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hardware removal at L4-L5, then Fusion at L5-S1

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:32 AM in Lower Back Pain
I have now the opinion of two docs and still have so many questions. One of them (Dr. M.) wants to leave the hardware in - that has two loose screws he continues to overlook (two docs confirmed they are loose) then fuse at L5-S1. With Spacers

If I go with the 2nd doctor (Dr. L.) who will most definitely take out the troublesome L4-L5 hardware - what will happen to that weakened area?? Then put in hardware at L5-S1 - won't that put pressure on L4-L5?

I will be asking the Dr. L this when I see him next but seeing how I am an R.N. and worked in the Recovery Room, I.C.U. and other areas my brain starts going over the logistics of it.

What do you guys think?


  • I would think that your doc would do as mine has and prepare the hardware for the level being targeted and additional hardware for the loose area. Once in, evaluate the stability of the spine in that area and make his determination and go from there. There's just so much that cannot be seen or properly evaluated via imaging studies. Some of it just has to be plain old hands on.

    I would say it's best to go with the doc you have the best intuitive feeling about and sit down and discuss this in length.

    Since you work in the recovery room ICU, you must have seen the results of many of these types of surgeries and maybe even these surgeons. It may or may not be an advantage for you. Sometimes too much information blinds us to the simple truth.

  • I was always told that pulling out any hardware was a last resort and something that needs to be considered very serious.

    I would definitely keep checking with other docs and be very cautious about pulling out any pieces. But there is always the option it is really what you need since it is not doing the job.

    I don't tolerate the docs that overlook important details and who don't listen. We're talking back surgery here! I notice that with most docs. They have an answer before they know your entire story. It's like they should be on some 1-800 physic hotline.

    Keep asking around to confirm his recommendations and good luck!

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  • I've known several people who have had hardware removed and been far better off because of it. Especially loose or broken hardware. Have you had a bad experience with this? Just curious as to why you would hear something totally opposite of what I've seen and heard. This is news to me.

  • No I have never had experience with it and don't know anyone that has had it done. So please take my comments with a grain of salt. I was just sharing what I was told.

    The two neurosurgeons and two PMs that I have talked to since surgery told me that pulling out the hardware was a terrible idea. My PM sees a lot of people and he seems pretty sharp. He said it would be a very, very bad idea to even think about for many reasons. I didn't ask him to elaborate since it seems to be all everyone tells me.

    Like I said I don't know anyone that has pulled it out. My sources may not be the best and because of what they said I have not looked into at all.

  • Moderator Bruce is someone here on this forum who has had great success with hardware removal, if you wanted to talk to someone first hand. I understand not questioning it any further if it wasn't a personal concern when you talked with your doc. I was just curious, since I've heard and seen nothing but good things about hardware removal.

    Thanks for getting back to me on this.

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  • Hello,

    I had a 360 done in Dec. 2008. which is a posterior/anterior back surgery(which was my 3rd back fusion). I had hardware removal of L4-L5 due to the L4 screw going through my spinal canal and my L5 screw 1 cm out of place. The doc then did a whole new fusion L3-L5. I must say my back does feel better now. I do have permanent nerve damage at the L5 nerve root though. I will always also have some back pain. If you have any questions please pm me.


  • I wondered what your symptoms are with your permanently damaged L5 nerve?? Please be specific, if you don't mind.
  • Hi Gwennie,

    I don't mind to answer your question. I have bladder problems due to my nerve damage in my back. I cannot tell when my bladder is full or when to use the bathroom. I also have RSD in all of my limbs. If you don't know what RSD is this is a great website www.rsdhope.org If you have more questions for me Qwennie would be happy to answer them.


  • I've had the fusion surgery, doc left in the loose screws and device (Dynesys). So now I have L3-S1 Fusion and he left that piece in (June 15/16 Anterior & posterior approach). I have peripheral nerve damage from before the surgery and it was healing but now it's gone backwards. My feet and legs are much worse. Also, my back is absolutely killing me. I cannot stand the pain. I am on 10X the amount of pain medication and it doesn't help much. I used to only take oxycodone maybe 20mg - 40mg a day. Now I am taking 30mg oxycondone, and oxycontin 10 mg 2X day, Neurontin 600mg 4Xday, Naproxen Sodium (Aleve) Ambien and Lorazapam (my doc cut off - after the MJ thing - I am sick of celebrities scaring the doctors into giving inadequate care!! - not that I don't care that a human life is taken, but it takes it tole on societal response)

    Anyway I was told that when I first had the surgery I would have relief right away and this did not happen. I couldn't believe how bad the pain was and the feeling of the rods in my back, the pressure of that L4-L5 area with rods and that device the doc. left in. I was told it would get better. I walked and was sort of getting around a month after the surgery. Then my toe was broken and I was back to bed and this time elevating my nerve damaged leg with a broken toe - same side. I've had a broken toe before but with nerve damage it makes it 100 X worse! I am in so much pain - I am barely breathing, cry in pain everyday, can hardly sleep. I am worse than ever despite starting up walking again (it's been 5 wks since my toe was broken and it's not healed all the way but I am trying to see if I can get endorphins going and of course walking the best thing for the back). Regardless, the pain is relentless. So, my surgeon wants to take ALL of the hardware out September 14) I am scared and not sure what to do but I have never been in so much pain. I have heard good responses to hardware removal especially if the pain is so bad.

    Someone posted that because I worked in the Recovery room before I have seen these cases. Yes, this is true but I took care of them for an hour or so and that was it. I did not have a full picture of what was going on with any patient who had back surgery. Recovery Room is acute care. Also, being a nurse doesn't help a whole lot because I am inside of this body and it's hard to see out. Someone also posted that all of this knowledge can blind me - Yes! that is the case with me. However, I have been doing tons of research and I have learned that if the hardware is so painful that it's effecting one's breathing, the pain management cannot catch up to the pain and the quality of life is (in bed most of the time) then it needs to come out.

    I am scared and sick of this whole life of back surgery. I have had 4 now and I am only 44. So, the hardware removal will be the 5th one. I welcome any comments I don't care if you have medical knowledge. It's the ones who have this going on in their lives or others who know of someone who has back surgeries etc. going on. Please let me know what you all think. In the mean time I'm dying here. Thank you for all of your posts. Oh, yeah, I'm worried that the surgeon might go in my frigging body again and leave something in there, only to tell me that he could jar it out of my body. I cannot see another surgeon for at least two years - because I'm considered post op and fusion and complete healing can take up to two years.

    Sorry it was such a long post. Thank you for all of your comments.
  • I had the Hardware removed from my L5-S1 Fusion on the 2oth of Dec.2o11.(it was installed (6-06) And from the moment I woke up I could feel a difference. That golfball sized knot was gone from my back.Along with the stabbing sensation that went along with it.
    Don't get me wrong this still hurts like hell but it's a different kind of pain.I think it's probably just the surgery area itself because of its locality and the fact that it is getting better everyday.
    I actually sat behind my drums for a minute today and have pretty good leg strength back in both legs but I'm not going to push it for a while.I like the possibility that this may be the last of my severe back pain.
    This may be the best Christmas I've had in a long time.
    Anyway If this is a procedure you are considering I highly recommend it if your Doctor says it's cool to take it out.
    It really seems to have helped with my pain. I'll keep you updated.
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