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Looking at hardware removal. Really need help

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:21 AM in Back Surgery and Neck Surgery
Hi everyone, I'm new here-1st post :)

To start off, I was in a car accident when I was 15 and fractured my vertebra. I had a spinal fusion of t12 to L3. I'm not completely sure of the vertebrae fused-it could have been up one, but 4 were fused together with a cage and screws. The fusion was successful.

I'm 21 now, so it's been almost 6 years since I've had the surgery. I have had lower back pain since, but nothing like lately.

For the last two, maybe three years I can't stand for more than 2 hours at a time without absolutely having to sit down and rest. I can't pick up more than 20 pounds, and that's with perfect posture. I can't do anything with my hands thats above my head or out in front of me without regretting it later.

I have these muscle spasms that leave me on the ground. This happened to me at work a while ago and I was laying on the floor crying and I couldn't move or do anything to get it to stop. No matter what I'm doing, even if it's just laying down, my back hurts or is uncomfortable. It is so frustrating. I don't feel like a 21 year old at all. I'm afraid that I'm going to be in a wheelchair by the time I'm 40.

I've done physical therapy and exercise. I was recently put on Flexerol, which works great if I wanna take a nap. Muscle relaxers aren't a long term solution for me.

This post is getting long, but it feels good to tell my story to people who actually understand what exactly I'm talking about.

I feel as though the root of my back problems comes down to the hardware. I can FEEL the hardware all the time, and I feel like it's rubbing up against soft tissue and causing pain. I'm very small, and I've read that other petite people have the same problem. So I've talked to the surgeon who did the surgery and I've talked to my insurance company, and the surgery to remove hardware is a definite option.
The surgeon said paralyzation is always a possibility when operating on the spine, but I have not found anyone that this has happened to. Has anyone?

I'm also worried about any other bad side effects-like worse pain or fused bone breaking off.

This surgery seems like my last option for a normal life so I want to be optimistic about it, but I don't want to be ignorant about it either. If anyone has been in this situation, will you please share your story with me? I want to have as much information as possible before I go into this.

Thanks a lot guys, Andrea



  • Im going in to re do my surgery. But as you know there are a few that have had removal.
    Has there been a new MRI showing anything new?? As in any new buldges , arthritis, scar tissue, any type of disk changes in any areas???
    Just wondering as personally I would not want to jump into removal till you knew the actual issue. I still feel my hardware to sometimes. but mine is low.
    I wish you the best of luck in what you decide. I wish I had more info for ya on removal hun.
    I feel your pain and being uncomfy I am here with ya right now.
    2 hrs of sleep then up a hour then sleep then up. When does it stop?? Not sure of that answer. But it sure is uncomfortable so I feel for ya!!!!!!
  • Do you have a Neurosurgeon? I can't tell from what you have said if you have had any testing or films done, I suggest you have a long talk with a Neurosurgeon, get an MRI, get a discogram to pinpoint where the pain is coming from - test test test and really make sure you have identified the real problem before going under.

    Good Luck
  • Hi Andrea. Here are my thoughts and also my story, as I have been through having my hardware removed.

    Spines being such complicated structures your ongoing pain could be due to a whole range of things. One thing that I have learned from being on Spine-health.com for 18 months, and doing a lot of research is that achieving a successful bone fusion does not necessarily equate to a successful surgery in terms of significantly reduced pain all it means is exactly what it says successful bone fusion. Unfortunately, the medical profession seems to rate the success of fusion surgery by measuring the success of bone fusion and not by how well the patient actually feels – a major anomaly, patient pain levels don’t seem to figure into the equation.

    My suggestion would be to find a spine specialist and push him/her to start really exploring what it is that could be causing your ongoing pain, rather than simply saying ‘well you appear to be fused, so you should not be in so much pain”.

    There could be many reasons for ongoing pain, even if you have fully fused:

    • Hardware-related issues causing pain (as I had)
    • Further disc herniation(s)
    • Bone spurs or other bone growth related to the fusion surgery impinging on the nerve roots or on the spinal cord (did the surgeon use BMP [Bone Morphenic Protein] when he fused you?).
    • Scar tissue (deep down)
    • Facet joints
    • …the list goes on

    There are lots of tests and things that a specialist can do to identify or rule out all the above. For example a plain x-ray will usually identify broken hardware, displaced hardware, bone fusion success. An MRI should be carried out (if you have not had a recent one) – since you have been fused and therefore have hardware in your back the radiologist would be expected to inject into you a contrast dye to make it easier to see your discs, nerve roots, vertebrae, etc., as the hardware can somewhat cloud the MRI.

