Movement over fusion area post hardware removal? Really??

**rtswen** · 12-08-2010, 03:02 PM

Quick history again:

Wife had L4-L5-S1 fusion in June, 2008
Scans showed full fusion six months out
December 2009 hardware removed due to pain - did not resolve
Numerous attempts since, but last week she had another MRI to check other levels

This MRI and the extension x-rays showed movement in the fusion area. (I feel like I need to bold that, though I refrained from putting it in all-caps. It seems incredibly frightening)

She is scheduled for a bone scan, and then a follow up with the doctor. In the mean time she has been advised: no stress, no twisting, light walking for exercise.

It's hard not to panic here.

Has anyone heard of this before? I don't even know where to begin to search for information on this, on how it happens (is it bone loss? She just turned 40, so that's awfully young. Is it an incomplete fusion in the first place? Is it something else entirely?), or on what the next steps and prognosis might be.

Anyone?

**Jack-of-all-trades** · 12-08-2010, 08:36 PM

Sounds like it wasn't fully fused. The instrumentation was helping to keep things rigid. Once it was gone, movement occurs and causes pain. There is a type of electric or some such belt that can be prescribed and worn over a period of a few months that might can help complete the fusion.

Why did they have to remove the hardware? Was a screw backing out? I was recently at a seminar where there is a double locking arrangement to keep this from happening.

**KBear** · 12-08-2010, 08:37 PM

Originally Posted by Jack-of-all-trades

Sounds like it wasn't fully fused. The instrumentation was helping to keep things rigid. Once it was gone, movement occurs and causes pain. There is a type of electric or some such belt that can be prescribed and worn over a period of a few months that might can help complete the fusion.

Why did they have to remove the hardware? Was a screw backing out? I was recently at a seminar where there is a double locking arrangement to keep this from happening.

That's what I was thinking too.

**Justin** · 12-08-2010, 11:52 PM

Originally Posted by rtswen

Has anyone heard of this before? I don't even know where to begin to search for information on this, on how it happens (is it bone loss? She just turned 40, so that's awfully young. Is it an incomplete fusion in the first place? Is it something else entirely?), or on what the next steps and prognosis might be.

Anyone?

Originally Posted by Jack-of-all-trades

Sounds like it wasn't fully fused. The instrumentation was helping to keep things rigid. Once it was gone, movement occurs and causes pain.

^ It does sound like your wife's spinal fusion was't entirely fused, as mentioned above. Has she had a DEXA scan (a test for osteopenia / osteoporosis)?

**Cindylou** · 12-08-2010, 11:56 PM

Originally Posted by Justin

^ It does sound like your wife's spinal fusion was entirely fused, as mentioned above. Has she had a DEXA scan (a test for osteopenia / osteoporosis)?

Did you mean was or wasn't entirely fused, Justin? Just for clarification......

**Justin** · 12-09-2010, 12:11 AM

Originally Posted by Cindylou

Did you mean was or wasn't entirely fused, Justin? Just for clarification......

I just fixed it...wasn't.

**mmarsh** · 12-09-2010, 08:06 PM

I'd have to agree with the others in thinking there was not a complete fusion to begin with. 2 years is a long time for bones to not have fused, however. It seems to me that a corset and a bone fuser thing (that is the latin term!) are appropriate. Best to you both and good luck!

**rtswen** · 12-10-2010, 12:58 PM

The MRI 6 months out showed good bone growth, and based on the doctor's assessment we considered it fully fused. The hardware was removed 18 months post-fusion due to unremitting pain that responded to diagnostic tests indicating that the screws were causing it. That was 12 months ago, still no relief, and now this news. She has a bone scan with contrast scheduled for Monday.

So either it wasn't fused and removing the hardware was the wrong course, or it was fused and something has changed. I'm trying to determine if that is even possible - if it can fully fuse, but then show signs of regression?

Thanks for the comments, the information is helpful as I try to search for details that are difficult to come by.

**Jack-of-all-trades** · 12-10-2010, 05:38 PM

The thing is the images are not like those taken from a camera we use. At best the images are fuzzy. They can be a little over exposed or under exposed, are not three dimensional, and generally just plain films and not infused CTs or MRIs. With metal at that level they would be distorted anyway. Even a hairline space can cause movement and pain. It could appear like there is good boney callous formation at 6 months and bone being laid down but I was told it would take up to a year for all new bone to form. It is not uncommon to not have bone bridging the whole gap. I doubt this is a fault of your surgeon but just one of those things. It is movement in the space that causes pain. If your instrumentation had held everything still, most likely there would be no pain. The screws backing out for some reason or the other happens too. I was at a meeting a few weeks back that had device supplier reps displaying a new locking type second screw to keep this from happening.