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Spinal Fusion Surgery with Implanted Hardware

The journal Spine has published an article questioning the use of implanted hardware in spinal fusion surgeries for back problems. The Spine study found that the implantation of hardware does not improve results. The authors also determined that the hardware carries a higher risk of complications, including infections which can occur more readily and can also be harder to see because the hardware can block a clear radiological view of the spine.

surgical decisions

Decisions about surgery are tough on any patient

The other problems is the hardware surviving over time.  When screws, plates or rods break, the results can push right on a nerve and the pain can be awful.

It is hard to offer a lot of opinions on this without seeing the study. (Oh, yeah, and the not being a spinal surgeon part.) Also, this is just one study. But in our practice we see a lot of disc injuries and other types of back complications resulting from trauma of a crash.

Rarely does hardware seem to be a magic elixir for the patient. Nor does multiple surgeries, which many times do not have a better outcome than the preceding surgery. One of our lawyers has an auto accident case in Baltimore where the client is on his 8th back surgery (no prior back complaints before the car crash). Just awful. But that is not to say that it is not medically indicated because sometimes you would rather have a 20% chance of success than a 5% chance.

The Good News

That’s the bad news. The good news is spinal surgery has come a long way. Not that many years ago, spinal surgery required a large incision and the patient was left in a body cast for six months to a year. Just last year, a spinal surgeon at the University of California performed one of the first minimally invasive spinal surgeries in the U.S. using a new technique to stabilize the lumbar spine called axial lumbar inter-body fusion. The fusion requires only a tiny incision in the back and can have patients up and walking with little pain within hours of leaving the operating room. Absolutely incredible.

Interestingly, the fusion is done in the front of the spine without having to go through the abdomen. The technique was developed 5 years ago by an interventional radiologist. The first surgeries were performed in Brazil, where 33 patients have been operated on since the technique was introduced there in 2003. The Food and Drug Administration (FDA) only recently approved the procedure for use in the U.S.

Who knows what the long term prospects for these patients will be? But many of the early returns have been very positive. Hopefully, the next ten years will provide a lot of relief for patients with chronic back pain.

Do I Really Need Back Surgery?

This is a section I am adding in 2014 because so many people are looking here and everywhere for answers.  I am not a doctor.  I’m speaking as a lawyer who has talked to hundreds motor vehicle accident patients with back problems.   This is not the take of a medical doctor.

Clearly, you should do what your doctor tells you to do.  The problem is that doctors rarely tell you that you need surgery and, when they do, it often contradicts what another equally qualified spinal surgeon tell us.   But the more common answer is that back surgery is a challenge, it can fail, and only you know the pain you are going through and only you can balance that pain against the risk.  This is not a lot of guidance.

I don’t have the answers.  But one key question to ask a surgeon is whether waiting for the surgery is going to make your injury or your prognosis worse.  Is delay causing you risk or is the reason to avoid the delay limited to the pain you are experiencing?

Ultimately, I think the key is to talk to more than one doctor not about what you should do but why you should do it.  In the end, you have to digest that advice and then follow your own heart.

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  • Patsy Mullican

    In September, 2006, I had my 5th back operation. This time discs were removed and replaced with artificial discs. Fusion was done at the L3-L5 level. For the first 5 weeks I was in awe. I felt absolutely wonderful. The surgeon was amazed but kept giving me these looks like I had lost it or something. Starting about week six I started having odd sensations in my legs, numbness, tingling, etc. It went to my feet. My feet started aching like I had been running on large rocks barefoot and burning. I went back to the Dr. and was told this was normal for post surgery and that before I was abnormal. That was in October. Since then it has spread over my body. My ankles ache all the time and swell. My knees feel like they are going to explode in the mornings. My hands are semi numb and tinglle all the time. My thumbs swell and are extremely painful. The pain radiates to my elbows and to my shoulders. Pain medication does not touch it. I am constantly rubbing them down in the lidocaine cream. IS THIS NORMAL? (My pharmacist says this is my body trying to accept the foreign material in my body.) IF SO, HOW LONG WILL IT LAST? Has anyone else experienced this? Please advise. I feel like I am going out of my mind, I can’t do anything.

  • Ron Walsh

    I have had a laminectomy, and after a few years the pain returned in earnest. After dealing with the pain for more than a year, taking numerous medications, I had a spinal fusion at the L4-S1 level. It has been almost three months since the surgery, and while the pain has abated some, I still have problems with pain and numbness through my lower back, buttocks and down my left leg.

    My doctor (Veterans Administration Surgeon), tells me that I will probably have to live with the pain, or face yet another surgery.

