The Expandable Spacer
Posted , 9 users are following.
Never heard of this until a month ago...thought it might help others...
In 2015 I had a fusion of L3 through S1...45 years of hockey finally caught up to me. Surgery was fine, wore a brace for a few months, kicked rehab's a$$, as usual. Back's been great ever since. Then I had my left knee replaced in March '16. Five weeks into rehab and I got a bit of sciatica which a chiropractor resolved fairly quickly (locked SI joints).
However, October 2016 found me with sciatica down BOTH legs. Walking bent over to alleviate the pain had my already weakened quads firing 24 x 7 so I was in a lot of pain. MRI and then a CT/Myelogram with contrast showed bilateral stenosis of L2/L3, right above my fusion. To confirm the diagnosis, my neurosurgeon did a pain shot at L2/L3 to see if that was the right spot. These shots usually do nothing for me but I did get a little temporary relief.
The surgeon then gave me a choice of operations... In Column "A", he'd unzip my back, remove all the current hardware, clean out and put in a spacer at L2/L3 and re-fuse me L2 through S1. Result: 10 days in the hospital, back in the brace, weeks on pain meds, 6 months of rehab.
For Column "B", he would employ a General Surgeon to open a path to my spine from the side and insert an "expandable" spacer into L2/L3. Once in place, he'll use a long Allen wrench to crank it open...just like a jack lifting up a car with a flat tire...thereby eliminating all the pressure on the nerves in that space. Result: instant pain relief, one night in the hospital, no brace, zero rehab.
I'll take one from Column "B", please. Thank you very much. He told me that it works with 80% of patients and that I'd know if it worked immediately. (My fingers and toes are crossed...)
It seems that this device and technique is especially useful for people who have had previous fusions and the vertebrae above or below the current hardware weaken or degenerate over time. It would also apply to people who have a non-fusion problem with only one vertebral segment. Given an 80% success rate, it might be an option for a lot of people who are in this situation but who don't know about the procedure.
Although there are a few companies that have this device, there's a cute animation of it on YT if you search for "Globus RISE-L". Shows how the hardware is inserted and then expanded. Regardless of manufacturer, you'll get an idea of what the procedure can do for you.
So, instead of another huge back operation, ask your doctor about these devices. Might work for you and save you a lot of time, pain and money.
5 likes, 12 replies
Carolineq8 CHICO_MARX
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Enna1 CHICO_MARX
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Sounds like you did a lot of research like me. My surgeon said that these points of surgery are very dangerous and might not even resolve the pain issue. My discs are L3.4 L4.5 and I think the botton S1 is going.
I have had sciatica for years and years, I had a good dr and then he went to Fleetwood and so noone in the practice would inject my thigh. I had to pay for my surgery finally my new doctor told me I was putting on the pain and the last one was our PCT was going bankrupt and she couldnt allow the op.
So what did I do, I went private one injection lasted about 3 months and I paid £1,000 for it. Once it didn't work very well I just put up with it but put a lot of weight on because I couldn't walk. The medication was terrible too, made my stomach really bad
So I ended up in Spain, to stand in line to be registered for the health system just about sent me round the bend and I had to go to the police station for 3 days in a row. Lots of people went in 2s one in line and one having coffee and then they swapped.
Once I got a dr at the hospital he really did put me an injection into leg. 4 injections into my right leg and 3 in the left. This went on for ages until I went to a surgeon in Valencia and you know what he told me. So he said that if the pain clinic I am sending you to doesn't work you can always go back. Now I look at people in the street, holding their right side, or dragging their leg and think no way. I just pill myself up 3 times a day and if I need an extra, I have another set which is the max.
