Failed spinal fusion
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- Опубліковано 27 вер 2024
- An interesting surgical case of a patient whose lumbar-spine fusion surgery failed. I will show you how I fixed this problem.
LINKS:
Lumbar Radiculopathy: • Lumbar Radiculopathy (...
Smoking and Spine Surgery: • How smoking ruins spin...
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The contents of this UA-cam video/ channel (including but not limited to: Images, text, graphics, links, other materials) are for educational/ informational purposes ONLY. This content is NOT professional medical advice, and is NOT meant to be a substitute for professional medical advice. Watching this video does not establish a patient-doctor relationship. The content of this UA-cam video should not be used to make judgments/ decisions regarding diagnosis or treatment. As with any medical condition, SEEK THE PROFESSIONAL OPINION OF A PHYSICIAN FOR A THOROUGH EVALUATION. All Images, text, graphics, audio, video etc. are SUBJECT TO COPYRIGHT.
If you like this video, please check out:
Smoking and spine surgery: ua-cam.com/video/qQVJCoZPmqs/v-deo.html
What is a spinal fusion: ua-cam.com/video/49DEQq9JmME/v-deo.html
Thank you for this video. I had to quit 3 weeks before my surgery and im recoverinĝ very well. Its been a month and i still crave a smoke, but after this. I think im just never gonna smoke again. ❤
Awesome to hear that!
I made another video about spine-surgery and smoking:
ua-cam.com/video/qQVJCoZPmqs/v-deo.html
Quitting tobacco/ nicotine is the best thing that you will ever do for your health.
Wishing you success and great health! 👍
Hi, Dr. Khan. I should have read through all the comments before I gave a reply to one who had a question about nicotine. I didn't see that you had answered in another comment reply, so my apologies!
I will say that when I was a nurse, I often witnessed the harmful effect of nicotine on surgical patients. I even knew a surgeon who would just refuse to operate on a smoker!
Excellent videos, sir!
@kathleenborsch1312: Thank you for taking the time to watch the video, thinking about it and commenting on it. You are correct: Nicotine is harmful to almost every organ system, including the musculoskeletal system. The incidence of medical/ surgical complications are therefore much higher amongst smokers.
Thank you for your kind words, appreciate it 👍
I recently had this surgery performed and am having amazing results (3 weeks post). I also used smokeless tobacco and have stopped for the time being. While I’m sure this is a healthier life choice, I sure do miss it. Not sure how long I’ll stay tobacco free. Thanks for the video and explanation. Great job.
Great to hear you are doing well. Stopping smoking is not easy but it is the best thing you can do for you health, no question. Good luck to you!
Hi
I'm so happy to see this video. I have been looking for an orthopedic for my fracture screws and rods. No doctor won't touch me. My first doctor retired.
That is terrifying and terrible. I guess this one isn't interested either..best of luck to you!
Thank you for reaching out. You may want to get a second opinion from another surgeon. Usually getting an evaluation from a University-based spine-surgeon is a good option for the complex situation that you described. Wishing you good luck.
I will stop smoking for. My surgery in October thank you doctor okay I got it
Great to hear that, good luck!
My bf was a pedestrian hit by an suv. A RESIDENT performed a spinal fusion on her (neck to C5) and it has been a problem ever since (her amputated leg was the least of her issues). No one will operate on her who actually thinks they can help. She slowly is becoming quadriplegic but they use a "t" word to describe it. As of a few months ago she is paralyzed on her left side. This hit and run happened in 2021. She was mending at one point until a doctor removed the pins from her elbow and it disintegrated. While she was under they had to go get plates from another hospital across the city. She had to have one of those metal cages around her arm and was saying how heavy it felt. Anyway she does not smoke. Of course you are talking about a different type of spinal fusion but perhaps you should make that more clear in your description so people like me looking for info won't see your video and get a glimmer of hope that their friend is not dying. Also, thos, what your saying re: smoking is the same for any surgery. It creates inflammation a d is a venous and vaso constrictor. I know that and I have not had one day of any kind of medical training.
