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Thread: CT Scan Results - Screw Issue?

  1. #1
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    Feb 2014
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    CT Scan Results - Screw Issue?

    Hello fellow scolis,

    I'm hoping someone might give me insight into the results of a CT scan I recently had. I'm going to see my surgeon for a follow-up in a few weeks, but I'm impatiently trying a bit to decipher the results ahead of time.

    Just as background - I've had a bad nerve pain for three years since my fusion. After trying many different avenues, including a ton of PT, I started to become more and more convinced it was my hardware that was irritating me. I have very small pedicles and it was hard for my surgeon to place the screws in. However, he said the x-rays looked fine and wasn't sure that was they were the cause. He ordered a new MRI and CT scan to check it out. I finally agreed to the CT scan after holding off for a couple years.

    Anyways, my CT scan says that my pedicle screws are broaching the medial cortex of the pedicle at several levels. Does anyone know if this means they could be near the nerve root and causing irritation or is this normal?

    Maybe Linda you would have some insight?

    Thanks in advance!
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
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    Quote Originally Posted by springchicken View Post
    Hello fellow scolis,

    I'm hoping someone might give me insight into the results of a CT scan I recently had. I'm going to see my surgeon for a follow-up in a few weeks, but I'm impatiently trying a bit to decipher the results ahead of time.

    Just as background - I've had a bad nerve pain for three years since my fusion. After trying many different avenues, including a ton of PT, I started to become more and more convinced it was my hardware that was irritating me. I have very small pedicles and it was hard for my surgeon to place the screws in. However, he said the x-rays looked fine and wasn't sure that was they were the cause. He ordered a new MRI and CT scan to check it out. I finally agreed to the CT scan after holding off for a couple years.

    Anyways, my CT scan says that my pedicle screws are broaching the medial cortex of the pedicle at several levels. Does anyone know if this means they could be near the nerve root and causing irritation or is this normal?

    Maybe Linda you would have some insight?

    Thanks in advance!
    If screws broach the medial cortex, it can cause dural and/or neural injury. So, it's definitely possible that screw placement is what is causing your symptoms.

    Do you have a follow-up appointment scheduled?

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
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  3. #3
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    Quote Originally Posted by LindaRacine View Post
    If screws broach the medial cortex, it can cause dural and/or neural injury. So, it's definitely possible that screw placement is what is causing your symptoms.

    Do you have a follow-up appointment scheduled?

    --Linda
    Thanks so much, Linda, for your input. I do in 2 weeks. I'm really anxious for something to be done but will have to see what Dr. Arlet recommends. If it means surgery, I don't know if it would just be a couple of screws or more extensive hardware which would be a bigger procedure. Obviously hoping it could be as simple as possible!
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  4. #4
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    Quote Originally Posted by springchicken View Post
    Thanks so much, Linda, for your input. I do in 2 weeks. I'm really anxious for something to be done but will have to see what Dr. Arlet recommends. If it means surgery, I don't know if it would just be a couple of screws or more extensive hardware which would be a bigger procedure. Obviously hoping it could be as simple as possible!
    Typically, the only time revision surgeries are really big surgeries is when the patient needs pedicle subtraction osteotomies or vertebral column resections to change the patient's posture.

    I hope that, if revision surgery is recommended, that it's small and that it resolves your pain.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  5. #5
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    Quote Originally Posted by LindaRacine View Post
    Typically, the only time revision surgeries are really big surgeries is when the patient needs pedicle subtraction osteotomies or vertebral column resections to change the patient's posture.

    I hope that, if revision surgery is recommended, that it's small and that it resolves your pain.

    --Linda
    Thanks, me too! I am afraid to hope. One last question for you-can you ever get most of your screws removed with the rods still in place or are the screws needed for stability? All the tests show that I'm fused as far one can tell.
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  6. #6
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    744
    If a surgeon needs to remove a cage is that a big deal?
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  7. #7
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    Quote Originally Posted by jackieg412 View Post
    If a surgeon needs to remove a cage is that a big deal?
    Yes, removing a cage is a lot more surgery than removing a screw.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  8. #8
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    Quote Originally Posted by springchicken View Post
    Thanks, me too! I am afraid to hope. One last question for you-can you ever get most of your screws removed with the rods still in place or are the screws needed for stability? All the tests show that I'm fused as far one can tell.
    It depends on where the screws are in the construct. If screws are removed from the top or bottom of a construct, and not replaced, the rods are typically shortened. If the screws are not at the top or bottom, nothing typically needs to be done to the rods.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  9. #9
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    Quote Originally Posted by LindaRacine View Post
    It depends on where the screws are in the construct. If screws are removed from the top or bottom of a construct, and not replaced, the rods are typically shortened. If the screws are not at the top or bottom, nothing typically needs to be done to the rods.
    Thanks, Linda. It looks like, after my appointment with my surgeon, that I will be getting some screws, and a hook, in the middle out. If anyone has gone through this I would be very grateful to hear about recovery times.

    Dr. Arlet made it sound like a very easy surgery, but he made it seem like that the first go around, too, and it was much harder than I expected (probably because of my ongoing pain issues). There's no guarantee this will help, but there's hope that it will.
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  10. #10
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    744
    I had 4 screws a portion of a rod and 2 connectors removed and it was really an easy surgery. I could have gone home as soon as I woke up. It was that easy.
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  11. #11
    Join Date
    Feb 2014
    Posts
    99
    Quote Originally Posted by jackieg412 View Post
    I had 4 screws a portion of a rod and 2 connectors removed and it was really an easy surgery. I could have gone home as soon as I woke up. It was that easy.
    Wow that is great to hear Jackie. I guess I am skeptical because I thought the first one would be relatively easy for me. Are you thinking of getting a cage removed?
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  12. #12
    Join Date
    Feb 2014
    Posts
    99

    More worries...

    Argh, I feel so bad going on when I've been reading others posts and the challenges they are going through. Pain is such a terrible thing to live with.

    I'm so much more nervous this time around. He said this will be a piece of cake, but the first surgery was supposedly going to be easy for me, too.

    I feel confident that the hardware is giving me the problems. But what if my surgeon gets in there and removes the screws he thinks are a problem, but leaves one intact that is the actual problem? This is a really silly question, but does anyone know if once your surgeon's in there, they would have a better idea of something is misplaced? He'll have my CT scans as guidance, too. I am so worried because I'd really like to avoid more surgery in the future if possible...
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  13. #13
    Join Date
    Apr 2010
    Location
    Waterloo, IL
    Posts
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    I hope the procedure is relatively simple and relieves your pain.
    Karen

    Surgery-Jan. 5, 2011-Dr. Lenke
    Fusion T-4-sacrum-2 cages/5 osteotomies
    70 degree thoracolumbar corrected to 25
    Rib Hump-GONE!
    Age-60 at the time of surgery
    Now 66
    Avid Golfer & Tap Dancer
    Retired Kdgn. Teacher

    See photobucket link for:
    Video of my 1st Day of Golf Post-Op-3/02/12-Bradenton, FL
    Before and After Picture of back 1/7/11
    tap dancing picture at 10 mos. post op 11/11/11-I'm the one on the right.
    http://s1119.photobucket.com/albums/k630/pottoff2/

  14. #14
    Join Date
    Feb 2014
    Posts
    99
    Quote Originally Posted by golfnut View Post
    I hope the procedure is relatively simple and relieves your pain.

    Many thanks, Karen.
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

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