    Special injections can be provided around the hardware (around the pedicle screws) to identify whether pain is emanating from the hardware.

    A little about my case……

    I was not injured – my condition was congenital. Interestingly my mum had spinal fusion on here lumbar spine too, in 1972, so I guess I might have inherited some bad genes somewhere along the way.

    I had severe degenerative disc disease and severe bilateral foraminal stenosis at L5-S1 and was living with constant back pain. While I did have some sciatic pain down my right leg, my back pain was, by far, the worse problem. The pain was a constant ache right across the lumbar area and down into my buttocks when it was bad.

    I had been through several rounds of physical therapy over the years but it did not help at all and I got to the point where a top surgeon in Singapore (where we have lived for the last 14 years) who is not scalpel-happy, recommended surgery. My physical therapist also recommended surgery. So, in Dec 2006 I had a laminectomy and fusion of L5-S1.

    Immediately after the surgery I noticed a major improvement in the back pain – basically it was gone, except for the surgery pain from the incision and cutting through the muscles of course. I had considerably my sciatic pain down my right leg, as he had to move around the nerve roots to clean up the bone and some bone spurs around the S1 nerve roots. This was hellish during the first 2 weeks but settled down after that and finally disappeared totally after several months.

    I commenced basic back stretching exercises at home (like knees to the chest, and such) after 4 weeks under the direction of my surgeon. I still had some pain around the surgery area and while it was getting less it was not going completely. I started a properly structured back rehabilitation physical therapy program at 4 months and was making progress but I still had some pain around the surgery area and lower down in the buttocks.

    The pain was localised – I had a sharpish pain around one pedicle screw always and particularly when I bent forward. Also I was getting some sciatic pain in my right leg back. My surgeon ordered a plain x-ray and from that he could see that one pedicle screw had come loose and moved and was now also impinging on a nerve root, so this was causing the sharp back pain and sciatic pain. So, I stopped PT at 6 months (after 2.5 months of PT) and because my surgeon had determined from the plain x-ray that my bone had fused well, he removed my hardware at 7 months.

    The removal surgery was also major surgery – same sized incision, same muscles cut through, but I was walking the next day and at home after 2 days. I went back to work (sedentary desk job) after 2 weeks. I recommenced my PT rehab program and continued with it until 2 weeks ago (basically one year of weekly sessions).

    To say that my recovery was easy would be a lie. It has been long and tough but it has been relatively smooth. Yes, I did trek up a 14,000 foot mountain 3 months after my hardware removal surgery and my back stood up to it very well (I wore a back support during the climb, but never wore a back brace after surgery). The forma PT back rehab program is what I believe has got me to where I am today. I can go for days and days with no back pain whatsoever and when I do get back ache it’s muscular only and from over exertion (like lifting something too heavy) and I have not needed to take any pain medications.

    The only time that I do get back pain related to my initial condition & surgery is if I lie flat on my back for any length of time, but as I always sleep on my side its not a big issue.

    During my 18 months of recovery I did have all sorts of new problems arise along the way, related to the surgery (apart from the hardware problem I mentioned above). This kind of surgery does alter the geometry of your spine slightly and this does put new stresses on other joints. One was in fact caused by my sacro-iliac joints, which is very common in people who have had lumbar fusions and can manifest itself as lumbar pain making people think that their fusion is causing the pain. Once my physical therapist identified the SIJ pain she worked on the SIJs over 2 or 3 sessions and cured that problem. I also had a lot of thoracic muscular pain but again, my physical therapist fixed that.

    I also have extremely tight hamstrings and this will also adversely impact upon your lumbar spine. A lot of time during my PT was devoted to stretching my hamstrings and calf muscles and building strength in the legs, including the psoas muscles, but the major aspect of the PT has been to get motion back into all spine joints and most importantly build core muscle strength to adequately support the back.