Thank you for your thoughtful comment. I am very sorry to hear about the terrible trauma that your friend had to endure (and which is still continuing). Wishing you and your friend all the best in the future👍
Holy hell. That should be a law suit for the hospital that has a resident performing a spinal fusion. 😔 very tough
Nice, enlightening video. Thanks.
Thank you for watching!
I’m glad my surgeon had me quit before my fusion. Surgical revision wasn’t something I was interested in.
I'm glad you were able to quit before surgery. It is not easy, but quitting smoking is the single best thing you can do for your health. Thank you for sharing.
Stopping smoking is the single best health decision one can make and it's for a multitude of health related issues. This is definitely up there on that list. Smokers usually have back issues.
100% correct! 👍
I had a spinal fusion. L4 -S1. I was not told to give up smoking. My fusion didn't take. I ended up having a 360 fusion through front and back 8 hour surgery. My second surgeon said he would not operate unless I gave up smoking. I did give up and it was the best decision ever. My fusion fused but unfortunately I now have adjacent segment disease so I need another fusion above, and now I might have flat back syndrome so not sure what will happen there.
Thank you for reaching out. Quitting smoking is the best thing you can ever do for your health.
There are many benefits to smoking cessation; I made a video about it:
ua-cam.com/video/qQVJCoZPmqs/v-deo.html
@SpineSurgeonSpeaks I fully agree with what you have said. It's a bummer ( sorry just my terms of people not understanding) it's a bummer that people still have thoughts that smoking can be fine no matter what. Babies are compromised from smoking, elderly people are compromised from smoking. The sooner people get real the least problems there will be.
Dr. You should learn how to do ADR and do it instead of old style fusions.
Thank you for your comment, I understand your concern, it seems quite valid. I hear this quite frequently from my patients.I think I need to make a video about this exact topic, which may turn out to be quite interesting.
The fact of the matter is that medical-device manufacturers have spent billions developing and marketing ADRs, but (to their surprise) with mixed results. If ADRs had turned out to be wildly successful (and therefore superior to the traditional fusion), surgeons would have stopped doing fusions. Also, as an insider, I know that ADRs are much easier (and faster to perform) compared to a fusion. Despite these realities, disc replacement has still not been adopted by the majority of (very experienced) spine surgeons. How could that possibly be?
I think that unfortunately the word "fusion" has developed a negative connotation, and in my opinion a better term would be "stabilization." Sometimes it is necessary (and unavoidable) to stabilize the spine.
You might find the following video interesting:
ua-cam.com/video/ekmio-Mzr1w/v-deo.html
Hope this gives you additional insight into this complicated (and highly tecnical) matter.
Thank you for watching the channel, appreciate it. I always enjoy hearing from my viewers.
Hello there,
I remembered your comment from two months ago.
Here is a video which may be of interest to you:
ua-cam.com/video/3vt-qLOWdaE/v-deo.html
For clarity, is this due to cigarettes or the actual nicotine itself?
NICOTINE is what you would need to discontinue, no matter the way it is consumed - cigarettes, cigars, pipes, vaping, gum, patches, chewing, etc. So I would recommend that you first totally quit with whatever method works for you, and then be totally clean of it by the time you head for the hospital for your surgery. Check with your surgeon on how long before your surgery you'll need to stop and also how long to stay free of nicotine for the long recovery time after ( several months). Hey, you might as well make this your chance to quit for good!
Here's why: Nicotine disrupts many of your body's healing processes, like healing of incisions and bone grafts, changing the effectiveness of some medications after surgery, and increasing the chance of infection.
Good luck!
(I have a degree in public health education, and I hope this info was helpful. But, as always, check with your doctor.)
Agreed, thank you
Good morning! Where is the address for that clinic?
Contact information:
www.mustafakhanmd.com/contact
in (potts spine) Laminatomy bone recovery again
I cannot make out from the xray if you did any facet joint resection. I can see that you removed the lamina though. How do you fuse posterolateraly if the facets are resected ? thank you !
Thank you for your excellent question.
In general, while doing an open-laminectomy I prefer to remove the facet joint up to the pedicle, which typically means that >50% of the facet has to be resected. Once the decompression reaches the medial-wall of the pedicle, the nerve is successfully (100%) decompressed.
