Post-Surgery Concerns After Total Vertebral Resection: A Patient's Journey

What are the issues after total vertebral body resection?

I underwent surgery for an L3 giant cell tumor, which involved the removal of the vertebral body.
It has been 7 months since the surgery, and I am currently taking denosumab.
This is a CT scan I had in August (6 months post-surgery).
I would like to ask if my bone fusion status looks good? A few days after this CT scan, during my follow-up appointment, my surgeon mentioned that I could avoid wearing a back brace at home, but should wear it when going out (perhaps due to concerns about falling?).
I usually don’t wear it even for quick trips to the convenience store.
I experience lower back soreness, pain, and stiffness, and sometimes my legs feel weak (which worries me the most).
Overall, my condition fluctuates between good and bad, but my doctor said the CT scan looks fine, and I should just wait to see if things improve.
I know it might seem foolish to worry about these things (after surgery, I had no bowel or bladder control and couldn’t walk; I’d be lucky if the tumor doesn’t return).
Regarding my sitting posture, is this position considered okay? How can I ensure that the lumbar curve is properly supported? Although I lean against the back of the chair and sit fully, my lower back still feels slightly rounded.
I tend to unconsciously place my feet back, which makes my thighs feel more comfortable, but it seems like that might not be ideal.

MING, 20~29 year old female. Ask Date: 2021/09/04

Dr. Wang Shouji reply Orthopedics

Hello, the CT scan shows no significant displacement.
The resected vertebra is supported by a cage and fixed with screws from the outside.
For this type of procedure, the cage must fuse with the upper and lower vertebrae to be considered successful.
From the CT scan, there are still some areas that cannot be completely confirmed as fused.
It is normal to experience pain and stiffness in the lower back, and occasional weakness in the legs may occur; however, regular exercise should help improve this.
The lumbar spine has two mobile joints that have been stabilized, which will certainly affect the range of motion.
Excessive activity may increase wear on the remaining mobile lumbar joints, so it is advisable to avoid this and focus on strengthening the core muscles to reduce discomfort.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2021/09/04

More Info

Post-surgery concerns after a total vertebral resection, especially following a significant procedure like the removal of a vertebral body due to a giant cell tumor, can be quite complex. Your journey over the past seven months, including the use of denosumab and the CT scan results, raises several important points regarding your recovery and ongoing management.

Q1: Bone Fusion Status
From your description, it seems that your surgeon has indicated that the bone fusion appears satisfactory based on the CT scan. In spinal surgery, particularly after a vertebral resection, achieving solid fusion is crucial for stability and pain relief. The fact that your surgeon has advised you that there are no apparent issues on the CT scan is a positive sign. However, it is essential to understand that bone healing can take time, and symptoms such as back pain, stiffness, and leg weakness can persist for several months post-surgery.

The recommendation to wear a back brace when going out is likely a precautionary measure to prevent falls and provide additional support as your body continues to heal. While it may feel cumbersome, wearing the brace during activities that could increase your risk of falling is wise. If you feel comfortable and stable at home, it is reasonable to not wear it during light activities like a quick trip to the store, but always listen to your body and consult your surgeon if you have concerns.

Q2: Sitting Posture
Regarding your sitting posture, maintaining proper spinal alignment is crucial for your recovery. The images you provided suggest that you are trying to support your lumbar curve, which is essential. However, if you feel that your lower back is excessively rounding or if you are instinctively adjusting your legs for comfort, it may indicate that your current seating arrangement is not providing adequate support.

Here are some tips to ensure your lumbar spine is well-supported while sitting:
1. Chair Selection: Use a chair that supports your lower back. Ideally, it should have lumbar support or be adjustable to fit your back's natural curve.

2. Foot Position: Your feet should rest flat on the floor or on a footrest. Avoid crossing your legs, as this can lead to misalignment and discomfort.

3. Knees and Hips: Your knees should be at or slightly below hip level. If your chair is too high, consider using a footrest.

4. Back Support: If your chair does not provide adequate lumbar support, consider using a small cushion or a rolled towel to support the natural curve of your lower back.

5. Posture Awareness: Regularly check in with your posture. Your back should be straight, shoulders relaxed, and your head aligned with your spine.

6. Movement Breaks: Take regular breaks to stand, stretch, and walk around. This can help alleviate stiffness and improve circulation.

Conclusion
Your concerns about ongoing pain and discomfort are valid and not uncommon after such a significant surgical procedure. While your surgeon's assessment of the CT scan is reassuring, it is essential to continue monitoring your symptoms. If your pain persists or worsens, or if you experience new symptoms, do not hesitate to reach out to your healthcare provider for further evaluation.

In the meantime, focus on maintaining good posture, using supportive seating, and following your surgeon's advice regarding activity levels and brace usage. Recovery can be a gradual process, and patience is key. Remember, your health and well-being are paramount, and seeking support from your medical team is always a good step if you have concerns.

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