HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Causes Unsuccessful Fusion Of Joints At L4-L5 Post Back Surgery?

Posted on Tue, 20 Oct 2015

Question: Hello Dr XXXXXXX In 2013 I had back surgery due to Spondylolisthesis. I had Standard noncontrast lumbar spine axia! CT images obtained with generation of coronal and sagittal reformats.. Findings:The patient is status post left L4 facetectomy and transformational lumbar Interbody fusion of L4-L5. The transpedicular screws at L4 and L5 are in satisfactory position.There is no evidence of hardware fracture or loosening.There is osseous in growth from the adjacent vertebral body endplates but there is persistent lucency through the ingrowth without complete osseous fusion.There is stranding of the midline paraspinal soft tissues extending from L2-L5 levels.There is minimal retrolisthesis of L5 on S1.There are degenerative changes of the bilateral sacroiliac joints with sclerosis.While there is osseous in growth into the internet spacer adjacent endplates at the L4-L5 level.Persistent lucency through the midportion of the osseous bridging indicates incomplete fusion... Why no healing

Answered by Dr. Aashish Raghu (27 minutes later)

Brief Answer:
Indicates non union between bones which were supposed to be fused

Detailed Answer:
Hi there.

Thanks for the query.

Do you still have back pain ?

Any tingling, numbness or weakness of the limbs?

I have read your query and made a note of the findings.

There appears to be an area of L4 L5 vertebral bodies such haven't fused.

Reasons could be due to incomplete removal of the intervening disc, less intra operative curettage of the end plates, death of the bone graft due to lack of vascularity, improper implant stability etc.

These findings indicate a region if non union between bones which were supposed to be fused. Now due to non union, the could be some motion between the frames which may be causing pain. In the pain is very severe, revision surgery may be required. If not, Conservative management with Medicine, posture changes, Physiotherapy will suffice.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Aashish Raghu (1 hour later)

Dr XXXXXXX
Thank you for responding back..I forgot to tell you I am diabetic.Do you think this may be hindering my back from healing also?.I do not have any more tinting,numbnes or pain in
My lower back where the surgery was performed.My severe pain is in my hip on the left side from the surgery which I suffer with alone with spasms.Did not have the hip pain before the surgery..What I do when I experience the spasms is walk them out.I also get my heating pad and it calms the spasms down sometimes.What is a good pain and spasm medication
For my situation.I also notice winter months I really suffer with hip,pain and spasms..And stiffness of the joints..XXXX

Answered by Dr. Aashish Raghu (4 hours later)

Brief Answer:
Try to do a PET Scan

Detailed Answer:
Hi there.

The hip and joint pain you experience which get worse in the winter is mostly due to Osteoarthritis. There will also be undressed stiffness of the joints at this time.

You may need to get flexion and extension views to look for a XXXXXXX segment of the spine which is causing pain and instability. If you have the provision of a PET Scan at your centre, this will be the best investigation to find out site of non union, instability and possible infection if any.

Kindly continue using hot pad for the painful regions.

I hope I have answered your query.

Regards,

Dr. Aashish Raghu

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T