bone spur 1 year post op

[gem]

Hello,

I had my one year 2 level ADR post op visit and x-rays today. My six month x-rays showed no bone spurs, but my 1 year x-rays show a sharp, pointy bone spur at the back of L3 pointing directly down at L4.

L3 had an avulsion fracture occur during the Prodisc placement that then seemed to heal without any problems. But, the theory today was that the fracture has caused the bone spur to develop.

Has anyone else had a problem developing a bone spur after ADR?

The Dr. wants to wait and see what my 18 month x-rays look like, but now wants to put me on Relafen to take as an anti-inflammatory.

I'm a little concerned as I've got nerve pain in my thighs again, which was originally gone after surgery and didn't come back until a few months ago.

Any advice would be appreciated.

Thanks,

Gem

[Harrison]

Gem, sorry to hear the news. How does the placement of the device look? Everything else look OK? No subsidence (movement), etc.?

[gem]

Hi Harrison,

No other problems, placement looks great, range of motion is good.

Just the ugly bone spur and the pain in the thighs.

I occasionally get achy in my lower back, but since my back feels 80-90% better than before the surgery I pretty much try to ignore it.

Gem

[Alastair]

Hi Gem,
well I'm in a similar position to you I had ADR almost three years ago at the Alphaklinik L5 /S1.

Three weeks ago I had problems with a lot of back pain whilst driving. Subsequent x-rays show a large osteophyte growing at L2/L1. I spoke with my doctor this morning who is recommending to "do nothing" -- -- -- meanwhile I'm back on the heavy painkillers again which I don't really want to do.

Is your bone spur at the same level as your ADR?

I e-mailed the Alphaklinik almost three weeks ago, and the latest x-rays went to them also. I have no response but I know they are busy at present. Mark is going across their today, he is going to get doctor Zeegers to e-mail me as soon as possible.
Have the USA doctors offered you a solution?
Best,
Alastair

[Alastair]

Bone spurs, or osteophytes, are bony projections that form along joints, and are often seen in conditions such as arthritis. Bone spurs are largely responsible for limitations in joint motion and can cause pain.
The reason for bone spur formation is the body is trying to increase the surface area of the joint to better distribute weight across a joint surface that has been damaged by arthritis or other conditions. Unfortunately, this is largely wasted effort by our body as the bone spur can become restrictive and painful.

Bone spurs themselves are not problematic, but they are a signal of an underlying problem that often needs to be addressed. Bone spurs are often documented to help assess the severity of a condition such as arthritis

[Rein]

Gem

Sorry to hear about your complication.

I'd never heard of an "avulsion fracture" before and looked it up:

"An avulsion fracture occurs when an injury causes a ligament or tendon to tear off (avulse) a small piece of a bone to which it's attached. The injury may be due to direct trauma, such as a hard tackle in football, or indirect trauma, such as an aggressive pivot in soccer or basketball. This type of fracture can also be associated with serious injury to the involved ligament or tendon.

Small avulsion fractures don't need surgery or casting. Treatment typically is with ice and rest. Small avulsions rarely cause any problems after the injury heals. The avulsion may still be visible on an X-ray. But it usually doesn't cause any pain or discomfort.

If the bone fragment is large and widely separated from the bone and is associated with significant tendon or ligament detachment, treatment may include surgical reattachment. In young children, avulsions that occur on a growth plate also may require surgery. Talk to your doctor about what the best treatment is for your specific injury."

From this description I'm very curious about your diagnosis because I don't understand how something like that could occur during surgery. I read several other descriptions of avulsion fractures (occurring throughout the body) and in all cases they were caused by severe trauma to the connecting tissues. I fail to see how that could occur in ADR surgery and have a suspicion that the cause for the fracture is not as diagnosed but something else, possibly initial chiseling for the superior prosthesis keel or when seating the prosthesis itself. Whether my theory is correct or not, I think it is very important to get the precise cause into the record because failure to do so doesn't do justice to medical science or help patients considering ADR. (I'm not suggesting that *you* get it into the record, I'm suggesting that your *surgeon* do that!)

If this were me, I'd be getting additional radiology to really look at that fracture if it isn't very clear in current films. I'd also be taking those films to second or third radiologists for interpretation.

Did you have a bone density scan done pre-surgery? Since the beginning of the testing of ADR's in this country we've learned a lot about the problems associated with accepting patients whose bone quality is less than optimal. I think it's pretty much required now to get a density test before they'll accept you. Is it possible you were one of those unfortunates who were accepted prior to bone quality testing and you suffered a fractured vertebra as a result?

[gem]

Hi Alastair,

I'm sorry to hear that you are having problems and are having so much pain. I'll be interested to see what solutions you are offered.

Yes, it is at the same level as my ADR. It is growing from the bottom of L3 and my ADR was L3/4 and L4/5

For now, the Dr. just wants to watch it and see what happens over the next few months. I'll try the Relafen and see if that makes any difference.

Thanks,

Gem

[gem]

Hi Rein,

Thank you for the detailed explanation - I didn't have that information. What I was told by the Dr. and what is in the op report is that during insertion of the core at that level the avulsion fracture occurred. That particular level was almost bone on bone and he said the spot where it fractured was where one of the ligaments attached.

The piece of bone stayed in place and the post surgical films show the fracture, but also show it being in place. They watched it carefully for the first two months and it seemed to heal in place and not move. I had one other Dr. evaluate the films and he agreed that there was a fracture, and that it looked healed. On my six month x-rays, the films and the report both indicate that it was healed and no sign of a bone spur.

I have had two bone density tests done, the last one was last week, and both no problems with bone density, it was actually over 100% of normal.

I'm just very frustrated, I was really down after I got home yesterday.

I'm still hoping for the best though.

Thanks,
Gem

[Alastair]

Hi Gem,
I have just been offered the Meds and thats it so far - - - -I await the Alphaklinik solution.

I am taking Trammadol again

No one mentioned this to me at all and I didn`t really notice as I was looking at the ADR level not above.I suppose if I was not complaining they didn`t look elsewhere. This has grown in the last year - -to be fair to everyone. Its a Whopper too!!!!

I have e mailed Zeegers again today and Mark is across there now and he is going to bring it ot Zeegers attention also

We shall see - - - it just shows there is more to ADR than a quick surgery and home again
Best
Alastair

Gem -

I, too, have a bone spur that looks just likeyours (a dagger that points directly down from one vertebra to the other, in the epidural space). However, this was there imemdiately after surgery and had presumably been there for a long while.

Just be careful in a assuming this spur is related. I know CurlsGirl had a spur removed after long after her ADR and it had no effect on her pain.

Alastair, if you have backpain, you might consider trying to stretch out your lower back (I cant believe Im giving a suggestion to YOU, of all people!!). I do this by performing toe touches and because of that I have little to no back pain. It seems to keep my facets loose and flexible.

Paul