Guest guest Posted August 14, 2006 Report Share Posted August 14, 2006 , your hardware is all titanium, right? So maybe an MRI would be a possibility? Sharon [ ] screws hi all,if you had pain iin your butt and numbness, tingling in your leg you suspected was caused by a screw, what tests would you ask for? I don't want to go in there and have them do the standard xrays again. I think a screw is pressing on a nerve and i think a screw is causing this deep pain behind the hip muscle but I can't prove it. I want to know what to ask for? any ideas? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2006 Report Share Posted August 14, 2006 I hate to sound stupid but do I ask for an MRI of the screws? > > , your hardware is all titanium, right? So maybe an MRI would be a possibility? > > Sharon > > [ ] screws > > > hi all, > if you had pain iin your butt and numbness, tingling in your leg you > suspected was caused by a screw, what tests would you ask for? I don't > want to go in there and have them do the standard xrays again. I think > a screw is pressing on a nerve and i think a screw is causing this > deep pain behind the hip muscle but I can't prove it. I want to know > what to ask for? any ideas? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2006 Report Share Posted August 15, 2006 - I too had the numbness and pain in the butt and tingling in my right leg. I thought for sure it was caused by the screw. So, last June, I had the screw removed, but it didn't help at all. I still have the numbness in the right leg with the tingling in my foot. I was so hoping with the removal of the screw I would be better, but nothing changed. Kathy G.redmarmie <vclark@...> wrote: hi all,if you had pain iin your butt and numbness, tingling in your leg you suspected was caused by a screw, what tests would you ask for? I don't want to go in there and have them do the standard xrays again. I think a screw is pressing on a nerve and i think a screw is causing this deep pain behind the hip muscle but I can't prove it. I want to know what to ask for? any ideas? How low will we go? Check out Messenger’s low PC-to-Phone call rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2006 Report Share Posted August 16, 2006 Kathy G, Did you have any specific tests at the time that made them think it was a screw? Thanks, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2006 Report Share Posted August 17, 2006 - The screw in my right hip protruded so that you could feel the screw. I had a regular x-ray and a C-scan. The dr removed the 6 inch screw and replaced it with a smaller screw. The dr didn't feel like that the screw was causing me any pain and he didn't want to remove it. It was only because I insisted that it be removed that he performed the removal. It is not as painful, but still hurts, but is bearable. I am able to walk better now that the larger screw is removed. It seems like most people who have the revision surgery are better, but for me, I did better before I had the surgery. But, who knows what I would of been like in the future. I wish I had never of had it done. But, that is hindsight and I just try not to think about it. Kathy G. <vclark@...> wrote: Kathy G,Did you have any specific tests at the time that made them think it wasa screw?Thanks, Stay in the know. Pulse on the new .com. Check it out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 With all the problems with hardware, it makes me wonder if the surgeons couldn't try to find a way to determine beforehand whether the illiac screws are absolutely necessary in all cases. There was one surgeon (Dr Kebaish at Hopkins) who recently told me he would not use cages or illiac screws in my revision. He is the only surgeon I consulted who said there'd be no hardware. Maybe I should see him again for more clarification. I'd like to hear if others have seen Dr Kebaish and received the same response. Judy Kathy G, > Did you have any specific tests at the time that made them think it was > a screw? > Thanks, > > > > > > > > --------------------------------- > Stay in the know. Pulse on the new .com. Check it out. