Neurosurgeon Questions

“Surgery Dilemma ”

I have a knee and back problem, I have had 4 back surgeries and I have very bad knees, because of the back problems I haven't been able to get knee replacements, now I have a lot going on in my knee which is a torn ACL & PCL with numerous moderate size intra-articular loose bodies with a prominent loose body along the popliteus tendon bursa. I had an appointment for a doctor to look at my knee when this happened, I bent over to sit down in a chair when I felt a wound pop in my back, I called the doctor who was booked so I went to the ER because I was in a lot of pain, they took X-rays and told me nothing is wrong it is a strain so I saw my back doctor a few days later and he showed me the x-ray and one of the rods in my back broke ( so much for the er doctor) he said that he might want to do a revision surgery but he want to wait to see if it stabilizes. well right now the pain has gotten worse but I wanted to get my knee done but my back is important too, so at this time I don't know what to do first, because my knee is so bad I use a walker to get around and my back hurst so much I feel like I am hunched over. Please help me make a decision.

Female | 69 years old
Complaint duration: 1 week for back 1 month for knee
Medications: RA meds
Conditions: autoimmune disease

7 Answers

The rod most likely did not just break. This is often fatigue of metal after a failed fusion. I think the knee needs to be addressed then look into the failed fusion
Either is reasonable to be done first. The most painful would make most sense to start with
If you are already scheduled for the knee I would proceed with that. The big question is when was the back fusion. It depends on how the CT scan of the fusion looks. If the bones have fused the rod is not needed and can be removed. The fact that you broke a rod, however, suggest that there is still motion at that location and the surgery may need to be revised. That can be done electively after your knee surgery
Go to a more complex spine surgeon
It is important to optimize all aspect of care prior to any surgery. This includes bone health (no osteopenia or osteoporosis), mobility, and other issues. It is difficult to decide which surgery to proceed with first without much clinical information but I would discuss this with both your spine and knee surgeon and have a consensus. You can also seek a second opinion to have a fresh set of eyes evaluating the clinical issue at hand. Hope this helps. Saeed S. Sadrameli, MD Endoscopic, Minimally Invasive and Robotic Spine Neurosurgeon Orlando Neurosurgery, AdventHealthCerebration
A broken rod will not "stabilize" but you may have a solid spinal fusion, making a broken rod potentially not a big problem. That is an important question you should ask. The over-arching concern is failed fusion, which is more likely in the setting of having to take R.A. meds (powerful anti-inflammatories) which are known to inhbit the fusion process. It is best to understand the exact causes of your pain, and why your rods broke. There are also other options for your knees (such as regenerative medicine) but that is also potentially affected by your R.A. meds. I hope this helps.
You obviously have a difficult decision to make. With four previous back surgeries, a fifth, no matter for what reason, has virtually no chance of improving your back pain. You must discuss your dilemma with the surgeons involved and come to a decision based on whatever additional advice you receive. Without knowing all of the relevant information, I am unable to advise you further.