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  • Pedicle screw removal???

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    Old 10-29-2003, 07:41 PM   #1
    angel1
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    Post Pedicle screw removal???

    Hey everyone,
    I hope this nite finds everyone well. If you dont know me you can read up on my history from my reply to LMVLMV's post 10-27-03 to gain some insight.
    I went to my Neuro today for my 3 mos follow up visit
    I woke up from my surgery with a "new" symptom. My left foot was totally numb. My doc said not to worry that it was not normal but he had seen this and was probably due to manipulation of the nerves during surgery. I have been on Neurontin 1200 mgs daily for about 1 1/2 mos now. I have been patient with this pain knowing that it takes awhile for nerves to heal if ever! ( pesky little things aren't they?) [img]http://www.healthboards.com/ubb/dizzy.gif[/img] Anywho, I have noticed that the longer I take the Neurontin the less effective it seems to become (pretty normal with me in anything that I take) I wish that I could say the same for the side affects of this stuff! During my visit today, My doc told me that it is possible that the 2 pedicle screws on the left side are touching a nerve there, but the CT scan and Xray's do not support this although my symptoms do.ie: severe pain across top of foot if touched, burning stinging sensations, etc. (please keep in mind that I trust my doctor 100%, he has always been completely upfront with me,I am extremely lucky) He also explained that because of the thin Myelin sheath's of my nerves it is possible that I may or may not recover from this.He suggested that since there is now bone growth [img]http://www.healthboards.com/ubb/t_up.gif[/img] that it would be ok to do this with hope that this is the problem. It could be but could not be and left the decision entirely up to me, I told him that I would have to think on this due to already having 2 surgeries since Jan. this year and so close to holidays and all. I have worked really hard just to get to the point of where I am now and this would certainly set me backwards. My struggle is this: 1) Do I have the surgery to remove the screws on a HOPE that this will solve the problem, and becoming pain-free: 2) Do I wait and see if this heals itself, (keep in mind this pain is close to the point of unbearable)and continue with the Neurontin which adds to my suffering with the side effects: Removing the screws at this point (new bone growth) He stated that he could do this without compromising the anatomical structure of the remaining hardware or my spine, if there were no bone growth he said that he would not recommend this procedure. Has anyone else out there had to have any of their instrumentation taken out? Or have you suffered this type of pain after surgery? What were the treatment options for you and what was the outcome? I have heard of the screws breaking and having to have them removed or replaced and I have heard of the screws being inserted incorrectly but this is not the case for me. He did tell me that sometimes the nerve can be hidden on the scans and xrays that would not show depending on how the radiologist took the pictures therefore creating a seemingly "normal" scan. I would greatly appreciate any input you guys would have on this, not looking for anyone to make this decision for me, just curious of your thoughts!
    God Bless
    Angel
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    Old 10-29-2003, 09:18 PM   #2
    L5S1
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    Hi Angel

    I had partial hardware removal (right side only) 7 months post-op fusion and currently deciding about having the left side hardware removed.

    First, I am suprised your doctor is discussing hardware removal or adjustment at 3 months post-op. Normally, the doctors do not want to perform any additional surgeries until at least 1 year post-op unless there is a fusion failure. I was fortunate that my ortho decided to remove my hardware because he could not see the loose screw on the x-ray. He told me if he performed a exploratory surgery and I was not fused, he would have to put in bigger screws. As he performed the surgery, he found a loose screw and since my back was completely fused, he removed the hardware. Note: The reason he kept the left side hardware in was because it was not causing any problems and would add support until the fusion matures.

    In August, I started developing sciatica again on my left side and the numbness increasing. I went to my doctor again and he scheduled a myelogram/CT Scan which was not conclusive because the image of the nerve roots on the left side were block by the hardware. The doctor started me on neurontin (which gave me terrible headaches) and Elavil (which made me weak and tired) but it did decrease the nerve pain. The doctor discussed the possiblity of having the remaining hardware removed but said he would not be able to see the nerves since he would have to perform a deeper incision which could increase scar tissue. He said the remaining hardware could be causing the sciatica but could not guarantee it would help me. To isolate the affected nerve(s) he has schedule a nerve root block. After the procedure, we will then decide if the hardware is should be removed.

    I hope this information is helpful to you. Please let me know if you have any additional questions.

    Take Care [img]http://www.healthboards.com/ubb/t_up.gif[/img]


    ------------------
    Spondylolisthesis - level 2 L5/S1
    Pars Defect
    End Plate Separation
    2 Nerve Root Blocks (no effect)
    L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
    Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
    Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
    Nerve Root Block 10/03
    __________________
    Spondylolisthesis - level 2 L5/S1
    Pars Defect
    End Plate Separation
    2 Nerve Root Blocks (no effect)
    L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
    Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
    Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
    11/03 MRI of cervical and thorasic spine

