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Do you still have fusion hardware??

Lala329LLala329 Posts: 283
edited 06/11/2012 - 8:44 AM in Spinal Cord Stimulation
Well, I did it. I had the SCS discussion with my doctor, and we're both in agreement that with the low back pain we're at a dead end as far as conservative management and the SCS is worth a shot.

BUT, to keep things interesting as always (and I'll keep this as brief as possible): I developed a "hamstring pull" in February, but then went on to develop full fledged S1 radicular symptoms in April (gluteal and hamstring cramping, burning down achilles tendon into heel of foot) so we're thinking maybe the "hamstring" in February was the start of the radiculopathy and I just didn't label it as such...Anyways, a new MRI to check the status of my cysts (which do sit on the nerve roots) showed little change except a possible increase in size in one of the sacral cysts. They also checked the iliosacral screws I have and they seem to be clear of the neural foramens (but of course being metal makes the MRI less than ideal for evaluating them. Under the fluroscope during my last ESI they looked ok, too).

All of this is to say, we're not 100% sure what is up with the leg symptoms. My doctor says he does not think it's the screws, and the cysts seem likely to be the cause, but there was no definitive compression on the MRI. If the cysts are compressing the nerve root then I'm going to need leads at 2 different levels to cover the S1 root as well as the low back pain (which my doctor said is going to make it much trickier than just doing leads at T-9 for the LBP).

I'm wondering if I need to look into hardware removal just to be good and certain that the radicular symptoms are from the cysts and not the screws. It'd be insane to have leads placed to cover pain coming from a hardware issue, but it'd also be insane to have hardware removal surgery if the hardware is fine. We're certain the LBP is from the cysts and not the hardware since the hardware is in my pelvis. My doctor didn't really seem to think the hardware is an issue, but I'm having a lot of anxiety about it because it's not definitive what caused the sudden onset of the radicular symptoms and I do remember when the screws were placed it was a *big* deal to avoid that S1 nerve root.

I'm seeing a neurosurgeon for one last eval before my SCS trial to be certain they can't operate on the cysts (which is more a peace of mind thing because they do not operate on these things unless you lose bowel/bladder control), so hopefully the NS will have an opinion on the hardware. I think my concern is I've heard that hardware can be aggravating to the nerves even if it isn't necessarily directly violating the nerve roots, so how will I be certain without pulling the screws out? I don't want any unnecessary surgery, and my SI joint is feeling great so the screws are doing their job (I'm thinking the SI joint would hurt if something had happened to the screws??), but if they are causing these radicular symptoms it makes sense to have them removed and then do just one lead location on the SCS to cover the low back pain...

Did you guys have your hardware pulled out before doing the SCS?? It can never be straightforward with spines can it :)


  • My hardware was removed about a year and half before I got my stimulator. If you're really questioning the hardware, you can always request to have a hardware block to determine if its causing any problems. Just so you know, its possible to still get coverage in the legs with the leads at T9. Of course my leads are abnormally low at T11/T12 and T12/L1.

  • I agree with Dave. If there's a way to eliminate a potential pain generator it seems like the logical choice to do that first. A hardware block is a small price to pay, for peace of mind.

  • Interesting thread Lala and I'll be interested to hear the responses. I've been questioning my hardware for quite sometime and so far they all say "it looks fine in the images" but still, I SO HAVE MY DOUBTS.

    At my last doctors appointment the SCS was brought up and I said "No thanks." I'm not convinced my mechanical issues are all solved. One of them being my hardware.

    I'm pretty sure, based on the research I have done, I would definitely want mine removed first to be absolutely sure it was not a pain generator before I had the SCS.

    Keep us posted on your findings.
  • I'd ask them to remove the hardware if there is any chance at all it is a pain generator.

    On the flip side, if it turns out that it is not the pain generator; many people have leads at different levels, some even have two ipgs implanted at different times. Like all procedures the more they have to do the more complicated and longer the process, but I would not let that stop me from having the trial.
  • Hello,
    After 13 months of back spasms and pain on the right side only the NS agreed to remove my PLIF hardware at L5-S1. My pain went from a 7-8 to a 2-3 in one month. I could not be more pleased. Also no more back spasms. It was not the smoking gun for my savage right heel pain but we now know that cause. They did not do a hardware block on me because I could put my fingers on the screw heads in my back. I would pursue it if you at all suspect an issue with hardware. It is funny that the left side gave me no issues at all.
    God Bless,
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