Back - T12-L5 Fusion :: Edema Around Screw


Jul 22, 2013

My last back surgery was a T12-L5 fusion to correct scoliosis. I would say it's a failed back surgery because my back is so weak I must use either a cane or walker most of the time. I have constantly had a burning pain in my groin and lower back for which I take oxycodone and use ice to relieve the pain.

Now the question: for more than a year (the surgery was 2 years ago) I have had swelling with fluid around one of the T12 screws. X-rays were done then and again the last of May and both show the screw has backed out somewhat but is still intact. In fact, the more recent x-ray is exactly like the first one, so it seems it isn't moving. My neurosurgeon said he could remove the screw and cut the rod down if I wanted him to. At the time, I said, "No, not yet." That was a couple months ago. However, the edema is getting larger, moving to the right side of my spine and moving lower. It's also getting almost impossible to get a good seating position because of it.

Sorry to be so long about this, but I'm wondering if any of you have had this problem, and if so, what did you do about it? At the moment, I'm facing a total shoulder replacement surgery in 2 weeks, and then possibly eye surgery after that, so I can't do anything soon, it seems. Just trying to see what my options are.

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My spinal surgeon wants to fuse L2 to the sacrum due to multi-level disc bulging and herniation at the end of April 2014.

Then people have steered me in the direction of what Laser Spine Institute can do and I actually have approval from insurance to have treatment there and the process of getting treated there is also underway parallel to the above mentioned surgery.

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On the other hand a full lumbar traditional fusion statistically gives relief to 30%, 30% get worse and 30% stay the same as for pain relief and with a 3-6months recover. And once you get fused like that, you paint yourself way into a corner if it is not an improvement for you.

The traditional surgeon does not have much good to say about LSI, but I am thinking of course he is not going to recommend that since he does the traditional approach.

Doing the LSI treatment does not exclude a traditional fusion later, however we have great insurance now, with great short term disability coverage and now is the ideal time to do a traditional fusion and be able to have the months of recovery without worries.

Reading about LSI people have varied opinions, many people say they have had great results and others say they are a quackery out to get people's money. Our insurance have said they would cover treatment though.

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my Daughter aged 9 year is suffering from cord edema due to road accident. she was hit by a bike three months before, and after all the examination her reports are fine but in MRI report the doctors find that :

There is a long segment T2W hyperintense extradural collection is seen in dorsal aspect of cord extending from D1 to L1 level. There is rupture of ligamentum flavum at D2/D3 level. T2W hyperintensity is also seen at interspinous at D2/D3 level. On T2W and STIR images paraspinal hyperintensity is seen from D2 to D6-7 level.

Prevertebral hyperintensity is seen from C2 to C5 level s/o edema/bleed.

Impression in MRI:-

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She's been on mirtazapine 20mg once daily for about five years (with no apparent ill effects) and olanzapine 10 mg once a day for three months. Two months ago she very rapidly - over a few days - developed massive swelling of her left hand, with complete loss of use of the middle, ring and little fingers of that hand. An X-ray was inconclusive, mainly as she couldn't straighten the three affected fingers, and her doctor has been mystified by this ever since. He finally decided it was arthritis but it didn't look much like it to me, given the degree of swelling and deformity, and the speed with which it had come on. Anti-inflammatory drugs have been prescribed, but with minimal effect.

I visit her in her high-security psycho-geriatric unit at least three times a week. Last Tuesday (six days ago) she was still feeding herself perfectly normally with her right hand, once her food had been cut up for her. Three days later, she could no longer hold a spoon, fork or cup. Her right hand isn't swollen but I can clearly see the identical deformity in her last three fingers as in her left hand. All three fingers on both hands are curled up and twisted over each other.

After raising Cain at the home, I've managed to get her an emergency appointment at a rheumatology clinic tomorrow. In preparation for this, I've been doing some research over the weekend (and no, not on Wikipedia) and have discovered peripheral oedema (swelling) is a rare, but known, side-effect of olanzapine. I also found a long paper that had clearly been published in a learned journal on the subject of peripheral oedema with combined mirtazapine and olanzapine use. Unfortunately, it was in Turkish!

Has anyone suffered from this and how quickly did it improve once the olanzapine dosage was reduced? Also, how serious is the rebound psychosis when olanzapine is withdrawn?

She was originally on risperidone, but when that had to be tailed off because it left her with severe Parkinson-like symptoms, it left her way more psychotic than she'd been at the outset, with the result she stabbed another resident in the lovely retirement home she was living in. She's stayed that way ever since, hence the transfer to a grim high-security psychiatric unit, where she'll end her days. She was subsequently put on clozapine for a couple of months, which caused terrible athetotic movements - constant bobbing, weaving movements of head, jaw, tongue, arms and upper trunk - which made her life unbearable. I have to say, however, that when that was gradually withdrawn, I didn't notice any rebound psychosis.

I'm furious with myself for not researching this sooner, as I'm a former nurse, though neuro was my speciality. I'm even more furious with her idiot doctor for prescribing a med that isn't authorised for dementia, then failing to notice she was suffering from a known side-effect. Ditto the nursing staff at the home. When I mentioned this to the head nurse today, she blithely said she'd known all along it was a side-effect of olanzapine - though I suspect she was just covering up her ignorance.

My friend is beside herself, and it breaks my heart to see her like this. She knows there's something wrong, but doesn't understand what it is. She can't feed herself at all now. I tried her with a biscuit this afternoon and she couldn't even hold that. She's already dangerously underweight (BMI 17) and now she's refusing to let the staff feed her, as she's not used to that. I'm the only one who's allowed to feed her, albeit only a few mouthfuls, but I'm 71 myself and can't continue going in twice a day. In the meantime she's screaming and shouting all day and all night in anguish and sheer terror, and attacking everyone who goes near her. She tried to bite my face today.

Sometimes patients who've been on this class of drugs for long periods know much more about them than the professionals, which is why I'm posting here. Is this terrible condition likely to be a result of olanzapine (and possibly mirtazapine)? And can we expect severe rebound psychosis if her doctor tails it off? (Always assuming he even agrees to do that.) Also, does anyone have any experience of other recently-developed anti-psychotics that don't cause appalling side-effects of one kind or another? Though I have to say, from my own nursing experience, that I suspect there's no such animal.

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