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hardware infection post plif - revision surgery/ hardware removal

nelnnel Posts: 402
edited 06/11/2012 - 8:53 AM in Back Surgery and Neck Surgery
HI all,
As some of you may know I have had some ups and downs in my recovery but the last six months were great!
My post op infection has now come back and I saw my surgeon today (feel like I live at his office!). He says the bloods show infection and the x ray shows the screws are loose.
He says the screws being loose is probably because of the infection.
Now, in my head, the worst case scenario was hardware removal, and from what I had read on here that wouldn't be too bad in terms of recovery.
But he said that he thinks the infection may have got into the fusion and ate at the bone and so he may need to 1) redo the fusion or 2) put some more bmp in the fusion site after taking the screws out.
So it now seems that my best case scenario is hardware removal.
I wondered if anyone can tell me how hard the recovery is from a redo and/or the extra bone procedure?
I am a bit fed up because I was fairly sure back in October that this was a deep infection and not the superficial one that he hoped it would be.
Anyway, if anyone has any info I would really appreciate it.


  • I had my hardware removed and a revision done at 10 months several years ago. Recovery was a walk in the park compared to the original fusion surgery.


  • I really hope that whatever needs to be done to move you forward in your recovery, it will be successful and your experience will be similar to Dave's, and that you will say it was much easier than your original fusion surgery.

    I am also having some 'issues' with my neck. I have been told that C3/4 and C4/5 are compressing my cord. No plan for surgery yet, but am to have x-rays and complete spine MRI to see what else is going on. Meanwhile they want to refer me to Pain Management.

    Never a dull moment!!

    Take care, >:D< >:D< >:D<
  • Thanks Dave! I think that was what I was hoping for.

    Jelly, sorry to year you have more issues. What is it with us spineys?
  • Yep, removal recovery was MUCH easier.

    That said, the actual days in the hospital were almost worse than the original surgery.

    They don't dose you as well with meds when you have a removal. Plus, I think I hda false expectations - thinking 'oh, hey, I've done this before, I'm sure it can't be as bad. This will be so easy.' Not.

    Best of luck on getting fused. Sucks about it all being due to infection!!!
  • Thanks for your response! I see my surgeon tomorrow afternoon UK time so will update you all then!
  • Well I saw the surgeon again today and now we have another story. The MRI did show loosening of the screws but the radiographer does not think this is consistent with my symptoms. What it did show was that my right side facet joint at l4l5 is "moth-eaten" and is surrounded by oedema.

    The surgeon did not have the results of the CT scan and seems, once again, to be taking quite a blase approach to all this. It seems to be a case of wait and see.

    I suppose that it means I have an infection in the facet joint, but whether it is in the bone or cartilage I don't know. My little bit of googling suggests that neither is good and I am not sure about this waiting and seeing.

    I can't keep waiting to get ill and I am pretty fed up with the pain. I know that the pain is not as bad as 4 weeks ago (pre antibiotics) but it is still pretty limiting and I don't feel able to make any more plans having cancelled my last holiday due to the reccurence of this infection.

    If I was in the US I would certainly be off for a second opinion I think.

    So I still don't know what will happen next or what my treatment options are in any of the circumstances.

    On the bright side he doesn't seem to think that removing the screws will fix the problem. (Trouble is I am not sure I believe a word he says any more!)

    Thanks for listening (reading)
  • Hi Helen

    This sounds ever so familiar. Did your doctor have a SPECT CT done to see where the infection is that is showing in your blood tests.

    I'm going through the same thing and my surgeon has decided that an infection is the cause of my loose screws and ongoing pain. A SPECT CT helped clarify an MRI which was not clear.
  • HI Emily, Sorry to hear you are going through this too. As if the decision to have surgery in the first place, followed by recovery wasn't hard enough - now we get this too!What is your surgeon going to do about it? Has he got a solution? I hope your problems are resolved soon.

    Anyway - I had a CT (no contrast) on Thursday but he had forgotten about that and did not have the results to comment on Grrrr.

