It is common for patients to experience discomfort and pain following spinal fusion surgery as their body readjusts. However, if pain starts to be a problem for the patient, then it could be symptomatic of a serious issue.
Early onset of pain
If there are pain symptoms in the weeks following spinal fusion surgery there are several possible causes:
- Infection
- Misplaced screws causing nerve pain
- Early failure of fixation – screws loosening
- Failure to address the original problem – in which case the original symptoms and pain persist.
Diagnosis
- Infection: a quick inspection of the wound may reveal an obvious problem. If still unsure, a CRP blood test can help determine if there is an infection.
- Ask about the location of the pain. Is it purely pain in the lower back, or is it nerve pain in the legs?
If it is lower back pain it is probable that it is the body still readjusting and the patient just needs to give the body time. Nonetheless if the pain is worsening, refer them back to the operating surgeon.
If there are any nerve pain issues your patient should be referred straight back to their operating surgeon.
A simple X-Ray or CT scan will determine if there has been any dislodgment of the fixation screws or fractured vertebrae.
Note the X-Ray should be taken in the standing position and cover all parts of the back that were operated on.
If the X-Ray reveals any dislodgment then send your patient straight back to the operating surgeon. Immediately.
If the surgeon is unavailable, or the patient distrusts the operating surgeon, then they should seek a second surgical opinion.
Later onset of pain
If pain or nerve symptoms appear six months or more after surgery there are several possible causes and all of them require attention:
- Failure of the fusion – possible breakage of the fixation hardware
- Vertebral fracture adjacent to the fusion
- Degenerative change of the disc space adjacent to the fusion with the potential for nerve compression
- Loss of spinal balance due to forward angulation above the fusion.
Any of these could get out of hand; the patient needs to be sent to their operating surgeon without too much delay.
Diagnosis
Ask the patient to try and determine how much is back pain and how much is leg pain.
If leg pain and there is weakness then it is urgent, and the patient may need to go to hospital immediately.
If back pain, there still needs to be a surgical review and an X-Ray in a standing position is an important starting point in the diagnosis. But it is best to leave any further investigations to the treating surgeon.
Next, read my article on Spinal Fusion Surgery.
And as always if you have any questions about a patient, please feel free to call me on 02 9650 4893. I will return your call and discuss how we can help.
You can also reach me via ralphstanford@powspine.com.au.
Live webinars for referrers: CAUDA EQUINA SYNDROME
My first webinar for GPs and other referrers was on Cauda Equina Syndrome
and involved a brief discussion about its causes, symptoms, and diagnosis.
Click here to view the replay and download the slides.
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Further Resources for Referrers include:
- Spinal Fusion surgery
- Foot Drop
- Why I only operate when it makes a difference to my patient's quality of life
- The limited role of cortisone injections for spinal conditions
- Cervical myelopathy – a disease of the spinal cord that may pass unnoticed
- Cervical Radiculopathy – shooting pains from the neck
- Back pain and how to manage it
Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.
Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.
As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.
As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.
Posted 26 July 2021
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