    I cannot speak highly enough of how I think that an extended PT rehab program helped me immensely and how extremely important it is to work with a good physical therapist during the entire program – he/she gets to know you and your body extremely well and can tailor the session to suit how you are on the day, as well as dealing with problems (e.g. SIJ and thoracic problems) that arose during my recovery. Not to mention giving you emotional support when you need it.

    So, I hope that this helps you in some way. As I mentioned earlier I think that what you need to do is find a specialist who is prepared to work with you to identify the root cause of your pain – once you have done this then you and the doctors and focus on pain management options.
    Keep positive!


    ...an old timer here and ex-moderator

  • WELCOME!!!
    Getting a MRI is a great idea. Maybe by ruling out other possibilities you'll feel more comfortable if you do end up having the hardware removal done, you'll know you've ruled out anything else.

    Obviously if it's not the hardware you'll still have this going on and will go through that intense surgery for nothing. I think if your surgeon is insistant on hardware removal only you might get a second opinion. Your surgeon should want to make sure as well.

    I don't diagnose as it is a doc's job to do so but if you were fused down to L3 the 2 levels below maybe now are acting up and are showing signs of taking the extra beating.

    Good Luck and glad to have you here keep us posted on what happens ok?
  • Thank you so much for the replies, they were really helpful.

    So here's some more information and an update:

    I was fused from T12 to L3 using bone from my hip.

    I called my surgeon to try to schedule a MRI and the nurse called back and said that an MRI wouldn't be helpful because it acts like a magnet, so it wouldn't show anything more than the x-ray. Basically she said that since there's so much metal in my back, an MRI wouldn't do anything.

    I have had x-rays taken about 6 months ago and it showed that the fusion took well and everything looked okay.

    I really want to make sure that there's nothing else wrong that could be causing problems before I do anything else.

    Oh, and just so you know, my surgeon is not pushing hardware removal at all. He said that he never recommends the surgery because there are always risks.

    So I have an appointment with the surgeon on the 21st to go over things and see if there are any more tests that can be done. Does anyone have any suggestions on tests that can be done or anything else I should ask while I'm there?

    Thanks a lot, Andrea

  • I have read everyone's stories on what they are going through. Some I feel is like what I am going through. I have searched and spent a lot of time with my pain doctor who I have been seeing for over a year now. I did go back to Texas Back Inst in Plano, where my surgeon is. He fused my L4-5 down to the sacrum. I have screws, rods, bone, and pedical screws. If I barely lean forward I get a horrible pinching. I am also having severe tenderness across the lower back/SI Joints. All the doctors I have been to said the hardware looks really good. However, I am stuck with chronic pain. My pain doctor says I have post lumbar laminectomy (nice way of saying I had failed back surgery). My surgeon said I had a lumbar strain since I started having this pain 6 months into the fusion. I had it on 1-10-05 and still in a lot of pain. I have exhausted pain managment. Went through a spinal chord stimulator and morphine pain pump trial. I went to the Mayo Clinic 1-12 - 1-16. Physical med doctor said I had chronic low back pain and Myofacial pain. Neurosurgeon said I had failed back surgery. I asked him why as I do not have to use a walker and I was a lot better. However, I am stuck with a severe pinching pain when I barely lean forward, bend, sitting still an issue, only able to stand for a minute, fells like i am going to fall down if i stand longer in one place, if you touch my skin near the tail end of my scar..it is severe, my left side/back of ribs are painful to touch, my sides of hips are painful when i lay down on a table on them and it cripples me to get up, back of my legs go numb, feet are still numb, if i trip over a rug, i scream as you can feel the nerve pulling, massages are unbearable and make me cry in the lower back/SI Joints, Sacroliitc/buttocks. No one realy seems to have a truely answer. I have asked them over and over..could it be the hardware. My SI joints look good in x-ray, bone scan, MRI. Also, I have had a mylogram and looked good. The neurosurgeon said my pain is in the soft tissues and it is not the structure of the back anymore due to nothing new showing and I told him my pain now is different than before the surgery. (Myaliga pain) Does anyone have any suggestions. My pain doctor only does manual thepary due to the chronic pain...I am in the need of answers. I am 30 years old and I feel so old that I am ready to go to the nursing home.
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