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 Well, I think I should call it a day. This is the second message I've sent out that I need to correct. I shouldn't have said that Kebaish would use no hardware. He would use rods and pedicle screws, just not iliac screws or cages. Judy [ ] Re: screws With all the problems with hardware, it makes me wonder if the surgeons couldn't try to find a way to determine beforehand whether the illiac screws are absolutely necessary in all cases. There was one surgeon (Dr Kebaish at Hopkins) who recently told me he would not use cages or illiac screws in my revision. He is the only surgeon I consulted who said there'd be no hardware. Maybe I should see him again for more clarification. I'd like to hear if others have seen Dr Kebaish and received the same response.Judy Kathy G,> Did you have any specific tests at the time that made them think it was> a screw?> Thanks,> > > > > > > > ---------------------------------> Stay in the know. Pulse on the new .com. Check it out.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 Dr Bridwell orders a CT scan of the pelvic area and iliac crests. I assume this is so he can evaluate whether the iliac screws will have enough bone to hold them. Kathy G, > > Did you have any specific tests at the time that made them think > it was > > a screw? > > Thanks, > > > > > > > > > > > > > > > > --------------------------------- > > Stay in the know. Pulse on the new .com. Check it out. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 Judy, In my case the cages replaced discs....is Kebaish planning on leaving yours in? Without implants to support fusion....how will he stabilize you....would you be braced and limited in your activities? If you are serious about considering his proposal, I would definitley seek clarification and be sure to understand the dfferences between his proposal and your other opinions. I would also recommend you insist on talking to one of his patients who is post HR who had the same surgery and is now at least 2 years post op. As to a surgeons ability to know if illiac screws are essential...I am confident if any of the guys who regularly do this surgery thought there was a better way....they would do it. I don't think they do it because they like to...they do it because it enhances the chance of a good fusion and outcome. From what I have read, removal of the screws at a later date, if necessary and once the fusion is solid, is not too problematic. I am guessing they figure " better safe than sorry " . I don't know what the most recent research is...but I do not believe that less half the patients who have illiac screws require them to be removed later. It is difficult to sort through the stacks of research but I bet if you go to Pubmed you can find statistics on the subject. If I get a chance on this rainy day I will take a look. Take Care, Cam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 Judy,Here is the link to the article I was thinking of by DrBridwell:http://www.spineuniverse.com/displayarticle.php/article2974.htmlOr here is the text, the yellow highlights are mine:Minimum 5-Year Analysis of L5-S1 Fusion Using Sacropelvic Fixation (Bilateral S1 and Iliac Screws) For Spinal DeformityKuniyoshi Tsuchiya, M.D.Washinton University School of MedicineSt. Louis, MO, USA Bridwell, M.D.Orthopaedic SurgeonWashington University School of MedicineSt. Louis, MO, USALFC R. Kuklo, M.D.Department of Orthopaedic Surgery and RehabilitationWalter Army Medical CenterWashington, DC, USAet al Abstract from the SRS 2004 Annual Meeting Related Professional Links• Long Adult Deformity Fusions to L5: The Fate of the L5-S1 Disc• Pseudarthrosisin Long Adult Spinal Deformity Instrumentation and Fusions: Risk factorand Clinical Outcome Analysis of 228 cases• Dowel Fibular Strut Grafts for High-Grade Dysplastic Isthmic Spondylolisthesis• a - Medtronic Sofamor Danek Objectives: To investigate clinical and radiographic outcomes for lumbosacral fusion (in spinal deformity patients) using a combination of bilateral sacral and iliac screws with minimum 5 year followup. Our hypothesis was that there would be a high percentage of clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain, and a high incidence of pseudarthrosis at L5-S1. Background: Long-term results (>5-year followup) of bilateral S1 screw/bilateral iliac screw fixation have never been published or presented. Materials and Methods: Total 67 consecutive patients (male 19, female 48, age 11-77, average 36.2 years) undergoing lumbosacral fusion bilateral sacral and iliac screws were analyzed for radiographic outcome and clinical course by outcome questionnaire analysis, collected prospectively. These 67 consecutive patients had surgeries at one institution between 1993 and 1998. Forty-four patients had anterior column support at L5- S1. 