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Post PLIF surgery scan, PLEASE HELP
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celticgrl31 posted:
Hi everyone,
I had posterior lumbar interbody fusion done on March 1 2011 at L4-L5 and L5-S1. All is going fairly well except for this nagging pain on the left side that burns and bothers me non-stop. I am on more pain meds now than before my surgery. I just went for a ct scan and got a copy of the images today. After looking them over I noticed that one of the screws at the L4-L5 level on the left side went through the pedical bone but didn't enter the actual vertebrae area. So the screw is actually sitting right beside the vertebrae. What does this mean? Will he have to fix this now seeing as there is a problem and it is quite painful? Is there any reason he would have purposfully placed it this way??? I am assuming not but who knows right.
Has anyone else had this happen?
Thanks in advance.
I have attached images for assistance.

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bj1208 responded:
hi and welcome to the support group -

when you are looking at the ct scan are you looking at the films? did you receive a written report that states this? Have you had any X-ray's done? This will show the level of fusion being taken and also a better view of the hardware.

there could be several reasons for the burning sensation - this could be nerves that were irritated during surgery and are going thru a repair cycle. sometimes it can take up to over a year for these nerve roots to calm down. it's best to let the surgeon review the films and determine what is causing your pains and if the screw is in the correct place. If not, he will let you know what needs to be done.

I know after I had my surgery (Anterior Lumbar Fusion L5-S1 done 2/25/08) and I had MRI's and CT Scans I would look at the films and almost swear that a screw was in a place it shouldn't be -

because of the hardware sometimes the images appear to look odd or not done right - It's best to wait and visit with your surgeon so he can review it - spine specialist are the only ones that can read film reports correctly.

It's been over 3 years since my surgery and I am in worse pain now than before. I have the same burning sensations on both sides (left and right) and also dead center at L5. My fusion took 100% but unfortunately because of time frame from when my disc ruptured to when the surgery happened I have a lot of damage - chronic pains and nerve damage in both legs that the surgery could not fix.

Let us know when your appt is and also if you have a written report that goes with the ct scan -

take care - Joy
 
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Rafael Levin, MD, MSc responded:
In general, peddicle screws are intended to go threw the pedicle and into the vertebral body. Despite our best efforts as surgeons, and even with the use of fluroscopic and other imaging guidance and neuro-monitoring, a small percentance (typically <10%) of screws do not have a perfect trajectory on post operative CT scans. Fortunately, in most cases, that does not mean that they need to revised. As long as the screw gets sufficient purchace in the pedicle and does not compromize the canal or the actual nerve root, or a major blood vessel, it will do its job.

In your particular case, your surgeon will review the CT scan in the context of your left lower extremity symptoms and clinical exam. He or she will determine whether the location of the screw is clinically relevant to your leg pain. In other words, it is possible that despite sub-optimal screw position, the position of the screw does not explain your symptoms, and no intervention is indicated. In rare occasions, a mal-positioned screw may be the cause of nerve irritation and in these cases the surgeon may sometime consider removal or re-positioning of the screw. Please review the CT scan with your surgeon and I am sure he will provide you with a more specific answer pertinent to your case.

I wish you all the best, please feel free to update us.


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