Considering Removal of Implants if Back Still Painful After Lumbar Surgery

Of the many patients who undergo surgery for chronic back pain, as many as 15 percent may need a second surgery to remove the hardware (screws, rods) that was installed. There are several reasons why a back surgery may not work properly, including pseudoarthritis, infections, and a failure for the spinal fusion to take. However, there are some patients who have pain that is not explained by any of the possibilities. It's with these patients that there is some controversy as to whether a second surgery to remove any hardware should be done. The authors of this study wanted to evaluate the safety and efficacy of such a second surgery.

The authors looked at files of patients who had undergone a second spinal surgery. They found 10 men and 15 women who fit their criteria. After the surgery, all the patients had continued pain (14 back pain and 11 both back and leg pain) that didn't respond to pain medication or physiotherapy. All 25 had the second surgery during which all the hardware was removed, as well as any tissue that had surrounded the implants.

After the surgery, the patients used the Visual Analog Scale to score their pain levels, and they answered questionnaires that measured their function, medication use and their satisfaction following the second surgery. After an average of 20 months follow-up, none of the patients showed any signs of infection. On examining the hardware that had been removed, the researchers noted that all of the patients had tissue form around the implants, three had loosening screw-bone interface, as well as a "halo formation" around the screws.

There was an average 50 percent decrease in pain reported by the patients and 46.2 percent reported that their function was "much better," while 38.5 percent said their function was "somewhat better." Reporting as "none better," was 11.5 percent. Only one patient (3.8 percent) said that he/she was "worse" and no patient reported "all better." Significantly, 85 percent of the patients said that they would have the surgery again and 89 percent said that they would recommend the surgery. Eight-one percent felt that their surgery was a success.

There is still much to be understood about post-implant surgery back pain. The diagnosis can only be made after ruling out all other possibilities, and surgery is the only true way to make a diagnosis. Many doctors say that there are other possibilities that could cause this pain, such as inflammation (swelling) around the foreign bodies in the back.

Reference: 

Ahmet Alanay, MD, et al. Safety and Efficacy of Implant Removal for Patients with Recurrent Back Pain After a Failed Degenerative Lumbar Spine Surgery. In Journal of Spinal Disorder and Techniques. June 2007. Vol. 20. No. 4. Pp. 271-277.

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