More Fusion Issues

Merry Christmas everyone! I know it has been a long time since my last update and I have had a number of people ask how I am doing. Overall I am doing pretty well!

I had a craniocervical revision done back in February of this year to replace loose occipital screws from my original fusion I had done back in December of 2013. The surgery went well and there were no complications. All of my imaging looked great and the surgeon was able to replace the loose screws and secure the fusion as we needed. I was in the hospital for two days and had good pain management. I was in a hard cervical collar for three months following this surgery. At three months post op imaging of my fusion (CT scan) was done to assess how well my body had responded to the surgery. The imaging at that point looked great! My screws were solid and looked like they were embedded into the bone as needed. I then was able to start weaning out of my cervical collar, which after three months was very exciting for me! After a couple of weeks I was not wearing my collar at all anymore except for on long car rides and I was feeling pretty well!

My neurosurgeon wanted to do another round of follow up imaging (an x-ray this time) three months after this appointment, which ended up being about 7 months post-op. Unfortunately this imaging did not go nearly as well as we would have liked. The x-ray showed that my cervical screws, which were secure before my surgery in February, were both loose on the left side. The occipital (skull) screws that had been replaced during my revision in February were still secure but now the lower  cervical screws were both loose on the left side. Thankfully the right side of my fusion was still secure and had good bone growth so it was just the left side we were worried about. At this point my neurosurgeon but me back into a hard cervical collar 24/7 and I waited about two weeks for an appointment with him to discuss our options.

At this appointment we discussed two possible options and of course neither of them were without their downfalls. The first option was to jump right in and do surgery. Since I had already had two fusions we felt that at this point I would need a more involved surgery that included fusing more levels of my spine. Right now I am fused from my skull down to my second cervical vertebra. This is the only area of my spine currently that is unstable so at this time I do not need any vertebrae further down my spine fused. With my current situation, however, we agreed that this fusion has been unstable for so long and we had now twice attempted to attain a solid fusion that we would need to go down another vertebra and include my C3 (third cervical vertebra) in the fusion. This can lead to many potential complications. I would have to have C3 included on both sides of my fusion. As the right side of my fusion is solid and has adequate bone growth it would be a risk to alter that at all. If we add onto the right side of my fusion it may cause it to become unstable as well. Additionally, including lower levels of my spine has the potential to cause what the neurosurgeon calls a domino effect. Basically we are permanently changing the way that my spine moves and sits. As your spine is all connected changing the way that the top of the spine sits may change the way lower portions of my spine are positioned. The more levels that are fused higher up the higher my risk of needing more fusions down the line on lower levels is.

Given all of the downsides there are to surgery we felt that we should first pursue a more conservative route. The alternative to another fusion revision surgery was to brace my neck and see if we could artificially hold it still enough to promote bone growth. Bracing would include me being in a hard cervical collar for six months. Our hope is that with holding the neck still for that long we will be able to encourage bone to form around the fusion, the ultimate goal regardless of the approach we take. This bone formation is what solidifies a fusion and how you know that a fusion was successful. The risk with this is that we may go six months and still end up needing to do more involved surgery if there is no bone growth after that time. Ultimately we decided that this is the best route to go for me and my current situation.

I am currently three months into wearing my cervical collar, so I am halfway there. I am just waiting at this point to do another round of imaging. I haven't scheduled my appointment yet but I will get imaging done and see the neurosurgeon sometime in March, putting me at about 13 months out from my revision surgery. We will determine at that point whether or not the bracing has allowed my fusion to solidify and bone to form or if we will need to move forward with another surgery at that point.

Besides my fusion issues my health has been very stable! It has been a huge relief to be so stable right now as school has been very busy! During the fall semester I was at a high school three days a week doing clinical work toward my degree in speech-language pathology. It was a nice change for both Reilly, my service dog, and myself, but exhausting none the less! I am so pleased that I will get to be at the same site three days a week during the spring semester! I am finishing up my graduate program and will graduate with my Master's degree in August. I can't believe this season of life has gone so quickly! Thank you as always for your continued prayers, it means so much to me and my family! I hope you all had a wonderful Holiday season and have a terrific 2018!