For the posterolateral fusion: I decorticate the transverse processes and onlay it with copious amount of bone-graft. Importantly, you have to burr-down (decorticate) the remaining facet-joint (for additional facet-fusion).
@@SpineSurgeonSpeaks Thank you for your good reply. It is very comprehensive. I am a spine sufferer that ended up in a bad situation because of unprofessional surgeons and I am left at 36 with a very bad pseudoartrosis and standalone alif titanium cage subsidence at L5S1. Basically the segment moved almost normally after surgery and dug in the S1 endplate, sinking by 2/3 of its height. After 8 months of suffering, I had surgery and posterior screws were added, but no bone graft was used and unfortunately the segment still moves badly after another 8 months. (16 months from the initial alif). How would you revise such a case ? Would you revise the anterior cage in this case or let it be ? Do you think posterior fusion with autologous bone on the facets and transverse processes could be enough to finally fuse this segment even if a small residual motion will still occur following this revision ? I am following you for some time and I really like the clarity and professionalism of your approach and I am sorry I did not find someone like you in my path. However, your reply will be most appreciated. Thank you.
The situation you describe is quite challenging; sorry to hear about your difficulties. You have been through a lot.
Obviously, since I am not familiar with your condition (physical examination/ medical-surgical history/ imaging studies etc), I cannot specifically comment on *your* condition.
But, having said that, if a segment has not healed/fused, most surgeons would revise it with iliac-crest bone-graft harvest (and bigger screws, possibly extending it up/down to get better immobilization/ fixation).
I would recommend that you get another opinion with an experienced spine-surgeon at an academic institution (university-affiliated) who may have proficiency with a complex situation like yours.
Good luck to you, and wishing you the best of health 👍
@@SpineSurgeonSpeaks
Thank you for your kind advice.
Now referring to your video and my case also, why is not an illiac crest bone used in the first place, if that is the fail safe solution anyway ?
I noticed in your video that you don't mention what type of bone graft was used in the initial surgery, however in the revision case you definitely specify that it was an autologous bone.
So what if the cause of failure is in fact the synthetic product used initially and not the smoking habit ?
How can we be sure of anything ?
You offer the link to more info but its a private video..not very helpful.
Thank you for reaching out. I corrected the link to a newer (updated/ better) video. Please try again, hope you find it helpful.
@@SpineSurgeonSpeaks thank you..much appreciated!!
My pleasure. Thank you for watching.
I had l5 s1 nerve compression , my doc on first visit asked me if I am a smoker, since these things are more likely observed in smokers. Dr khan is it right?
Hi Rich.
Most docs will ask the question regardless, for a variety of reasons.
Patients who smoke will experience disc-degeneration two or three times faster than nonsmokers, so they are more likely to develop arthritis of the back (resulting in bone-spur formation) which can lead to pinched nerves. I see this all the time in my clinical practice. Quitting smoking is the best thing anybody with back pain can do to improve their condition.
@@SpineSurgeonSpeaks thank u doctor for such elaborate answer. Just one more thing I had micro lumbar diskectomy on 16 Aug for my right leg and now I have started feeling pain in my left leg. Right feels fine as of now. Any specific reasons or just shock of operation,
The disc degeneration continues despite the surgery. Sometimes it can herniate/ bulge on the other side
Hi Dr, does drinking alcohol cause the same risk for recovery as smoking ?
That's a good question. Yes, alcohol suppresses the immune system and it slows down the healing of soft tissue, with higher rates of infection. It should be avoided as much as possible.
Thank you sir
Alcohol does just as much as smoking. I've had my fusion 5 years ago, and my surgeons all said to stop both before surgery. I just stopped two days before mainly I know the anesthesiologist needs to know the truth when they put you to sleep.
But also, I know people that's
will lye about smoking and drinking to their doc..
I hace c6 and c7 and d5 fracures due to wipslash lots of symtoms accuring in my right side inluding opening my mouth and all the symtoms mentioned above its been only 2 months and week that this happend im only texting with my left hand i dont use the right its week allong with my right leg my doc said 8 should use my collar for the cerical and back support lots catsscan anmri of the cerv8cal is done should also problems with vision and ear should i listen to the specialist or see him again specially when those symptoms are not getting any better as of yet
It sounds like you need to follow your doctor's recommendations carefully. Good luck.
