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  • LBM
    Post count: 6

    Hello Dr – firstly, thank you kindly for opening this forum and giving up your time and expertise – its greatly appreciated.

    I am a post ALIF (with posterior fixation) patient – I’m 7 months post op. The surgery was for an unstable grade 2 spondy at L5/S1

    All has gone very well and the fusion seems to be progressing very quickly. A 15’ titanium cage with cancellous bone chips and BMP was used and the posterior reduction screws reduced the slippage to virtually zero and full lordosis has been restored.

    My issue now, is pain exactly where the pedicle screws head are. They seem to be sitting directly in the lumbar fascia and the pain increases when I totally relax the lumbar musculature – such as when laying down on my bed. The pain in excruciating but very transient until I try to move once again. It’s localised to the sacral area and painful to palpating on the screw heads (which you can feel and are very prominent). I’m a relatively small framed person but with significant lumbar/gluteal muscle mass.

    My question simply is: is this something you’ve come across with either your own patients or from other surgeons?

    Many thanks

    Donald Corenman, MD, DC
    Post count: 8455

    Hardware can cause pain due to either bone/metal interface or screw prominence irritating soft tissues like muscle or fascia. One question that need to be answered is whether you have a solid fusion or not. If you are at least 5 months out, you could have a CT scan. With a solid fusion, you could have the screws taken out. The screws cannot come out until you have a solid fusion.

    Dr. Corenman

    Post count: 6

    Hi Dr,

    Greatly appreciate your reply.

    I’ve recently had a CT and my surgeon wants to give it another 3 months. After that we will CT and X Ray to make sure all is fully fused and will then process with the hardware removal.

    The ALIF cage has 3 internal screws also, so that is pretty solid itself.

    Thank you again sir.


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