Shoreline

Hi Tim, It sounds like your doc is using every description to describe your pain without coming out and saying your fusion failed. Hardware is designed to hold things in place untill a fusion grows, once the bone and Donar bone grows the hardware should be comletely reducndent. However if the fusion failed, the hardware will continue to carru the load ,maintaing the disc space untill the hardware fails. Hardware isn't designed tolast forveer and it doesn't. Screws and rods snap, screws toggle in the holes and can pull out, screw head can shear off and the movement of hardware is very distinct, crunching grinding and squeeking, not the kind of symptoms you had before. he hardware may be preventing nerve impingement for now as long as it maitains the proper spacing but if the fsion failed it's just a matter of time untill theharware starts to fail. I've broken 2 sets of hardware from failture to fuse. I crucnh and squeek and grind but so far the 12 screws abd 8 rods haven't colapsed so they maintain the disc spacing and prevent nerves from getting crsuhed. However without the fusion, the hardware won't last forvery. It may take 1-2 years for signs of broken hardware to start apearung or it may take longer, it just depends on multiple factors, youir weight, the amount of stree you put on the fused area, theharware he used etc. But titanium hardware does and can snap, I', living prooff. Each time they went in to revise the fusion and replace the broken hardware I came out of surgery with ore of my spine fused and twice as much hardware. The last set is already fauiling anbut it took several years for the implanted bone for fusion to be reabsorbed. Otherwise, the standard felexion and extension Xrays that show everything is still being held in place either by fusion or by the hardware on it's leads docs to call failed fusion a success untill enough bone is reabsorbed or the hardware starts failing.

The last revison on me turned into a 12 hour surgery that doubled the length of y fusion to cover L1-S1. Screws pull out of my sacrum and LA, screw jheads are sheared at L2 and L5, there is no bone left after 5 years that they implanted and the only thing keeping my spine from topling and shearing off nerves or damagng the cord is the remmaining hardware that hasn't broken yet.

If hes' talking about mechanical pain in that sense, you either lean to live with it and mask what you can with meds, but regardlessof the dose of meds, when a screw pulls half way out and you can't get it back in the hole the pain is crippling and you can'tmask it with meds.. I feel like I need a rubber mallet to smack the screws in my sacrum back into my place.

The implanted stims are for nerve pain,I haven't heard of them being used for muscle pasm or pain, not that irt's going to make a failed fusion grow,. There are implanted bone browth stims but hat;'s usally done at the tinme the revise the fusion. So i really don't know what he's talking about as far as muscle sim for spasm.

If you staill have nerve pain or radicluopothy "p[ain running down your eg, he's likely taking about a spinal cord stim. Again it's just a tool to mask a muych greater problem, the lack of fusion and stability. The hardware only last so long before you through a rod, snap screws or pull them out when you bend forward. Stengthening your core muscles help with stability but without a fusion and once enough harware starts snappjng the fused area can loose all stabiltiy and you can develop mechanical problems that involve the movement of vertabrea When vertabrea shift out of alignment it's called spondyliotheises or retrothesis, dependiong on which direction they slip, once this occurs it stretches or compress nerves and can eventaully lead to complet toppling of vertabrea called spondyliotopsis.

Afte the last 6 level attempt, my options are either learn to live with it and the pain or try agan and have the fusion revised again. A 4th surgery to replace the broken hardware, revise the fusion by atempting a global fusion where an anterior aproach and posterior aproach is taken is my only surgical option. The discs would be completely removed, replaced with cages, They would remove a rib from each side and extend the fusion from L1-S1 up to T10 and then run a cross bar from hip to hip to build an posterior ladder up my spine that suported by the cross bar rather than the 2 screws that toggle in my sacrunm and hope this surgery doesn't leave me in worse condition.

The last 6 level fusion reviision left me bed wridden for almosty a year and nobody would admit this fusion failed untill hardware started snapping again. The odds of a succesful 4th surgery iinvolving 9 levels is so outragous, the odds are actually about 150% chance of failure. If you think thngs can't get worse than they are know, your very mistaken.

So mechanical instability could be referring to the hardware or refering to the actual vertabrea. Vertbrea interlock with facet joints and slippage or movement that's unnatural is also considered a mechanical problem. The spine itself is a mechanical mechanism that everything has to work properly or you have problems. So It's hard to say exactly what your doc means by mechanical dysfunction, Sounds like a nice way to say the surgery and fusion failed and it's just a mater of time untill the hardware fails if it's not already failing, snappjng, cracking, togglling or bending.

Hopefuly the PM doc will be a little more upfront and give you a DX you can actually investigate and consider your options, whether it's surgery or trying pain management. But the goal of pain anagement is never complete relief and you will remain unstable untill the problem is corected. Either through more surgery and new hardware or a different aproach to fusing like anterior instead of posterior or combinging the two methods.

Good luck, Dave