@@SpineSurgeonSpeaks 😊
@@SpineSurgeonSpeaks i god luck to get better 😊
when might you recommend and SI joint fusion?
Thank you for reaching out. I do not perform SI-joint fusions, so I cannot give you a specific opinion. In my experience SI-joint fusions work very well for some patients, but for others they do not (I have seen a wide-range of outcomes). Your best bet is to get an evaluation by two surgeons who perform this procedure, so that you can get a good idea about whether or not this procedure is right for you. Good luck.
Same thing happened to me. After spinal fusion the bone did not heal, the titanium disc slipped out of place and the cage came loose. But I've never smoked in my life, or did drugs, or drank alcohol. I'm slender, normal BP, low cholesterol and normal blood sugar. Had a second surgery but I'm still in pain and after a year I still need a walker to get around. Doctors tell me nothing can be done.
Sorry to hear about your difficult situation. Sometimes a fusion can fail for no clear reason.
Also: You may want to get your Vitamin-D levels checked:
ua-cam.com/video/w1ag0kgDreA/v-deo.html
@@SpineSurgeonSpeaks I'm in the sun a lot, drink milk everyday and take a vitamin D supplement daily.
Extremely informative thank you Dr! What about marijuana?
Thank you, I appreciate your compliment.
I don't believe that I have enough information to comment on the effects of THC and healing after spine surgery.
But I do have a more in-depth video about the effects of cigarettes/nicotine on healing after spine surgery:
ua-cam.com/video/qQVJCoZPmqs/v-deo.html
By this logic, no smoker would ever heal from anything.
The risks of nonhealing amongst smokers for any type of surgery (spine, orthopedic, plastics, cardiac, vascular etc.) are much, much higher than the general population. The difference (in terms of duration of healing, complications requiring surgery/ antibiotic therapy, need for another surgery in the future, need for opioid medications, chronic pain etc.) is dramatic, not subtle. And yes, smokers have a very difficult time healing after surgery. Thank you for your query, hope it helps.
I had S1 through L1 fusion 7-24-23 Big surgery I'm 68 the minute I woke no feeling left leg zero my Dr said inflammation and will get better 6 months it hasn't I'm giving it another 6 months to see plus MRI after surgery seen my T5 is broke wasn't before is after surgery.if my leg doesn't come back can I have hardware removed?
Thank you for reaching out. Since I am not familiar with your case, obviously I cannot give you specific treatment recommendations. However, it would be quite reasonable to get a second opinion from another surgeon (in a different practice) so you can get a different/ unbiased perspective. For a problem as complicated as you are describing, you may want to get a second opinion from a university-based hospital system (where the surgeons are usually highly experienced). Good luck to you.
@@SpineSurgeonSpeaks thank you for your time I will check out UOfM in Ann Arbor if you still practice would you be willing to see me? Thank you Mark Schwartz
Years ago, a foreign lady from church broke her ankle really bad and they told her that if she didn't stop smoking it wouldn't heal. She didn't quit smoking and she didn't heal right.
Even I'm facing this issue bue to smocking
Any updates
Tlif surgery sir. 1of yr bed rest.. How recovery time sir.
Thank you for your query. Actually, we discourage bed-rest after surgery: The patient is made to walk the day of surgery (with the help of a walker), and gradually (over two or three days) the expectation is to have them go up and down stairs with physical therapy. Most patients make a very good recovery between 4-8wks, and can be quite active (i.e. back to work, driving, traveling). However, the *total* recovery after a spine surgery can take up to a year [meaning the bone, soft-tissues, nerves etc. have to heal completely]. Hope this answers your question.
@@SpineSurgeonSpeaks tq ❤
sir am i 12 weeks l4l5 after spine surgery so at now something smoke
Is thc bad?
Thank you for your question. I am not sure I have the correct answer for you since there is conflicting information available on this matter. I suspect that it is harmful, since any type of smoke is likely to have significant amount of carbon-monoxide.
Don’t smoke or vape anything, edibles may be a better bet.
