Post-Spinal Surgery Pain: Could Screws Be the Culprit?

Is it possible that the soreness after spinal surgery is caused by the screws?

Hello, my mother underwent minimally invasive spinal surgery last year, during which a brace and six screws were implanted.
However, nearly six months post-surgery, she still experiences persistent lower back pain and a sensation of foreign objects.
Could the screws be causing the pain? Once the bone heals, is it possible to remove the screws? Would removing the screws lead to any complications? Additionally, what other factors could be causing the pain, and what methods can be used to alleviate it? Thank you!

Xiao Qing, 30~39 year old female. Ask Date: 2020/06/19

Dr. Chen Bochen reply Orthopedics

Hello, there are several possible causes for discomfort after spinal surgery: 1.
Postoperative muscle weakness, which generally requires rehabilitation, nutritional supplementation, and personal exercise.
2.
The area that was not operated on may still have issues, such as pre-existing degeneration or nerve compression that has not been adequately addressed.
3.
Improper positioning of screws or rods, which should be explained by the surgeon who performed your operation, although this is relatively uncommon.
4.
Being underweight may lead to screws not being covered by muscle and fat, resulting in a foreign body sensation.
5.
Scar tissue formation after surgery can cause poor circulation; this can be alleviated through exercise, heat therapy, and electrical stimulation.
6.
Postoperative peripheral edema may benefit from hyperbaric oxygen therapy, as many cases have shown improvement (though this is considered an experimental treatment and is not guaranteed to help).
Additionally, removing the screws should only be considered if absolutely necessary (for example, if there is clear evidence that the screws are irritating a nerve or if they have become loose); otherwise, removal generally does not provide significant benefit and is typically avoided unless absolutely required.
I hope this information is helpful to you.
If you have any questions, please feel free to ask.
Wishing your mother a speedy recovery.
Dr.
Chen Bo-Chen, Orthopedic Department, Changhua Hospital.

Reply Date: 2020/06/19

More Info

Post-spinal surgery pain can be a complex issue, especially when hardware such as screws and rods are involved. It’s not uncommon for patients to experience persistent discomfort after spinal surgery, and there are several factors that could contribute to this sensation.

Firstly, the presence of screws and rods is intended to stabilize the spine and promote healing. However, in some cases, these implants can cause discomfort or pain. This could be due to several reasons:
1. Hardware Sensitivity: Some patients may have a sensitivity or allergic reaction to the metal used in the screws. This can lead to inflammation and pain around the surgical site.

2. Post-operative Adhesions: After surgery, scar tissue can form around the surgical site, which may lead to nerve entrapment or irritation. This can cause pain that feels like it is coming from the hardware itself.

3. Incomplete Healing: If the bones have not fully fused or healed, this can lead to instability and pain. The screws are meant to hold the bones in place, but if the healing process is not progressing as expected, pain can persist.

4. Muscle Strain: After surgery, the surrounding muscles may be weak or strained due to changes in movement patterns or compensatory mechanisms. This can lead to discomfort in the lower back and surrounding areas.

5. Nerve Irritation: If the surgery involved manipulation of nerves, there may be lingering nerve irritation or damage that can cause pain or abnormal sensations.

Regarding your question about removing the screws, it is generally considered only if there are significant complications or if the hardware is causing persistent pain that cannot be managed through conservative treatment. Removal of screws is a surgical procedure that carries its own risks, including infection, bleeding, and further nerve damage. It’s essential to have a thorough discussion with the surgeon about the potential benefits and risks of hardware removal.

To alleviate pain, several strategies can be employed:
- Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the spine, improve flexibility, and reduce pain. A physical therapist can tailor exercises to your mother’s specific needs.

- Pain Management: Medications such as NSAIDs (non-steroidal anti-inflammatory drugs) can help reduce inflammation and pain. In some cases, stronger pain medications may be necessary, but these should be used under the guidance of a physician.

- Alternative Therapies: Techniques such as acupuncture, chiropractic care, or massage therapy may provide relief for some patients. These should be discussed with the healthcare provider to ensure they are safe and appropriate.

- Injections: In some cases, corticosteroid injections can help reduce inflammation and provide temporary relief from pain.

- Lifestyle Modifications: Encouraging your mother to maintain a healthy weight, engage in low-impact exercises, and practice good posture can also contribute to pain management.

In conclusion, while it is possible that the screws could be contributing to your mother’s pain, it is essential to consider all potential factors. A comprehensive evaluation by her healthcare provider, possibly including imaging studies, may be necessary to determine the exact cause of her discomfort and to develop an appropriate treatment plan. Open communication with her surgical team is crucial to address her concerns and explore all available options for pain relief.

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