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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Had lumber fusion. Have chronic pain. Need surgery?

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Dr. Visvanathan K

Neurologist, Surgical

Practicing since :1997

Answered : 96 Questions

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Posted on Mon, 11 Feb 2013 in Bones, Muscles and Joints
Question: 360 degree three level fusion 1.5 years ago. Lot's of frequent lumbar strains. This past July chronic pain changed entirely in nature to nerve like. Sought help, but treated like a drug seeker. Finally I got some attention after going to my PCP in excruciating muscle spasms of such severity that you could see and feel the knots, plus screw visible and palpable. Now with a second opinion Dr I'm having the hardware removed posteriorly. Also of importance is: I have muscle wasting and atrophy and I'm extremely frightened of fears of the unknown. Am I clear from the abdominal aorta during removal hardware by way of a posterior approach surgery soon? What's my chances of pain relief once malpositioned instrumentation is removed, with the cause of pain being from placing pressure on my back and spine with muscle atrophy/scarring? Have been stuck in bed for months, but I get up and walk around to prevent DDT and do deeo breathing exercises. During first surgery the aorta had to be exposed for safety and for surgery, but that was when I was having the anterior section done, before flipping me over to do instrumentation part I presume.
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Answered by Dr. Visvanathan K 5 hours later
Hi XXXXXXX

During the 360 degree fusion, it is during the anterior approach the large veins and arteries of the abdomen, especially the iliac vessels/aorta or the inferior vena cava which are close. Therefore, usually removing the posterior hardware should not place these vessels at risk.

I presume your doctor must have looked at scans and X-rays and has offered to remove the hardware, if there is a possibility of the pain being caused due to the hardware. Unfortunately, most of the time it is difficult to know how much one single factor is the cause of the backache. The muscle atrophy and scarring happens due to the fact that the back has to be opened and the muscles stretched in order to put in the metalwork. The metalwork itself is not the direct cause of paraspinal muscle atrophy/scaring.

Once the posterior metalwork has been removed, your doctor/surgeon will reassess your condition after you have recovered from the surgery and start getting back on your feet. At that time, he/she will also explore the suitability of other pain reliving procedures like intrathecal drug infusion pumps and spinal cord stimulation. This would be done in consultation with the Pain specialist.

I have given this answer assuming your fixation has been in the lumbo-sacral region. Hope this has answered your questions.

If you have any other questions or any further clarifications are needed please get back to me.

Above answer was peer-reviewed by : Dr. Shanthi.E
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