What about marijuana?
I have been asked this question by many people: To my knowledge there has been no systematic research about the effects of THC on healing after spine surgery. Therefore, I am unable to compare the effects of smoking THC vs. nicotine.
@@SpineSurgeonSpeaks I just had my thorasic spine t4-t10 fusion with hardware. I feel like maybe I broke some grafts, or is it just me and the new feeling of hardware under muscles?
Does this include smoking weed?
I am not sure I know the answer to that question since I am not familiar with the data. But tobacco has been definitely associated with poor outcomes after spine surgery.
No it the nic thst is the problem. There is no nic in cannibis
@@SpineSurgeonSpeaks What does tobacco affect the outcome of spine surgery?
sir minimum day after spine surgery discipline smoke another side continues please answer me sir
The healing of bone takes between 6-12 months. Ideally the patient should stop smoking for at least this period. Of course, the best option would be to stop smoking completely forever. I also remind my patients that nicotine/smoking accelerates the degeneration of NORMAL discs. So if you start smoking AFTER the fusion surgery has healed, the degeneration of the normal disc next to the fusion will likely be accelerated.
Dr.
Is it possible that had this patient stop smoking earlier that the non-surgical solutions could have worked?
If the patient had not been smoking, there is a high probability that the degeneration of the spine would not have progressed as rapidly. So yes, it is very likely that it was a big factor.
I am still having pain in my lower back now my upper back neck as well 2022 August had ALIF surgery back hurting sciatica nerve pain I want to have surgery for the sciatica nerve far as my back still hurting I want pain free from this if I have to have another back surgery I am all for it.Question why is my back still hurting after my ALIF surgery 2 years ago now my upper back hurting going to my middle back neck I can hear cracking sound turned left to right hurts
Thank you for reaching out. Yes, your question is quite appropriate and reasonable.
I cannot diagnose your condition, of course, since I am not familiar with your case. However, one of the most common reasons why patients may have persistent back pain after spine surgery is because the fusion has not healed.
Here is a video I made about what a spinal fusion is, hopefully it is helpful:
ua-cam.com/video/49DEQq9JmME/v-deo.html
It may also be helpful to get a second opinion from another surgeon (in a different medical practice).
Best of luck to you 👍
Why not put a cage in addition to posterilateral fusion ???
If you look at the literature, the pros/cons of a fusion with cage balance out with the pros/cons of a posterolateral fusion without cage:
Fusion with a cage requires a unilateral facetectomy, so automatically the concurrent posterolateral fusion has to rely on the contralateral side only (with the remaining facet). Also, the incidence of cage-subsidence is not insignificant (especially with osteoporotic bone). Additionally, sometimes the cage can back-out and impinge against the nerve root or the cauda-equina: In that case removing the cage can be very dangerous (since the dura is scarred down very tightly).
For these reasons the surgeon has to balance the pros/cons of using the cage for each patient.
Your question was excellent; maybe I will make a video about it 🤔
Smoking screws up everything. Just stop!
I couldn't have said it better myself!
WOW, very helpful 👍
Thank you, glad you found it helpful.
I have several family members that had fusions back to the day. And they smoked like trainspoke they never had to issue with it
Very informative!! Thank you Sir.
Thank you for watching, very happy to hear that you found it helpful 👍
Hello, if I may ask. What would you recommend to a 26YO now 7 months after T3-L1 scoliosis surgery + cleaning inside after 3 weeks due to infection. (staphylococcus aureus) physically? Still discomfort. No long sitting, standing. Diagnosed with Astma in the meantime, no good physical condition. Feel pinching, heavy weight and tightning on chest.
Strength training, cardio, bedrest, non at all?
Greetings from the Netherlands!
How much was he smoking?
I was vaping for 3 weeks after a spinal fusion and am worried what if it doesn't heal properly. Haven't faced any pain returning though. Stopped vaping completely. Not sure if since I stopped things will be okay or if perhaps I halted the healing t the most important part
Great to hear that you stopped, since even a little bit of nicotine can be harmful. Keep up the good work, and good luck to you!
What about the occasional cigar? (Non-inhaling)
@@A_Trade10X No !!!