accross the sacrum.

I have visited the local orthopedic surgeron (the only one who does spines and pelvises). He told me that at the very least, they needed to go in and add a second plate (for increased stability) and remove the bone fragments that are floating around; basically to clean it up. He ordered a cat-scan (this is how I found out about the second disc) and after that he told me he never said anything about a second plate etc. etc. I was in tears. He then told me that when my pain is no longer manageable without invasive procedures that he'd go in and clean it up.

Well when it became necessary to start multiple injections and radio frequency procedures (which also use needles, at least 6 on the left side) to control my pain I went back to the surgeon. My understanding is that an invasive procedure is anything that breaks the skin and enters the body; cutting, punctures (needles!) and such. He was very very rude on that visit! He told me that those are not invasive and there is nothing wrong with me then walked out of the room while I was trying to talk to him. I followed and continued to try and speak with him. He totally ignored me and entered a different treatment room closing the door behind him. I went home in tears. A few months later he was arrested for posession of cocaine with intent to sell, so in hindsight I am glad I've never undergone surgery with this man despite his reputation of being a great surgeon.

Mar G, I hope that answered the question of why the fusion failed. Just be aware that a spinal fusion is different from an SI fusion and my experiences are not typical, so please don't panic yourself worrying that this will happen to you also. I do not know if pseudoarthrosis can occur in a spinal fusion, though it probably wouldn't hurt to ask your doctor about it. I hope I did not scare you! I hope your recovery continues to go very well!