Red Flags to Look Out for After Back Surgery

by Christina Lasich, MD Health Professional

Dear Dr Lasich - I'm six weeks post op spinal fusion surgery.Dec. 8, 2011 and then again eight days later I was in so much pain. The doctors went back in and found that a screw had broken by bone and some hardware was removed. My foot feels like it's on fire and top of my toes feels like someone is holding a match to them. I know nerve damage takes time to heal but I'm to the point not taking much more. I'm on Percocet and Lyrica. Can you please recommend something else I can take to help?Also will these pains go away eventually? I can't imagine living like this the rest of my life. I'm only 43 -Sad

Dear Sad,

Surgeons use hardware such as screws and rods to fix a spine. Unfortunately, this fix can sometimes ruin a life, especially when the screws go askew. These screws are called pedicle screws because they are lodged into the pedicle, which is a narrow strip of bone which helps to form the neuroforamen. Tucked within this protective cave is a very sensitive structure called the dorsal root ganglion (DRG). Anything that damages the DRG can cause severe nerve pain. The DRG is that sensitive because it is the "brain" or "grey matter" of the spinal nerve root that passes through the neuroforamen on its way to the limb. In your case, the most likely scenario is that the broken screw damaged the L5 DRG. The feet and tops of the toes have a burning sensation as a result of the nerve pain being generated in the L5 DRG.

The dorsal root ganglion has been the subject of great deal of research because it is such a key player in the generation of pain, spinal pain. A Medline search with the words "Dorsal Root Ganglion" generates over 19,000 hits. From there, it becomes a scientific quagmire. Some believe that the holy grail of pain relief lies in the DRG. And they may be right to a certain extent. One thing is for certain, DRG damage is a very painful experience. You are not the only one to have this unfortunate experience.

The key to surviving this problem is twofold: aggressive initial action and patience. Obviously, the surgeon in this case acted aggressively when the problem unfolded. Removing the offending screws is critical to minimize the damage. Medications like Lyrica that help to control the eruption of nerve signals from a very angry mother ship, the DRG, should also be used aggressively. I would even argue for the treatment with epidural steroid injections, even if that could jeopardize the bone fusion. Failure of the bone to fuse seems like a minimal problem compared to the current one at hand.

Nervous system sensitization is a much more serious problem. Controlling the initial swelling and inflammation with epidural steroids (and possibly Ketamine) can help to prevent the sensitization of the nervous system. In fact, steroids applied to the nerve roots during a spinal operation can reduce the amount of pain experienced after the surgery. If I were you, I would have demanded for steroid injections yesterday.

Other medications worth considering are all the ones specific to nerve pain. Tramadol and Nucynta come to mind as alternatives to Percocet. And I would also consider the old trusty tricyclic analgesic (aka Tricyclic Antidepressants) medications like amitriptyline. Your problem with nerve pain after a broken screw will require a shotgun blast of medications used aggressively in these early, critical stages. Later on, more exotic procedures like repeat pulsed radiofrequency (PRF) and continuous radiofrequency (CRF) lesioning of the dorsal root ganglion (DRG) might be needed. (And yes, I would recommend Harvard and Dr. Bajwa.)

The second aspect of surviving a hit to the DRG is patience. Like much of the nervous system, the DRG can heal, just like the brain can heal after a stroke. If I was seeing you, I would recommend Acetyl-L-Carnitine and Alpha Lipoic Acid, which are two supplements known to help protect and heal the nerves. I would also look for ways to improve your health by exploring vitamins, nutrition, and lifestyle habits. All of these potential solutions take time to work because they assist healing.
Healing takes time.

One could only hope that this situation is temporary and that your life is not completely ruined by a surgery meant to fix your spine. With proper care and enough time, anything is possible.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.