    I don’t think I can go through that again, but I guess if the pain gets bad enough, I will do what I have to.

  • Carmen Nazario

    I had 3 disc fusion C (5,6,&7)with a titian plate and six screws. Six months later I developed a herination in C4. Can this possibly cause carpal tunnel syndrome? Please response.

  • ivan holod

    well being a person that has had 2 spinal fusions and a number of screws put in my spine .after having 900kg land on me form a work accident im glad that there is a new method of easying our pain

  • Vicki Hansen

    I am fused on 12 levels. I’ve been on Dissability for over 3 years now from a work-related injury (lifting low level and twisting at the same time). I have had 2 back surgeries. The first was the mother of all invasive surgeries, it involoved an anterior entry as well, and the placement of 28 pieces of hardware (what was this Dr. thinking?) After an entire month in the hospital where the BEST part was the variety of roomates, I went home with an addiction to morphine and a real bad attitude. 10 months later, I had all of that hardware removed and replaced with donor bone, and my back, most of the time, feels like a million bucks. Now, let’s discuss all of the complications from (not the recent, surgery) but the first surgery.

    The blog from Patsy Mullican caught my eye, since one of the problems I still have is the burning/tingling/stabbing in my right foot due, supposidily, from the siatic nerve irratation during surgery. It’s not so much painfull as it is bothersome, and prevents me from sleeping. Anyone out there who is not a good sleeper by nature can relate, no doubt, to this situation. I take Neurontin which works, so far, to keep it under control. Sometimes, no matter how many doses I take, it doesn’t work, but usually it does, providing I take it exactally on time.

    The second worst of all post surgery complications, by far, is the de-nervated area of my abdomen (like a big hernia that wraps around my side going from front to back) It’s unbelievabally painful feels just like my guts are going to fall out. If I catch it in time, I can manually push (my guts) back in to some degree, and bend/stretch really hard over my opposite hip.

    Enough rambling about my complications. Absolutely the worst is the narcotic addiction. I’m very proud of myself for overcoming my addiction to oxycontin (cold turkey, one of the hardest things I’ve ever done, including childbirth) both mentally and physically, even if no one else in my family cares. Now I face the final addiction, that is to withdraw completely from narcotics (percoset/nucyenta)which I’m not looking forward to at all, but will take place with-in the next couple of months. I need help and support with this, and that’s probably why I’m here on your site. No one in my family understands addiction, they all just smoke pot and drink beer. So, in short, everyone’s normal and happy but me. You would think that after having to live for 54 years I would have figured it out by now, but no. signed,
    lost

  • Dianne Lauf

    The key is having the right neurosurgeon. I was quickly losing my ability to walk, stand, and even lift a plate of food. Dr. Srinath Samudrala performed a perfect anterior cervical discectomy and fusion (ACDF) and I reclaimed my life. I experienced no pain following surgery or for the past 2 years. We need more neurosurgeons with the insight, talent, and integrity of Dr. Samudrala.

  • Monica Griffin

    I had PLIF in April 2010 L4-5(bone graft & hardware)I am about at the end of my rope! I hurt more now than I did before surgery and I just don’t understand it… I had a great surgeon that I trust did a good job and keeps saying I am doing fine! I am off Oxy and on hydrocodone 2x a day and he is dropping the pain meds with each visit. I am not even in physical therapy yet and the bones are NOT fused! I can’t sleep and walking, bending, stooping etc are very painful. Is this normal 4 months post op? Someone please reply! I need to talk to someone that understands this… No I am not working or driving yet and just stay in the house all the time!

  • Sara

    This is to Monica. You are not fine and your Dr. is not doing you any favors in reducing your pain meds. He’s only covering his a$$ because he/she wants you to think you are OK. Find a pain management Dr. and try the epidural shot. This doc will also prescribe the proper pain meds so you can function.

  • http://www.saspine.com Orthopedic and Spine Institute

    I agree with Monica You are not fine and your Dr. is not doing you any favors in reducing your pain meds. He’s only covering his a$$ because he/she wants you to think you are OK.

  • Jason giacalone

    After 2failed back surgeries one of them being a multi level fusion I still can’t do anything at all..I can barley walk and have a severe limp now.. The pain it self is unbearable and I havet sat down in a chair for over 2 years or ate a meal sitting down either. I can’t bend sit run sleep or even go to the bathroom the same way…. I’ve been too 4 doctors since the surgery and they all told me there’s nothing they can do for me just pain mgmt… Has this happen to anyone ? Could it be the doctor messed up? Cause that’s what a few doctors implied just don’t kno what to do

  • sissy green

    I had c6 and c7 fussion and also L4, L5 and S1 I have been fighting the pain, for three years and not getting any relief, I have osteop. and scoliosis, and spondolitheis, My Doc to my pain killers hydrocodone,and gave me tramidol. said I was to young to be on narcotic, I have tried the epodural injections did not work I filled for my disability three years ago was denied twice.

