New search

Note: The answers given here are for the purpose of providing general information regarding spine treatment. They are not intended to replace evaluation and treatment by your physician. If you have questions regarding your specific spine condition, we advise you to see a physician.

If you’re having trouble with the terminology, check the glossary.

Subject: Hardware Removal After Fusion Surgery

Question: Hello, I would first like to thank you for taking time to read my concerns. It is greatly appreciated.

I was diagnosed with grade 1-2 spondylolisthesis in 1996. A surgery was performed to fuse L5-S1. Since the surgery, I have been experiencing mild, moderate and severe levels of pain. Because of the pedicle screws, MRIs and CT scans will not give a clear pictue of what is happening at the hardware site. I saw my surgeon recently, who had me go get a CT myelogram done. The impression from that particular exam states, "There is a moderate-sized, right paramedian disc protrusion at L2-L3 possibly compromising the L3 nerve root. There is mild diffuse disc bulging at L3-4. Post surgical changes at L5-S1. The metallic artifact from the posterior fusion hardware precludes satisfactory evaluation of the L4-5 and L5-S1 disc spaces."

The surgeon had asked for the report as well as the pictures. He said that he saw what was going on above the fusion but did not comment on how it could be fixed. I expected more from him concerning the disc protrusion at L2-3. I asked the surgeon if he would consider pulling out the bolts; if that did not offer relief, we coujld at least see what was going on with an MRI. He is in accord with pulling out the screws. This would tell us for sure if the fusion is stable. However, I am not sure if all options are being looked over for my well-being. My last exam (approx. 1 month ago) was very limited to 30 seconds of moving m6y legs around and nothing else. Then he was gone. My questions to you are:

1) What does post-surgical change of posterior fusion at L5-S1 mean?

2) Can a fusion cause disc problems at a higher level as I have noted above?

3) With the information that the myelogram has provided, why would the surgeon dismiss the "disc protrusion at L2-3 possible compromising the L3 nerve root." He noted that this existed but that was the end of it. I think that the fusion has aggravated upper levels. I also think more attention should have been donated to the findings on the report. Do you?

4) Would pulling out the bolts prove anything? What are the chances of relief?

Once Again, Thank You.

Answer: We cannot answer all your questions without seeing you.
Screws can be painful. Removing them might help your pain. Surgery should include exploration of the fusion to be sure it is solid. However, a good quality CT should show this despite the metal artifact. A plain x-ray, although not definitive, will show the fusion status as well. X-rays should be done standing with bending films and obliques. These will show if there is any motion (should be none) and allow a look at the fusion mass.

Taking out the screws helps 1/2 the patients a good deal, and as you implied, allows us to properly evaluate what is wrong.

Although fusion is well known to cause problems above, it is usually at the L3/4 or L4/5 level, not L2/3.

L2/3 HNP might cause pain in the groin or inside of the leg. It can also cause higher up low back pain. Rarely pain down low.

New search