    I forgot to say above that he did say he thinks that it probably means infection in my facet joint but he doesn't know how it got there.

    So frustrating. I don't feel I can make any plans or anything. Any holiday insurance this will be a pre existing and I am a teacher so can only take holiday when they say anyway.

    Anyway, will keep you all posted.
  • Thanks Nel!

    No kidding. I am so cross that although bad before the first surgery I am now even worse off.

    There is no question that the infection is introduced during the first op and can be a complication of other things like steroid injections in the area too.

    There are basically 2 schools of thought: Longterm antibiotics and leave the hardware in, or take the hardware out (if fused) followed by antibiotics or take it out, replace and give antibiotics.(if not fused). The infection tends to come back if they leave the hardware in and my surgeon is strongly opposed to doing that.

    So, we have decided on the hardware removal and replacement approach. I have almost no fusion, the infection is in a spot that can't be sampled with a needle and everything is loose. If I twist slightly an almighty clunk can be felt and heard! and shortly after I have immense pain.

    They are going to go in through the abdomen, remove the cages, put in a new set and then culture the tissue to identify the bug and see what it is sensitive to. (This takes a week). When we know what it is, treatment will start and they will go in through the back and replace the screws.

    A marathon that I am dreading but that apparently gives me my best shot at being kind of normal.
  • Wow Emily, That all sound awful. It seems that my screws are only a little loose at the moment so I have to feel that is a good thing. I certainly don't clunk when I move. That must be horrid for you.

    I had sort of thought that what you say about the three approaches were the options and I had also worked out that leaving the hardware in, if infected, would just lead to more issues later on. That is why I can't really understand this wait and see approach that he seems to be suggesting at the moment. It seems to me that I am just waiting to get worse, because how can it just get better by itself? I am also a bit dismayed at the thought that the initial infection has already spread to my facet joint. Where will it go next?

    I really hope your marathon will be worth it and that you will get to be normal in the end.

    Best wishes
  • There are people who treat the infection with the hardware left in and that claim good success. It seems counterintuitive, because the bugs get trapped on the surface of the implants.

    The wait and see is probably because infection and inflammation can look very similar on imaging. But, if your CRP and ESR are up and there's no other infection in your body (Bladder etc) then it needs to be treated!

    My GP has been a helpful advocate for me. Have you discussed your situation with yours?
  • I have been thinking about going to the GP - that is next on my list so that I can get referered for a second opinion anyway! To be honest I just thought any doctor might give me a better idea of the "game" he is playing.

    MY ESR isn't up just my CRP. Maybe that is why he is waiting. Not sure how you explain a sudden increase in temp to 38.9C coupled with severe pain that came together and both went together when treated with fluclox if it isn't an infection though!

    Think I will get on the phone tomorrow!
  • Sounds like a very good idea!

    Good luck :)
  • Hi again,

    I saw the surgeon again today and now we get another story!
    He now says that I did have infection but that it has gone (heard that one before).
    He says the CT shows fusion (thank god for that!)
    He says the damage to my facet joint is probably as a result of the screw rubbing on it.
    He says the residual pain I have is probably from the loose screws.

    He said that if the infection returned he would take the screws out. He also said that if I can live with the pain of the loose screws that is better than having them removed but he will remove them if they cause me too many problems.

    So I am going to try going back to normal and see what happens. I haven't swum for 5 weeks so I think that might be a good test. The thing is I still feel quite tired but maybe doing more will help with that?

    So I guess - watch this space!
  • Hi Nel! I have thought about you so often (and my other spiney friends) and I'm just so saddened to hear that you are having problems.....

    Hang in there my dear, although I know it is easier said than done!

    There are a few options to help with pain that stems from facet joints if/when.....

    The other thing that I thought about is if anyone has looked at your SI joints. The facet pain and SI pain can often over lap, so sometimes it is trial and error.....

    I will keep you in my thoughts and prayers! Thinking of you! Shari
  • Thanks Shari,

    How are you getting on now? Still accident prone?

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