  • pat

    Hi in dec-10-2010 i had 3 level fusion and one decompression.one week in healing good then the next week im taking 2 steps back.im walking almost 2 miles aday but still having some burning in my feet.im not taking any pain meds at all..this is going on 8 weeks after surgery…cant do alot around the house and car rides mack me sore…how much longer will this go on ..any heip i would i would be very thankful for you help

  • Beverley B. Shoemaker

    I can sympathize with each and every person who has posted a message on this board. I developed scoliosis when I was in junior high. The curvature kept increasing, so I decided I had to have it repaired at age 54, as the pain was increasing as well.

    In Nov. 2009, I had anterior surgery on L4 and 5, in which the surgeon placed “cages” where the disc material was removed. Three days later, I was fused from the posterior from my sacrum to L1–9 levels. I was in the hospital (Reston, Virginia) for 8 days. I had to be medically transported home, because I could not stand without extreme S/I joint pain.

    My surgeon, Dr. Christopher Good, of the Virginia Spine Institute, performed my 10 hour surgery. I feel confident he is an expert in this field of scoliosis repair. In addition to the two cages, I have two titanium rods plus 34 screws.

    Dr. Good would not allow me to bend or twist whatsoever, as to allow the graft (donor) to heal. He had said I would have to follow these instructons for a year to allow for complete fusion.

    He said I was doing so well in my recuperation, he allowed me to “do my thing” at eight months. I did five months of physical therapy afterwards.

    I can only bend at my hips. My leg muscles have tightened considerably. The scoliosis, stenosis, arthritis pain is gone, but I still have numbness across my lower back, and in my right leg. When low pressure moves in, I feel quite terrible at times, as though I have the flu.

    It’s a toss up as to whether I think the surgery and excruciating pain was worth it. I am only truly comfortable while lying down or reclining in an easy chair. I also have myopathy now. The muscles around the rods have become permanently contracted, which is very uncomfortble.

    I was using a fentanyl patch with dilaudid as needed for breakthrough pain pre-surgery. I now take six 5-325mg percocet.

    Think long and hard before you make the decision to have surgery. The loss of range of motion has been my greatest challenge. No more golf, gardening, horseback riding, playing in the ocean, sitting comfortably with family and friends, or playing with my future grandchildren on the floor. All the things I loved to do are now forbidden or I fear to attempt.

  • Ellen

    I had a spinal fusion on the T11/12 the dr. made a mistake and pulled the L1 disc as a result I have extra screws and rod. I have not had any relief from the surgery and pain is now worse. I am still taking lortab and it doesn’t help. I am told be the last mri that I am completely fused. Is this normal to be in so much pain? My surgery was on 11.2.10. My dr. was real compassionate at first and now had his assistant give me the results of the last mri. I have had no physical therapy. Any suggestions?

  • Debra

    It’s surprising such a high percentage of people don’t seek non-surgical treatments first. Sometimes they work, but sometimes spine surgery is inevitable. Solutions can’t be rushed and there is no need to foolishly undergo surgery.

  • Brenda Hess

    I’am 57. Have went to 5 drs about my back. I have scoliosis,stenosis,disgenerated disc. The pain in the lower back is so unbareable. Some days I feel like heavy weights on my back and down both legs. Yes,I still trying to work. I’am single and trying to survive. I’am told that 5L,4L,3L, and 2L thats needs 4 rods and under 2L they will put a bracklet. I know of 1 person that had this done. He has 2 rods and still in a lot of pain. I’am so glad I found this site. I guess I will deal with this pain. I have tried the shots, chiropracters, exercises,and everything I can think of. God bless you guys. I do know what that pain is all about.

  • Mary Cahill

    In September of 2010, I had a 360 spinal surgery for scoliosis, spinal stenosis and degenerative disc disease. My fusion was from T-10 to S-1. I have rods, multiple screws, etc in my back. I am 74 years old and had gotten to the point that I was in such pain that I had to do something to remain functional. I was in the hospital for 5 days, and in rehab for 3 weeks. had in-home and outpatient physical therapy. I wore a brace for almost three months. The post-operative pain was excruciating, but gradually I was up and about in relative comfort. I went back to work in 12 weeks but was still taking pain meds. It took me a long time to be happy that I had the surgery, and while I have my days when I am in a lot of pain, I can control it with lidoderm patches. The most painful areas have always been and continue to be my buttocks where I have screws to anchor the rods. That has gotten much better and I just take tylenol. I will probably never completely pain free because of the extent of my surgery and my age, but I am grateful that I am able to move and work and get around. I doubt that I will ever have the screws removed, as has been mentioned by my pain management dr. The discomfort gets better as the day goes on, but mornings are really bad. I had this extensive surgery because I didn’t want it done in stages. I wanted it over with.

