Maybe, just maybe, the insurance hesitation in authorizing the added lumbar surgeries is a blessing and a way of highlighting prospects for an intra-thecal pump (pain pump).
That a lengthy fusion was initially performed (L1-L5) is at play with your current lumbar dysfunction and pain. The lumbar spine is meant to move. The biomechanics of the lower spine are forever disrupted with a full segmental lumbar fusion. The degenerative changes noted on your recent imaging and failed fusion at L5 are likely due to the altered biomechanics from the initial fusion.
The fusion may have been what you needed at the time, but added surgery to restore the fusion at L1 may not give you pain relief nor a long-term solution. Altered biomechanical forces will continue to be in play, as the body will have to continue to shift forces of weight bearing, gravity, and translational forces of the body in motion. Think of Tiger Woods and tremendous forces at play when he unleashes a long drive with a 9 iron on the fair way, and you can appreciate the lumbar spine at work.
All to say . . . An intra-thecal pump (pain pump) may be the better option for you than additional surgery. In that pain and the secondary effects of pain are your primary presenting issues (no neurological deficits) the intra-thecal pump may be the wiser option.
It certainly would be worth trying an intrathecal pump before pursing a more intrusive surgical remedy.
Failed back syndrome is real. I cannot tell you how many individuals I saw when I was practicing as a physical therapist who underwent repeated back surgeries, thinking that the next surgery would be the Holy Grail that would bring pain relief . . . And wasn’t. Each surgery brought a higher level of pain and a higher degree of impaired daily function/self care. The final blow would come as the surgeon would remark, “There is nothing more that can be done.” These patients unexpectently were dismissed and tossed to the side - with lumbar nerve roots that had been overly traumatized with repeated surgeries and resulting pain hypersensitivity. It was heartbreaking to see.
In that you have no neurological deficits (a positive finding, to be sure), an intra-thecal pump may be the better means of giving you pain relief and a renewed quality of life.
Every surgery has risks. No surgery should be taken lightly.
Give the intra-thecal pump extra thought.
Pituitary failure, wide-spread endocrine dysfunction
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)
Post Edited ((Seashell)) : 4/23/2019 3:43:10 PM (GMT-6)