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Tuesday, January 13, 2009 jmweissler asks

Q: I am new to forum. Please review my history and share any comments or information that might help me

I am a 52 year old male. I don't smoke or drink. I am not overweight. I suffered a fractured vertabrae in my lower back (L5/S1) in 1998. Ended up with spondylolisthsis (vertebrae slips over another one) and had spinal fusion with 4 pedicle screws and 2 rods. They used bone from my hip to build bone around the fracture. I never felt much relief and lived in pain for 10 years. Lived on morphine for the last 5 years and had a spinal cord stimulator implanted in 2005. Finally found a spine surgeon who was willing to open me up and take a look. All other surgeons told me that the fusion was solid and instrumentation was in place based on all the films (X-Ray, MRI, CT). I was operated on in June of 2008 twice. The bone never fused, the screws were loose and my spine was at an angle. First my lower lumbar was fused from the back (Posterior Lumbar Fusion). Two weeks later, I was fused from the front (Anterior Lumbar Fusion). They removed all the instrumentation and all new (titanium) screws and rods were inserted. During the procedure my surgeon noticed that my bones didn't seem "right". He prescribed a QCT test. The results showed that I had severe osteoporosis (T-score = -3.9 and a Z-score = -2.8. I went to see an Endocrinologist and he verified the results with a DXS test. He prescribed Forteo. I will need to inject myself daily for 2 years. Currently, my medical insurance company has denied the medication and the doctor is appealing.

 

What can I expect? Anyone similar to me (male, 50s)? Any assistance will be greatly appreciated.

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Pam Flores, Health Guide
1/14/09 11:18am

Hi jm:  I'm not male but we have similar medical backgrounds and age.  Was your fracture from a accident or was it from a fragility fracture, coughing, sneezing etc?

 

Hopefully your latest surgery will get rid of the pain since the hardware wasn't doing it's job nor were you fused.  Just watch this last surgery and check on the fusion.  Did the Dr say how long it would take to become solid?

 

Did the surgery correct the spondy?  I hope so because that instability will cause pain if it isn't stabilized.

 

Hopefully the insurance will ok the forteo...  I took forteo for 2 years and did really well on it. 

 

If they turn you down on the first appeal--appeal again! 

 

I'm curious, was your QCT scores similar to the DXA or did they look worse?  I had 2 QCT's because I have rods and screws in my lumbar, and was told that they overestimate the score some, making the bone density look artificially worse.  My DXA scores were better than the QCT but I still had severe osteo. Did they scan your spine above the fusion/screws and rods because if not the screws and rods can underestimate the dxa score.  Hopefully they were able to scan L1-L4 with no problems.

 

It's hard to say what you could expect since anything is possible, but I would hope the insurance co ok's the forteo, your last surgery is a success, and your scores improve greatly from the forteo, provided you can take that.  Just don't give up easily with the insurance co.  You aren't one that can do just any weight bearing exercise so I would ask your Dr or a Physical Therapist to give you a routine you can do with your back limitations.

 

Good luck...

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By jmweissler— Last Modified: 12/25/10, First Published: 01/13/09