    I would really like to hear from someone who has had similar surgery to see if this is normal. The pain I have now is nothing like the pain I had before I had surgery, but I am 18 months post-op and I guess I thought I wouldn’t have any pain at all. I work 8 hour days on my feet and I couldn’t do that before surgery. I hope to hear from some of you. Thanks

  • robert

    am only thirtyone years old. I use to be extremely active in sports and have worked in manual labor since i was seventeen. have had to failed “microsurgeries.” about to go in for a fusion in a little over a month. little bit confused about the hardware. after hearing some stories would just like some type of advice from people who have gone through it

  • John Robert

    Hello to all of you and I have come to know how chronic pain as an every day part of my life. I originally started having lower back problems in ’03 and went to a clinic for Spinal Disorders in Thornton, CO and they did a Lapro or partial disc removal to get the remaining disc material to go back under the vertabrae. I must say I had to continue medicinal therapy along side of rigorous physical therapy and buying a EMPI 300pv High voltage neuro stimulator with pre-programmed settings for muscle re-education and seconds as a tens unit. For the next three years, I used the unit and, even tho I moved from CO to TX, my back problem got to the point that I had to end up with a posterior fusion on the L5-S1 area with donor bone used to re-create the gap between the vertabrae on 4-4-06. Upon coming from under the anestesia, I found that the issue I had with just one legwas now going thru both legs. The same can be said today and it debilitates me to the point to where I HAVE to seek pain management soecialists help. Here lies yet ANOTHER problem. Coming from such a small town in MS, it is virtually impossible to get ANY kind of medicinal help. Since I no longer have insurance and am a self-pay person, the shots I got… i.e. Epidural Steroidal Injections, trigger point injections, and nerve block injections have all failed to lessen the pain I feel 24/7/365.

    It has been just over six years since my fusion and I have been diagnosed with Failed back surgery Syndrome… i.e. the screws used were TOO sharp and have eaten their way thru both the L5 and the S1 bone.

    I am really at my wits end with all of this and am begging for SOME kind of help!!! I dont want to end up in a wheelchair because I love being outdoors and also love how it makes me feel. Taking this away would definately compromise my life, my marrige, and my ability to be as self-sufficient as I currently am.

    Is there a program that helps persons, such as myself, that I am over-looking because I have made over 100 calls this last week alone to Doctors, pain clinics, and Gov’t funded assisted programs but, all have fell short and/or are too expensive for initial visits. I am in REAL need of assistance and don’t know where else or who else to turn to.

    Thank you for youe time and all feedback would be greatly appreciated.

    Regards,
    John

  • Carol

    I am so sorry that I followed the lead of my referring doctors into surgery.

  • linda barrett

    Yes I CAN HEAR EVERYONE IN WHAT THEY ARE SAYING. surgery sucks.

    I Had bad surgery 9mos months ago. And nothing has changed. Infact it is worse for me. I KEPT HAVING a problem with cyst growing on my back. Dr. removed one. And a another grew back. The size of a cherry. SO HE told me to prevent them from coming back ever agin. Was to put six screws in my back two rods down my sides. AT First I was totaly against it. BUT The Dr. and my husband talked me into it. I was ready to be wheeled in I SAID NO! MY HUSBAND TAKLKED TO ME TIL I WAS BLUE IN THE FACE…TNEN I GAVE IN WHICH TO THIS DAY I WISH I HADN’T. I HAVE HAD NOTHING BUT TROUBLE EVER SINCE… A LOT OF PAIN GOING DOWN BOTH OF MY LEGS. HURT ME 24-7. ALL THE TIME. NO REIEF WHAT SO EVER. SO I KNOW WHAT YOU ARE TALKING ABOUT JOHN.MAYBE IT DOES HAVE SOMETHING TO DO WITH DONORBONE USED ON YOU. IS WHY YOU LEGS HURT SO BAD. LIKE THAT ONE LADY SAID, I DONT’T KNOW BUT IT SOUND GOOD AND IT MADE LOT OF SENSE TO ME. WELL GUESS I’LL HAVE TO JUST LIVE THE REST OF MY LIVE OUT IN PAIN.WISH I NEVER HAD IT DONE. TO LATE FOR ME ANY ANSWERS??????