So i went to the pain clinic, what an arrangement. It was my appointment day and my partner answered the phone at 7, he didn't understand what they were saying (Valenciano) so just put the phone down. Later in the day, the last appointment the nurse or whatever came to see us and said she had rung us but still didn't know what it was for. I suspect, maybe it was authority to have this injection as it was down in the spine. Had those and they didnt work. So eventually 3 months later I actually got to see this pain surgeon and got on with him fantastically, he spoke English as good as me. And so far, I have been having thigh injections which was fab, I even did walking, I walked up a hill to our local castle which if you saw it you wouldn't believe me. The last injection was crap so I have just taken my meds and tried my best to get on with it. I do a bit of exercise but back to where the weight was originally. Its crap isn't it. You must be a lot younger than me. I know the man who was a rep for X Stop, he lives in Valencia and if you have a false disc as the years go on, the above or below disc gets worse, I think thats what you say. I forgot to tell you, I had one of those on thre NHS and what I didn't say was I had decompression, filing down of a bone so that it didn't touch the bone, I paid for that too, because of that horrible doctor in Kendal. So I have done most things. Valencia is a fabulous place for surgery but not sure at my age I will do anything. I sort of got adjusted to it now. I take a drink wherever I go in case I need medication and sit until it starts to work, my friend is a heavy handed physio, she didn't work either, in fact for the first 3 days I was worse.
Yours was hockey, well mine I fell downstairs when I was in my 30s.
I wish you the best of luck mine is a long story and I have missed bits out but it doesn;t matter its 15 or more years since I went for my first decompression. Now because of Brexit I might have to go home because I dont know whether we will get reciprocal health, so do a bit of praying for me that we will get, it will give me 2 years of good health treatment. Cheers.
CHICO_MARX
Posted
UPDATE:
2 1/2 weeks post-op; just saw the surgeon this morning. "Oh...didn't we tell you that the first few weeks after surgery would be hell?" NO, YOU DIDN'T!!!!! ...or maybe I was so enthralled by the "one night stay...no rehab" promise that I didn't hear the rest.
The truth is that, at least for L2/L3, those nerves go through your lower back and down the front of your quads. This is nerve pain so you can forget the normal opioids like Vicodin and Percocet. You need Lyrica, Neurontin or Gabapentin. Unfortunately, the first two do nothing for me and the last one puts on 20 pounds in a month. Not going there.
So Tylenol-3 (codeine) takes the edge off, I use Aspercreme 4% Lidocaine as a topical and keep the heating pads running. It's getting me through the worst of it but the doc says to expect a 6-week recovery on the nerve pain. No bending, lifting, ladders, etc. (typical back precautions).
Wish I had listened harder or asked better questions but the end result is zero stenosis pain; the rest of this is temporary. The finished work is attached. All in all, a good result.
Carolineq8 CHICO_MARX
Posted
Ah I remember waking up from my fussion and thinking what the hell have I done!! So I totally understand what your going through, hope your pain settles very soon and your up and about in no time, thanks for the update it's really interesting to have someone that's gone through it and share with the rest of us, take care and keep us posted on your recovery 😊
Reddave8 CHICO_MARX
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regards Reddave8
jack61423 CHICO_MARX
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CHICO_MARX jack61423
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As we say in Brooklyn..."Poifect!"
One night in the hospital, stenosis pain gone instantly, no brace, no rehab. Haven't felt a thing from it in eight months...don't ever expect to. Yes, because they retract the nerve roots during the op, I had some decreasing tingling nerve pain in my quads for a few weeks. Nothing I couldn't handle with a little topical Lidocaine. After that, zip, nada, nothing. This was literally a "silver bullet" procedure.
jack61423 CHICO_MARX
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CHICO_MARX jack61423
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I'm fused by a TLIF (rails and screws) from L3 through S1...this is a single-level LLIF at L2/L3.
deb06149 CHICO_MARX
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Ducksoup CHICO_MARX
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Of course with option one there would only be a few days in the hospital, instead of ten,
CHICO_MARX Ducksoup
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I had a TLIF fusion of L3 through S1 a number of years ago. Typical rods and screws. That was 12 days in the hospital plus 3-4 months of rehab. The LLIF is a freaking miracle!!!!!!!!!!!!