Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Fusion Q and nervous about surgery Q

Hello everyone.

I searched everywhere on the internet while looking for very descriptive definitions about the fusion process but I can't find a certain answer that I am looking for.

I read in several places that AS is also considered a soft tissue disease. So with that in mind... is it the soft tissues within the joint that fuse, such as the ligaments that hold the joint together, or is it actual bones fusing together as I had originally thought? I hope nothing happens to the disks.

Second question,
Supposedly and I hope, I am supposed to get a neck operation towards the end of the year. I have a fused over cervical compression and it is probably going to be fixed with a wedge type operation to position my head back up. T1 looks good, but C7 looks very compacted and falling forward. Anyways back to the question. When they perform an operation like this, do they keep the disk in place so that the spine will have it's cushion to rely on? If they take it out, would I be at higher risk for fractures?

PS, I am fused but I have osteoporosis too.
Can you tell I am getting nervous? lol.

Any Ideas?
Thanks,
James.

Edited: Corrected mistake in spine reference #'s :-) (again)

hi james,
My understanding, from my discussions with my neurosurgeon, is that as long as the disc is healthy and not causing any nerve compression type problems,then they leave it be. In regards to your quesion about the discs fusing, I have personally not heard of this being related to a.s.. In my case, I have degenerative disc disease (DDD) and it causes the disc to shrink and lose the moisture in the centre of the disc, but it's not related to a.s., it's just my dumb-luck. I hope this helps in your quest.

Don't worry and goodluck.

loriann

Hi, James:

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is it the soft tissues within the joint that fuse, such as the ligaments that hold the joint together, or is it actual bones fusing together as I had originally thought?

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Both: It is the cartilage within the joint sac that fuses, as well as ligaments where they attach to bones. The result can be a bone-to-bone fusion, but few actual joints, outside of the spine, will progress to this stage.

Quote:

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When they perform an operation like this, do they keep the disk in place so that the spine will have it's cushion to rely on? If they take it out, would I be at higher risk for fractures?

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The simple, short answer (opinion) is yes:

To amplify...
The problem with AS is that syndesmophytes (bridging osteophytes) connect one vertebra firmly to the adjacent two, right around the discs, which will naturally lose mass and degenerate. The spine is now prone to fracture along these syndesmophytes (called pseudarthroses) and impinge on local nerves (at the most inappropriate of times), so an operation can be performed to fix the vertebrae in place. They do not usually bother to remove the discs, but the new brackets assure that the discs provide no shock absorption whatsoever.

This fixation does fix the one problem area, but adjacent vertebrae are more prone to pseudarthroses, since the forces are transferred to these, away from the original fracture through the metal appliances. AS can require a whole new bionic spine (I'm half way there).

Syndesmophytes are not nearly as strong as real bone, but they are composed of the missing calcium that results in our osteoporosis.

My own C7 is now a thing of the past, and I have metal brackets from C6 all the way up to where my skull attaches.

I know that your surgery is less radical, and I hope all goes well with you, but tell the surgeon to have a lot of moly bolts on hand--mine said that, due to osteoporosis, my spine was like "wet drywall."

Best of luck with everything,
John

Hi Loriann,

I'm pretty sure that my discs are not causing any damage, but by the looks of 2 of my joints, the discs may be in trouble. I'm glad to hear you say that you haven't heard of discs fusing though, that's a relief.

I'm sorry to hear about you having DDD. I personally know a few people with that, and they tell me how painful it can be at times. I hope your not in any major pain and feeling good these days.

Take care,
Thanks for the reply,
James.

Hi John,

Thanks for your reply. You must have put in a lot of time studying AS, because you sure have a way of helping us understand.

Yep, my neck is pretty bad, but it's mostly due to one joint. It won't need as much work as yours did. My rheumy starting seeing how bad this problem is for me, when I showed him how my cartilage in my throat is lowered into my chest at such an angle, causing choking and swallowing problems. My adam's apple gets caught on my collar bones when I swallow while laying on my sides.

Oh, and the reason why I have to wait is because I was -3.1 on my BMD, and he wants the Boniva and calcium to rebuild bone before he start making the plans. He is sending me to an 'ears nose and throat' doctor at the end of the month, to get a reading about the obstructions and then I see my Rheumy right afterwards.

My back's vertebral compression he said he isn't going to fix, but now I get to wear a metal brace for that, one prevents slouching and forward bending. I only wear it as needed (sitting, walking, etc), so it that it doesn't let my back fuse any worse than it is.

Thanks for letting me know about the hardware too. I wasn't sure if there was going to be any or not, because my rheumy made no mention of things like that. My GP mentioned it to me a while ago, but he said he would rather see me they way I am than get a painful spine operation.

You have been through too much John... so I can only hope that the struggle is much easier for you now than it was previously. I hope the recovery process for your neck is over by now. Thanks for sharing your experiences.

Take Care,
James.