     
    Old 10-29-2003, 09:53 PM   #3
    angel1
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    Hey L5S1,
    Thanks for the quick reply! Let me begin by saying that the only reason that he is even considering this surgery is because 1st there is bone growth to support the spine and 2nd because of the severe pain, he did advise me that typically this would not be an option if there was no bone growth and my pain was at least tolerable.
    Boy that Neurontin is something isnt it? I to have the bad headaches with it among other side effects. How long did you take it? But what to you do, take the pain or take the side effects? Tough choice isn't it? [img]http://www.healthboards.com/ubb/confused.gif[/img]
    When will you be having the nerve block? How have you been able to cope with the nerve pain? How bad did it set you back as far as recovery time when you had the hardware removed, Do you feel that removing the hardware affected you in any way? Were you having symptoms that made you feel like it was a "hardware" problem if so what were they if you dont mind me asking. What would be your deciding factor to have the remaining hardware removed? You stated that this was done 7 mos post op. You were completly fused at 7 mos? Wow that's encouraging to hear! [img]http://www.healthboards.com/ubb/wow.gif[/img]

    Thank you so very much, your information was extremely helpful.
    and as always
    God Bless, Angel
    ---------------------------------
    20+ years chronic back and leg pain
    Epidural injections given 1986 ,1987, 1988 3 shots per session with no results and excess of 100 lbs gained

    Future Epidural injections refused
    (lost all the weight!) Not willing to subject to again
    DDD dx'd 1/17/03
    Lumbar Spondylosis dx'd 1/17/03
    partial hemilaminectomy / Nerve root decompression 2/14/03
    PLIF w/cage L5S1 8/18/03
    Neurontin 1200 mg
    Tylox for pain

    [This message has been edited by angel1 (edited 10-30-2003).]
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    Angel
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    Old 10-30-2003, 08:45 AM   #4
    L5S1
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    Hi Angel

    I tried neurontin for two weeks but the headaches were worse than the back pain. The doctor then prescribe Elavil which I also took for two weeks but it caused me to be weak and so tired I did not want to get out of bed. I stopped the Elavil this week because the doctor was scheduling the nerve root block and I wanted to know if the nerve root block helped the sciatica or if it was still the medications. I thought I was going to have the nerve root block tomorrow but they are still waiting on insurance approval. That can be a separate thread just to discuss health insurance

    At 5 months post-op, I started to begin exercising at a health club. When I first started exercising, I was doing very well but began noticing the pain and swelling in my back increasing. My biggest problem was swimming (aquatherapy) . As soon as my back was below water level, the pain and swelling really increased and I also felt I did not have support in my back. I feel it was due to the change in weightlessness once my back was under the water. I had discussed my symptoms with my ortho and he said he could not see a hardware problem on the x-ray and thought I might have a facet joint problem. Note: The ortho said the area around the hardware would be black on th x-ray if it reflected loose hardware. My ortho referred me to a chiro who performed treatments for two weeks but could not improve the pain or swelling. Note: Please be aware if you have ultrasound treatment on your back, the therapist should be aware to set the ultrasound to the pulse setting or it could cause the hardware to heat up and cause internal burning. The ortho referred me back to my ortho telling him he also believed I had a hardware problem. As mentioned in the previous post the ortho performed exploratory surgery and found the loose screw. Note: When I had a x-ray after the hardware removal the ortho showed me how the screw was rounding out and said the image on the prior x-rays were blocked by the hardware.

    The doctor informed me the surgery to remove the hardware only took 45 minutes. After I got to my room I was able to get out of bed and go to the bathroom (no catheter!!). Later that afternoon, the pt came to my room to begin walking. I immediately got out of bed and walked around the hospital without any assistance. The next day I was sent home and was able to return to work after 1 week (desk job). I noticed an immediate improvement after the hardware was removed and never had any more back swelling.

    My deciding factor to have the remaining hardware removed is complicated. My doctor does not know if the hardware is causing the sciatica and I originally thought if he removed the remaining hardware he could also see the nerves and tell if it was the hardware; scar tissue; or bone growth in the nerve canal which is causing the sciatica. The doctor said he would only remove the hardware and does not want to make the incision any deeper to see the nerves because it would increase the scar tissue. The doctor also mentioned the sciatica might be caused by Arachnoiditis since the myelogram dye caused extreme pain on the nerve which is causing the sciatica. I feel he is wanting to see if the medication and nerve root block helped with the pain and possibly isolate the nerve. I am trying all the possible alternatives before deciding to have the remaining hardware removed.

    I hope I answered all your questions and my experience is helpful to you. I know it is a very difficult decision to have further surgeries. I wish you the best on your decision.

    Take Care [img]http://www.healthboards.com/ubb/t_up.gif[/img]



    ------------------
    Spondylolisthesis - level 2 L5/S1
    Pars Defect
    End Plate Separation
    2 Nerve Root Blocks (no effect)
    L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
    Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
    Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
    Nerve Root Block 10/03
    __________________
    Spondylolisthesis - level 2 L5/S1
    Pars Defect
    End Plate Separation
    2 Nerve Root Blocks (no effect)
    L5/S1 Posterior Fusion with hardware (no BAK cages due to lack of disk space) - August 2002
    Right side hardware removed due to loose screw and rod rubbing against facet joint - March 2003
    Sciatica returned 8/03 - Tried Neurontin and Elavil - Eased sciatica but could not tolerate medicine.
    11/03 MRI of cervical and thorasic spine

     
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