Thread: Hi from Northern Ireland - need help

Hi everyone, I have been surfing through this board for a while and have found it very useful, so today I registered and would like to ask you guys a question. I had spinal fusion with hardware at L3/L5 in 1995. I have never really been free of problems or pain ever since. I have had further surgery, but for the most part I manage my pain as most surgeons I see, tell me to grin and bear it and that they can't help. Recently however, I went to get out of bed and heard a loud crunch in my lower back and from that point on my pain level has increased dramatically and is accompanied by nurabness in both feet, tingling and warm flush feelings in my legs. Interestingly, I now feel and hear something moving about in my lower spine each time I get out of bed, move in a chair or bend. Could these symptoms be loose hardware?

I am due to see a surgeon next week and another in a few weeks time. In the meantime I am scared to move wrong incase something is actually moving.

Thanks

Welcome to the board. One would assume that since your surgery was over 10 years ago, that hardware should not be an issue. Have you had imaging along the way that has indicated your hardware was intact and that you had fused? From what you describe, it certainly sounRAB like hardware might be to blame...but if you have fused, the hardware "should" be encased by bone by now and I wouldn't think that a screw could break at this point, or that anything could come loose. However, if there is one area that never fused, I would think it possible. But don't be surprised if your doctors scoff at the notion and refuse to investigate further.

I know it can be hard to tell because the metal throws off a certain amount of "artifact" that makes it difficult to get a clear image. There are other tests that can be done that indicate whether hardware might be causing a problem, but they are not 100% reliable. The only way to tell for sure is by direct physical examination, which is obviously not done unless the surgeon has a reason to be operating on you for some other reason!

But the fact that you've had problems ever since the first surgery raises the question of whether you were ever completely fused. If not, that instability can lead to other spinal issues. I have a friend going through the same thing right now, and I know how frustrating the whole process can be. I don't know how things work in Northern Ireland, but here in the US, it can be difficult to convince another surgeon to take on the case, and to say that the hardware is an issue. Many surgeons will not operate on a patient if he has had spine surgery with another surgeon.

I hope you can get some new imaging, both MRI and X-Ray. And I hope your doctor will take your concerns seriously. It may be that the L5-S1 segment has broken down from all the excess stress put on it from the fusion directly above it. This is not an unusual happening after a person has been fused for a nuraber of years -- but I wouldn't think that would account for the metalic, crunching noises you're hearing when getting out of bed, etc.

The symptoms you are having are indicative of some lurabar nerve compression. You are wise to carefully monitor your movements...avoid activities that involve bending or twisting at the waist, pushing, pulling and lifting more than a gallon of milk (whatever equivalent that is for you!!) Try to maintain good body mechanics and posture...and just be really careful until you find out what is going on.

Glad you joined the board. Please post often with your questions, concerns or if you need to just let off some frustrations. Everyone here can relate, at least to some degree, what you are dealing with and what it feels like.
Please keep us posted on your upcoming appointments.

TT

Many Thanks tetonteri66 for your informative and swift reply! To answer some of your questions. L5/S1 showed signs of wear and tear yrs ago and is now near bone on bone. Mild slippage occurs at this level because of the lack of disc. From the outset, I was told that there was a strong fusion, but over the yrs questions were raised concerning pseudarthrosis but due to distortion of MRI images no surgeon has ever committed to this diagnosis. Its the same in NI as the US, surgeons don't like to take on other surgeons work, hence 16yrs of pain management. CT scan from 2yrs ago showed degenerative disc disease at L2/3 & L1/2 and no disc in L5/S1. The last surgeon to see me, gave me facet joint injections into L5/s1, ordered me to do Pilates, discharged me and sent me my merry way with his final worRAB being..."I give the rest of your lurabar spine less than 5 yes then you need revision surgery". My main concern is the movement I'm feeling and I am 100% sure it's above the fusion site or at the very least at the top level. What I really would appreciate is, if there are any other people on this board from the UK who could suggest surgeons who are willing to take on people who have had previous surgery.

I underwent reconstructive surgery this past May due to loose hardware and a lack of fusion at the L3 L4 level. I went through months of pain and tests before my Dr. was able to get a good image that showed the real problem. It was done by CT Scan with contrast directly injected in the spine....all other tests would not work. MRI scans were unreadable couse of the hardware as TT siad above. X-rays did not show the detail needed to see the damage and lack of fusion. The CT Scan showed a distinct halo around the head of one of the screws. I would ask your Dr if this procedure can be done to get the best "picture" of whats going on in your back.I never had the crunching experience you are having,just pain and felt the area was not stable. And even though its been 10 years since your fusion and if the fusion was not 100% you can damage/break it at anytime. Do you remeraber a recent slip,fall,lifting of something heavy? Also remeraber as we age the bones become weaker too. Hopefully your Dr will be proactive and investigate this,fill him in on all the details and do not accept an answer of "grin and bear it" Tell him you know what you hear and feel and you want some imaging by CT to get some answers. Best of luck.

Rich

Thanks Rich, I can't get any more MRI's now as I have an ICD implanted because I have LongQT syndrome, so it's a good excuse to demand a CT with contrast. I Think I have been around the block a few times now to put my foot down and not settle for 'grin and bear it'. It will also also help that I'm going private as previous experienc has proved surgeons who see you on the NHS are more worried about their statistics than actually figuring out whats wrong with you. As you stated and also from reading posts I have learned that loose screws will have a distinct halo, so I will most likely get a CT with contrast and take it to a few different surgeons for their opinions. Thanks again, all input is gratefully received!

SounRAB like you are on the right track. Sometimes we just have to be very persistent...and keep going till we find someone who takes our concerns seriously. It sounRAB like you have several candidates for what could be causing your problems, and it looks like a revision of some sort is in your future.

I wish you the best...and I know you will keep after your doctors until you get some answers.