21 had previous surgery, 12 involved L5-S1 non-union on presentation to us. Follow-up period was minimum 5 years (5 to 9+8 years, average 6+3 years). Patients were divided into 2 groups. Group 1: 34 high-grade spondylolisthesis patients; group 2: 32 adult scoliosis patients fused from the thoracic spine to the sacrum. A true AP pelvis film was obtained in all patients to assess for sacroiliac joint arthritis, and standard spine radiographs. Patients were administered SRS, Oswestry and directed buttock pain questionnaires at latest followup. See attached demographic table. Results: There were no cases of sacral screw failure (screw halo, partial screw pullout, or fracture of the sacral screw). There were 5 cases of non-union at L5-S1, which presented as either rod breakage between L5 and S1 or failure of pedicle screws at L4 or L5 (3 spondylos, 2 adult deformity). Four of the 5 did not have anterior column support at L5-S1. Three of the 5 were revised and subsequently achieved union. Iliac screws were removed electively on one or both sides in 23 of the patients (18 group 1; 5 group 2; p=0.0041) after 2 years postop, because of prominence. There were 7 cases of iliac screw breakage (4 group 1; 3 group 2). Iliac screw halos were observed in 29 patients. No sacroiliac osteoarthritis was observed on the true AP pelvis films. At ultimate follow-up, average Oswestry scores were 16.6 and 24.3, respectively in groups 1 and 2; SRS scores adding pain, function, and satisfaction were group 1 (50.34/ 60) and group 2 (45.11/60); indicating minimal pathology for the majority of patients at ultimate follow-up. On the directed buttock pain questionnaire, 48% of the patients reported no buttock pain. Of those who reported pain (52%) the mean VAS score for group 1 was 2.54±1.93 and group 2 was 3.67±2.77. Conclusions: For high-grade spondylolisthesis and long adult deformity fusions to the sacrum a montage of bilateral S1 screws and iliac screws is effective in protecting the sacral screws from failure. There was a low incidence of pseudarthrosis at L5-S1. We saw no evidence of long-term effect of the iliac screws predisposing the sacroiliac joints to degeneration at follow-up ranging from 5-10 years. Demographic Table Total (N=67) 19 male/48 female Group 1 (n=34) Group 2 (n=33) Male/female 12/22 7/26 Mean age 25 48 (p<0.0001) Prior surgery at L5-S1 5 7 Iliac screw breakage 4 3 Halos at iliac screws 12 17 Iliac screws removed 18 5 (p<0.0041) - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 Cam, thanks so much. Somehow the idea of the iliac screws bothers me more than the pedicle screws. If there was a way to avoid them without compromising the outcome, I would. But then, that's the surgeons call. Judy [ ] Re: screws Judy,Here is the link to the article I was thinking of by DrBridwell:http://www.spineuniverse.com/displayarticle.php/article2974.htmlOr here is the text, the yellow highlights are mine: Minimum 5-Year Analysis of L5-S1 Fusion Using Sacropelvic Fixation (Bilateral S1 and Iliac Screws) For Spinal Deformity Kuniyoshi Tsuchiya, M.D.Washinton University School of MedicineSt. Louis, MO, USA Bridwell, M.D.Orthopaedic SurgeonWashington University School of MedicineSt. Louis, MO, USA LFC R. Kuklo, M.D.Department of Orthopaedic Surgery and RehabilitationWalter Army Medical CenterWashington, DC, USA et al Abstract from the SRS 2004 Annual Meeting Related Professional Links • Long Adult Deformity Fusions to L5: The Fate of the L5-S1 Disc• Pseudarthrosisin Long Adult Spinal Deformity Instrumentation and Fusions: Risk factorand Clinical Outcome Analysis of 228 cases• Dowel Fibular Strut Grafts for High-Grade Dysplastic Isthmic Spondylolisthesis • a - Medtronic Sofamor Danek Objectives: To investigate clinical and radiographic outcomes for lumbosacral fusion (in spinal deformity patients) using a combination of bilateral sacral and iliac screws with minimum 5 year followup. Our hypothesis was that there would be a high percentage of clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain, and a high incidence of pseudarthrosis at L5-S1. Background: Long-term results (>5-year followup) of bilateral S1 screw/bilateral iliac screw fixation have never been published or presented. Materials and Methods: Total 67 consecutive patients (male 19, female 48, age 11-77, average 36.2 years) undergoing lumbosacral fusion bilateral sacral and iliac screws were analyzed for radiographic outcome and clinical course by outcome questionnaire analysis, collected prospectively. These 67 consecutive patients had surgeries at one institution between 1993 and 1998. Forty-four patients had anterior column support at L5- S1. 21 had previous surgery, 12 involved L5-S1 non-union on presentation to us. Follow-up period was minimum 5 years (5 to 9+8 years, average 6+3 years). Patients were divided into 2 groups. Group 1: 34 high-grade spondylolisthesis patients; group 2: 32 adult scoliosis patients fused from the thoracic spine to the sacrum. A true AP pelvis film was obtained in all patients to assess for sacroiliac joint arthritis, and standard spine radiographs. Patients were administered SRS, Oswestry and directed buttock pain questionnaires at latest followup. See attached demographic table. Results: There were no cases of sacral screw failure (screw halo, partial screw pullout, or fracture of the sacral screw). There were 5 cases of non-union at L5-S1, which presented as either rod breakage between L5 and S1 or failure of pedicle screws at L4 or L5 (3 spondylos, 2 adult deformity). Four of the 5 did not have anterior column support at L5-S1. Three of the 5 were revised and subsequently achieved union. Iliac screws were removed electively on one or both sides in 23 of the patients (18 group 1; 5 group 2; p=0.0041) after 2 years postop, because of prominence. There were 7 cases of iliac screw breakage (4 group 1; 3 group 2). Iliac screw halos were observed in 29 patients. No sacroiliac osteoarthritis was observed on the true AP pelvis films. At ultimate follow-up, average Oswestry scores were 16.6 and 24.3, respectively in groups 1 and 2; SRS scores adding pain, function, and satisfaction were group 1 (50.34/ 60) and group 2 (45.11/60); indicating minimal pathology for the majority of patients at ultimate follow-up. On the directed buttock pain questionnaire, 48% of the patients reported no buttock pain. Of those who reported pain (52%) the mean VAS score for group 1 was 2.54±1.93 and group 2 was 3.67±2.77. Conclusions: For high-grade spondylolisthesis and long adult deformity fusions to the sacrum a montage of bilateral S1 screws and iliac screws is effective in protecting the sacral screws from failure. There was a low incidence of pseudarthrosis at L5-S1. We saw no evidence of long-term effect of the iliac screws predisposing the sacroiliac joints to degeneration at follow-up ranging from 5-10 years. Demographic Table Total (N=67) 19 male/48 female Group 1 (n=34) Group 2 (n=33) Male/female 12/22 7/26 Mean age 25 48 (p<0.0001) Prior surgery at L5-S1 5 7 Iliac screw breakage 4 3 Halos at iliac screws 12 17 Iliac screws removed 18 5 (p<0.0041) - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2006 Report Share Posted September 3, 2006 Judy, I wonder why the idea of the screws bothers you...is it because they look so frightful on all our x-rays? They do positively look like something out of a enstein movie. Ghastly....but I can say that I haven't been bothered by mine so far and I just look at them as part and parcel of the whole construct holding this together now...or then. As often says, once you pick a surgeon and decide you have confidence in him, it is wisest to let he or she choose the appropriate techiques for dealing with your particular issues. Take Care, Cam > > Cam, thanks so much. Somehow the idea of the iliac screws bothers me more than the pedicle screws. If there was a way to avoid them without compromising the outcome, I would. But then, that's the surgeons call. > Judy > > [ ] Re: screws > > > Judy, > > Here is the link to the article I was thinking of by DrBridwell: > > http://www.spineuniverse.com/displayarticle.php/article2974.html > > Or here is the text, the yellow highlights are mine: > > Minimum 5-Year Analysis of L5-S1 Fusion Using Sacropelvic Fixation (Bilateral S1 and Iliac Screws) For Spinal Deformity > > Kuniyoshi Tsuchiya, M.D. > Washinton University School of Medicine > St. Louis, MO, USA > > Bridwell, M.D. > Orthopaedic Surgeon > Washington University School of Medicine > St. Louis, MO, USA > > > LFC R. Kuklo, M.D. > Department of Orthopaedic Surgery and Rehabilitation > Walter Army Medical Center > Washington, DC, USA > > > et al > > > > > > > Abstract from the SRS 2004 Annual Meeting > > > Related Professional Links > . Long Adult Deformity Fusions to L5: The Fate of the L5-S1 Disc > . Pseudarthrosisin Long Adult Spinal Deformity Instrumentation and Fusions: Risk factorand Clinical Outcome Analysis of 228 cases > . Dowel Fibular Strut Grafts for High-Grade Dysplastic Isthmic Spondylolisthesis > > > . a - Medtronic Sofamor Danek > > Objectives: To investigate clinical and radiographic outcomes for lumbosacral fusion (in spinal deformity patients) using a combination of bilateral sacral and iliac screws with minimum 5 year followup. Our hypothesis was that there would be a high percentage of clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain, and a high incidence of pseudarthrosis at L5-S1. > > Background: Long-term results (>5-year followup) of bilateral S1 screw/bilateral iliac screw fixation have never been published or presented. > > Materials and Methods: Total 67 consecutive patients (male 19, female 48, age 11-77, average 36.2 years) undergoing lumbosacral fusion bilateral sacral and iliac screws were analyzed for radiographic outcome and clinical course by outcome questionnaire analysis, collected prospectively. These 67 consecutive patients had surgeries at one institution between 1993 and 1998. Forty-four patients had anterior column support at L5- S1. 21 had previous surgery, 12 involved L5-S1 non-union on presentation to us. Follow-up period was minimum 5 years (5 to 9+8 years, average 6+3 years). Patients were divided into 2 groups. Group 1: 34 high-grade spondylolisthesis patients; group 2: 32 adult scoliosis patients fused from the thoracic spine to the sacrum. A true AP pelvis film was obtained in all patients to assess for sacroiliac joint arthritis, and standard spine radiographs. Patients were administered SRS, Oswestry and directed buttock pain questionnaires at latest followup. See attached demographic table. > > Results: There were no cases of sacral screw failure (screw halo, partial screw pullout, or fracture of the sacral screw). There were 5 cases of non-union at L5-S1, which presented as either rod breakage between L5 and S1 or failure of pedicle screws at L4 or L5 (3 spondylos, 2 adult deformity). Four of the 5 did not have anterior column support at L5-S1. Three of the 5 were revised and subsequently achieved union. Iliac screws were removed electively on one or both sides in 23 of the patients (18 group 1; 5 group 2; p=0.0041) after 2 years postop, because of prominence. There were 7 cases of iliac screw breakage (4 group 1; 3 group 2). Iliac screw halos were observed in 29 patients. No sacroiliac osteoarthritis was observed on the true AP pelvis films. At ultimate follow-up, average Oswestry scores were 16.6 and 24.3, respectively in groups 1 and 2; SRS scores adding pain, function, and satisfaction were group 1 (50.34/ 60) and group 2 (45.11/60); indicating minimal pathology for the majority of patients at ultimate follow-up. On the directed buttock pain questionnaire, 48% of the patients reported no buttock pain. Of those who reported pain (52%) the mean VAS score for group 1 was 2.54±1.93 and group 2 was 3.67±2.77. > > Conclusions: For high-grade spondylolisthesis and long adult deformity fusions to the sacrum a montage of bilateral S1 screws and iliac screws is effective in protecting the sacral screws from failure. There was a low incidence of pseudarthrosis at L5-S1. We saw no evidence of long-term effect of the iliac screws predisposing the sacroiliac joints to degeneration at follow-up ranging from 5-10 years. > > > > Demographic Table > Total (N=67) 19 male/48 female Group 1 (n=34) Group 2 (n=33) > Male/female 12/22 7/26 > Mean age 25 48 (p<0.0001) > Prior surgery at L5-S1 5 7 > Iliac screw breakage 4 3 > Halos at iliac screws 12 17 > Iliac screws removed 18 5 (p<0.0041) > > > > > - > Quote Link to comment Share on other sites More sharing options...
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