Post-Surgery Spinal Issues: Pain, Risks, and Options

Post-spinal surgery

Hello, doctor.
I am an 8-year post-operative patient with scoliosis.
Initially, my curvature was about 40 degrees, with an S-shaped curve extending from the thoracic to the lumbar spine, nearly 30 cm long.
The last two segments of my lumbar spine were not fused, so I still have some mobility.
However, after the surgery, I feel as if my body is strapped to a wooden board, with tightness and sharp pain in my back.
Certain points in my lower back and hips are constantly painful, and I cannot relax at any time.

Question 1: Is this a flat back syndrome or a pseudo-joint mobility issue, or could it be due to other reasons? (I have been receiving acupuncture from traditional Chinese medicine and manual therapy from Western medicine, with rehabilitation about five days a week, but the discomfort remains significant.
Whether standing, lying down, or sitting, I feel a heavy foreign body sensation, and at night, I struggle to sleep due to pain and have to take sleeping pills.)
Question 2: Recently, I have been inquiring about the possibility of another surgery.
Is this considered spinal revision surgery? (Note: My original surgeon does not recommend further surgery or the removal of the rods.)
Question 3: If the rods are removed, will my spine revert to its original curvature? Will it collapse, or has it been stabilized for 8 years, meaning the muscles and bones are fixed and will not curve back?
Question 4: A doctor mentioned the possibility of switching to a dynamic rod, but I am unclear about what that entails.
He mentioned a Peek Rod; what is a Peek Rod? If I switch to a dynamic rod, will my flat back become a hunchback, making the situation worse?
Question 5: If I choose to undergo another surgery, what risks should I consider? Will there be muscle adhesions? Could there be nerve damage? Is there a risk of paralysis? After the surgery, will my condition improve or worsen? I am currently living in significant pain and have many doubts and anxieties about the possibility of surgery, so I hope you can kindly address my lengthy concerns.
Thank you.

Tongku de Wanyou, 40~49 year old female. Ask Date: 2023/09/20

Dr. Chen Bochen reply Orthopedics

Hello, thank you for your hard work.
Your issue is quite complex, and you should seek an in-person evaluation from a specialist in scoliosis.
I recommend a few scoliosis specialists: Dr.
Hsien-Te Chen, Chief of Orthopedics at China Medical University Hospital; Dr.
Chien-Chun Chang, Director of the Taichung Tzu Chi Spine and Joint Center; and Dr.
Po-Liang Lai, Director of Orthopedics at Linkou Chang Gung Memorial Hospital.

Reply Date: 2023/09/20

More Info

Understanding post-surgery spinal issues, particularly after spinal fusion or correction surgery for scoliosis, can be complex and multifaceted. Your experience of persistent pain and discomfort eight years post-surgery is not uncommon, and it raises several important questions regarding your current condition and potential treatment options.

Question 1: Is this flat back syndrome or a pseudo-joint issue?
The symptoms you describe, including tightness, pain, and a constant feeling of tension in your back, could indeed be indicative of flat back syndrome, which can occur after spinal fusion surgeries. This condition is characterized by a loss of the normal lumbar lordosis, leading to a straightened spine that can cause discomfort and pain. Additionally, pseudo-joint formation can occur at the fusion site if the bones do not fuse properly, leading to instability and pain. The ongoing physical therapy and acupuncture you are receiving are beneficial, but if the discomfort persists, it may be necessary to reassess your treatment plan with your healthcare provider.

Question 2: Is there a possibility of revision surgery?
When considering revision surgery, it is essential to evaluate the reasons for the initial surgery's failure to alleviate symptoms. If your original surgeon has advised against further surgery, it may be due to the risks associated with additional procedures, especially if the fusion has stabilized. However, if your quality of life is significantly impacted by pain, seeking a second opinion from a spine specialist who has experience with revision surgeries may provide you with more options.

Question 3: Will removing the rods cause the spine to revert to its original curvature?
Removing the rods after eight years of fusion is a complex decision. In general, if the fusion has solidified, the spine should maintain its corrected position even after the rods are removed. However, there is always a risk that the spine could shift, especially if the surrounding muscles and ligaments are not strong enough to support the spine without the rods. Your surgeon will likely conduct imaging studies to assess the integrity of the fusion before making a recommendation.

Question 4: What is a Peek Rod, and how does it differ from traditional rods?
Peek rods are made from polyether ether ketone (PEEK), a biocompatible polymer that is used in spinal surgery as an alternative to traditional metal rods. They are designed to provide flexibility and may reduce the risk of stress shielding, which can occur with metal rods. However, the choice between traditional and PEEK rods should be made based on individual anatomical considerations and the specific goals of your surgery. Concerns about developing a hunchback (kyphosis) after switching to a more flexible system should be discussed with your surgeon, as they can provide insights based on your unique spinal structure.

Question 5: What risks should I consider if I opt for another surgery?
Every surgical procedure carries inherent risks, including infection, bleeding, and complications related to anesthesia. In the context of spinal surgery, there is also the risk of nerve damage, which could lead to weakness or paralysis. Additionally, scar tissue formation (adhesions) can complicate recovery and lead to chronic pain. It is crucial to have a thorough discussion with your surgeon about these risks and the potential benefits of surgery versus conservative management.

Conclusion
Navigating post-surgical spinal issues can be daunting, especially when faced with chronic pain and uncertainty about treatment options. It is essential to maintain open communication with your healthcare providers, seek second opinions when necessary, and explore all available treatment avenues, including physical therapy, pain management strategies, and potential surgical interventions. Your well-being is paramount, and finding a treatment plan that aligns with your needs and lifestyle is crucial for improving your quality of life.

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