What causes neck pain after a fusion?

Answer 1

That's a loaded question - there are so many things that can affect the fusion area. It depends on how much pain we're talking about. If it's bad enough that you've been referred to a Pain Management Program, then it's possible the hardware might be installed wrong. If it's pain that just requires some Percocet or Vicodin on an as-needed basis, it's probably scar tissue buildup and spinal stenosis, which is common in patients who've had fusions.

I've had 3 so far - C5/6/7 in '96, L4/5/S1 in '99, and L3/4 in '06. I've been in a formal Pain program for 11 years, but have dealt with spinal pain for a lot longer than that. In my case, I was told a long time ago it was 'Failed Fusion Syndrome', or Post Laminectomy Syndrome, whatever you want to call it. Essentially if there's no visible cause for the pain, the chalk it up to residual pain from the procedure.

However, I learned prior to my 3rd fusion operation that my problems were due to improper installation of my fusion hardware in both '96 and '99. It was confirmed during surgery (using everyone's favorite tool, an EMG machine" to verify nerve conduction) that 2 of the 8 screws in my lower spine were in fact screwed through the pedicles too far and were into flesh and nerves, specifically 2 leg nerves. In my neck, one screw holding my plate in is actually screwed through a disk - only the last 2-3 threads are actually inserted into the vertebral bone.

For me, my pain started to get much worse about 6 months after my second fusion, and it got to the point where I had to start using Duragesic Patches, which are currently the strongest opiate meds available. For the past 9 years I've used Duragesic 100mcg patches and Percocet 10/325's for my pain as a result of the previous screwup (no pun intended). I use between 120/150 Percocet's per month, and 3 boxes of patches per month (1 every 48 hours). I've had to increase my meds occasionally, as in '06 when my L3 disk collapsed and the L3 vertebrae slipped forward onto the L4, resulting in bone-bone contact. But essentially my dosages haven't changed since 2000.

Post-op Physical Therapy has a lot to do with residual pain also. If you get into a good PT program, your pain will eventually get less over time, but scar tissue buildup is always a possiblity and results in the bulk of post-op pain after a year or two.

Remember also that the primary cause of pain over time for fusion patients is the added stress the fusion puts on the disk directly above the fusion site. In my case, the surgeon should've fused L3-S1, but he stopped at L4. As a result, in addition to the pain from the screws, I had to deal with the pressure on a disk that was already failing for 6 years until it finally collapsed completely. The pressure on the area above the fusion is a result of a fulcrum effect.

You can get an idea yourself where the pain is coming from, since the type of pain indicates the injury, and in the case of spinal nerves, if the pain traces a nerve path, it will tell you which disk is pressing on which nerve. Sharp pain is normally nerve related, as is some pins/needle pain and burning pain. Throbbing and aching is usually deep tissue or muscular in nature; burning/tearing can be nerves but can also be ligaments too. Muscles and Ligaments are often accompanied by stiffness as well.

If you're referring to post-op fusion pain within 6 months of the surgery, you're still likely to have some back muscle spasms - if your doctor didn't prescribe Flexeril or a similar muscle relaxant to deal with the spasms, you should think about another doctor.

One way to tell if it's a possible hardware problem is too look at your 3 month X-Rays. The hardware pedicle screws should be inserted on an even, parallel basis with the screw opposite it. You can look closely and sometimes see if the screw is through the bone or not. Realistically though, that kind of pain is pretty bad, so if it's hardware related you should be a regular opiate patient like me by now, or in complete and total misery and hell.

The kind of surgeon you used has an effect also. Neurosurgeons are less likely to screw up a laminectomy/fusion, but Orthopedists don't tend to do so well with nerves - they're bone doctors after all.

The original reason for the fusion also plays a role in your post-op pain. If like me you have a disease or condition in which the spine or disks are going to continue to degenerate and get worse over time, then that's a contributing factor. In my case, vertebral slippage over a collapsed disk and bone-bone contact with the vertebrae below it is normal - my problem is hereditary, and was aggravated by things I did when I was younger. If your fusion was supposed to get rid of the disk pain, then I'd start looking for other causes if you still have it, or if it's gotten worse over time. Don't buy the "Post-fusion Syndrome", or "Failed Fusion Syndrome" crap like I did for so many years. Get a CT Myelogram performed and have them do a top-bottom spinal series so you have a baseline record.

There are some sites that you can learn more about Pain and post-op Spinal pain symptoms - the links are at the bottom.

Answer 2

the tenchion