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What is Failed Spinal Fusion?

Failed Spinal Fusion occurs when there is continued pain after the fusion of 2 or more spinal vertebrae. This specific term describes patients who have not had a successful result with back surgery or spine surgery and who continue to experience pain after surgery due to failure of the bones to fuse, failure of an implant, or transfer lesions where nearby vertebrae cause pain. Back surgery can be life changing but even with optimal conditions will only be successful about 95% of the time. Since pain cannot be seen, there can be no guarantee that surgery will eliminate the pain. Selection of the correct procedure is paramount to get the best result from back surgery.

Symptoms

Symptoms of failed spinal fusion are generally the same as the symptoms the patient had surgery for in the first place. Pain is the most common symptom which can be chronic, debilitating, sharp or dull. The pain may have been reduced or even eliminated after the previous surgery but then returns. Regardless of the cause, the most common symptoms include neck or back pain and stiffness, numbness or tingling in the arms and neck and legs, weakness of the arms and legs, a burning sensation in the arms and legs, or trouble with walking or hand coordination.

Causes

The causes of failed spinal fusion include failure of the spinal bones to fuse together, one or more of the implant hardware failing, and transfer lesions which is pain in adjacent vertebra that is new onset.

Failed solid spinal fusion occurs when the bones of the spine fail to fuse. Patients tend to do better when the area of back pain or spinal instability is repaired with a solid connection of bone between vertebrae. Should the bones not fuse but the implants are still intact and stabilizing the spine, then you may still have effective back pain relief from the back surgery. Both solid fusion and spinal stability together would be ideal but either may provide pain relief.

Implants like screws or rods can assist in holding the spinal bone together while it fuses. These metal implants can wear and fatigue over time and may break before the bone has completely healed. This is called implant failure or hardware failure or metal failure. Ideally the implants should hold while the bones of the spine fuse around them, but they may fail if the spine is not supported enough while fusing. Poorly stabilized spines are more likely to have implant failure, especially in the period directly after surgery. Larger patients who put too much stress on the repair area and patients with multiple fusion levels tend to have failed spinal fusion more often.

Transfer lesions occur when the spinal vertebrae right next to previous repair causes symptoms. You may have had a successful spinal fusion surgery and years later begin having pain. This occurs when the next level of spine above or below the area of repair has broken down enough to cause pain. Transfer lesions are more common in younger patients who are more mobile than older patients. The lower lumbar spine is most commonly affected.

Any surgery that does not control your symptoms of pain can be considered failed back surgery. Spinal surgery can only stabilize a painful back joint or decompress a nerve root or the spinal cord. Surgery cannot always remove pain. Back surgery can change back anatomy and correct the spine in the most likely area of back pain, but even a successful surgery can leave a patient with pain. Correct diagnosis as well as an appropriate surgery can prevent failed spinal fusion from occurring in most but not all cases.

Diagnosis

Diagnosis of failed spinal fusion includes back pain after back fusion surgery. This may be present immediately after surgery or may progress over a period of months or years. You may also have numbness or dysfunction in the nerves being compressed by the newly mobile spine and discs. Diagnosis involves a combination of the patient’s history, examination and testing which may include:

  • A complete physical and neurological exam which includes evaluation of loss of sensation, weakness and decreased or absent reflexes. A neurological deficit could help locate the area of cervical spinal compression. Also a review of the procedures the patient has already had is important.
  • Imaging tests may include X-rays which use radiation to look at the bony anatomy of your cervical spine and may be a first test used. Magnetic resonance imaging (MRI) uses powerful magnets to evaluate the structure of the spinal cord and spinal verves. Computed tomography (CT) scans use X-rays and are excellent for evaluating bony anatomy or acute bleeding of the spinal cord. Imaging studies will show implant failure but may or may not show that the spinal sections have fused. Fusion may take 3 to 12 months and generally watchful waiting is the best course during this time.
  • A Myelogram uses a special dye injected into the spinal fluid and an X-ray or CT scan to better look at the spinal cord. EMG or electromyography tests the health of muscles and the nerves that serve them.

Treatment

Proper diagnosis is paramount with both primary back surgery as well as for failed spinal fusion. Your care will depend on the severity and causes of your symptoms. Conservative treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and swelling, and steroid injections that reduce swelling. Heat or cold like an ice bag, heating pad, or hot shower can help reduce pain. Physical therapy can involve muscle strengthening exercises or training in how to control your cervical spine more safely. A cervical collar or back brace might be used to support your spinal cord while limiting movement.

An additional surgery may be indicated in where there is chronic severe pain, that is not relieved by conservative treatment. Surgery will also relieve pain much more rapidly than rest and medication. Spinal fusion involves connecting two of more of the spinal vertebrae so that they are permanently attached together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments. This requires general anesthesia and a short hospital stay. Spine fusion for spinal instability has excellent predictive results while spinal fusion for multi-level degenerative disc disease may be less effective for pain reduction.

Contact Us

The best way to manage your failed spinal fusion is to educate yourself as much as you can regarding your condition, and to become involved in your own care and treatment with your healthcare providers.

The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of failed spinal fusion. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).

Meet

Moustafa Mourad, MD, FACS is double board-certified in Head and Neck Surgery and Facial Plastic Surgery and Reconstruction. He is a Fellow of the American College of Surgeons and a Member of the American Academy of Facial Plastic and Reconstructive Surgery. He treats many conditions,... Learn More »