Question
In 1996 I had spinal fusion with herringbone rod placement from C-7 to L-2. After about 2 years after surgery I have this burning and extreme pain, located in between the scaplus and runs parrell to the mid and bottom of scapuals. The Fentanyl 75mcg  patches dull the pain, but it never goes away.Its been now, 10 years of the excact pain and discomfort, Please advise on next step.

Answer
Burning Pain Between Scapulas.

Hello Stacey, sorry to hear of your surgery and complications.

For spinal pain, spinal problems like a burning pain, your family Doctor of Chiropractic, your local spinal specialist,  would be a good choice for evaluation and perhaps treatment.  Burning pains, shooting pains, dull aches, tingling, numbness; all of these are terms that patients use when coming to the Doctor of Chiropractic (DC). Usually, good results are obtained through conservative, noninvasife, safe chiropractic techniques.

As you know, the pain patches may kill the pain, may dull the pain, but do not treat the cause of the pain.  The symptom of pain shows that there is a problem in the body, and the cause should be evaluated and treated if possible.

I am familiar with spinal fusion surgery, rod placement, spinal procedures; but I am not an MD or surgeon, as such I will not comment on whether the medical appliance or the surgery was the best procedure available, appropriate, or involved in the complications you are experienceing.  By law, only Medical Doctors can prescribe, and comment specifically upon medical procedures.

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From a medically oriented public website:
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestU...

Spinal instrumentation is a method of straightening and stabilizing the spine after spinal fusion, by surgically attaching hooks, rods, and wire to the spine in a way that redistributes the stresses on the bones and keeps them in proper alignment.

Purpose
Spinal instrumentation is used to treat instability and deformity of the spine. Instability occurs when the spine no longer maintains its normal shape during movement. Such instability results in nerve damage, spinal deformities, and disabling pain. Spinal deformities may be caused by:

birth defects

fractures

marfan syndrome

neurofibromatosis

neuromuscular diseases

severe injuries

tumors


Curvature of the spine (scoliosis) is usually treated with spinal fusion and spinal instrumentation. Scoliosis is a disorder of unknown origin. It causes bending and twisting of the spine that eventually results in distortion of the chest and back. About 85% of cases occur in girls between the ages of 12 and 15, who are experiencing adolescent growth spurt.

Spinal instrumentation serves three purposes. It provides a stable, rigid column that encourages bones to fuse after spinal-fusion surgery. Second, it redirects the stresses over a wider area. Third, it restores the spine to its proper alignment.

Different types of spinal instrumentation are used to treat different spinal problems. Several common types of spinal instrumentation are explained below. Although the details of the insertion of rods, wires, and hooks varies, the purpose of all spinal instrumentation is the same-to correct and stabilize the backbone.

Harrington rod
The Harrington Rod is one of the oldest and most proven forms of spinal instrumentation. It is used to straighten and stabilize the spine when curvature is greater than 60 degrees. It is an appropriate treatment for scoliosis.

Advantages of the Harrington rod are its relative simplicity of installation, the low rate of complications, and a proven record of reducing curvature of the spine. The main disadvantage is that the patient must remain in a body cast for about six months, then wear a brace for another three to six months while the bone fusion solidifies.

Precautions

Since the hooks and rods of spinal instrumentation are anchored in the bones of the back, spinal instrumentation should not be performed on people with serious osteoporosis. To overcome this limitation, techniques are being explored that help anchor instrumentation in fragile bones.

Description

Spinal instrumentation is performed by a neuro and/or orthopedic surgical team with special experience in spinal operations. The surgery is done in a hospital under general anesthesia. It is done at the same time as spinal fusion.

The surgeon strips the muscles away from the area to be fused. The surface of the bone is peeled away. A piece of bone is removed from the hip and placed along side the area to be fused. The stripping of the bone helps the bone graft to fuse.

After the fusion site is prepared, the rods, hooks, and wires are inserted. There is some variation in how this is done based on the spinal instrumentation chosen. In general, Harrington rods are the simplest instrumentation to install, and Cotrel-Dubousset instrumentation is the most complex and risky. Once the rods are in place, the incision is closed.

Preparation

Spinal fusion with spinal instrumentation  is   major   surgery . The patient will undergo many tests to determine that nature and exact location of the back problem. These tests are likely to include x rays, magnetic resonance imaging (MRI), computed tomography scans (CT scans), and myleograms. In addition, the patient will undergo a battery of blood and urine tests, and possibly an electrocardiogram to provide the surgeon and anesthesiologist with information that will allow the operation to be performed safely. In Harrington rod instrumentation, the patient may be placed in traction or an upper body cast to stretch contracted muscles before surgery.

Aftercare

After surgery, the patient will be confined to bed. A catheter is inserted so that the patient can urinate without getting up. Vital signs are monitored, and the patient's position is changed frequently so that bedsores do not develop.

Recovery from spinal instrumentation  can   be   a   long,   arduous process.    Movement is severely limited for a period of time. In certain types of instrumentation, the patient is put in a cast to allow the realigned bones to stay in position until healing takes place. This can be as long as six to eight months. Many patients will need to wear a brace after the cast is removed.

During the recovery period, the patient is taught respiratory exercises to help maintain respiratory function during the time of limited mobility. Physical therapists assist the patient in learning self-care and in performing strengthening and range of motion exercises. Length of hospital stay depends on the age and health of the patient, as well as the specific problem that was corrected. The patient can expect to remain under a physician's care for many months.

Risks

Spinal instrumentation carries a significant risk of nerve damage and paralysis. The skill of the surgeon can affect the outcome of the operation, so patients should look for a hospital and surgical team that has a lot of experience doing spinal procedures.

After surgery there is a risk of infection or an inflammatory reaction due to the presence of the foreign material in the body. Serious infection of the membranes covering the spinal cord and brain can occur. In the long-term, the instrumentation may move or break, causing nerve damage and requiring a second surgery. Some bone grafts do not heal well, lengthening the time the patient must spend in a cast or brace, or necessitating additional surgery. Casting and wearing a brace may take an emotional toll, especially on young people. Patients who have had spinal instrumentation must avoid contact sports, and, for the rest of their lives, eliminate situations that will abnormally put stress on their spines.

Normal results

Many young people with scoliosis heal with significantly improved alignment of the spine. Results of spinal instrumentation done for other conditions vary widely.

Thank you:  http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestU...

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Of course your family Doctor of Chiropractic probably tried all of the conservative noninvasive techniques available prior to sending you forward for invasive surgery.

Surgery certainly changes the 'architecture' of the spine- and certainly alters the techniques and approaches available to the Doctor who practices Chiropractic.  But, even after surgery, spinal surgical patients can be evaluated by their family DC and perhaps treated via certain chiropractic and physical medicine techniques.

Spinal Surgery does limit and alter the approaches a DC may take, but treatment avenues are varied and vast within chiropractic, and certain techniques should give you some relief.

I would visit my family Doctor of Chiropractic, certainly give a complete accurate history, bring Xray reports, MRI, CT scans, emg/ncv reports, and even surgical reports ( to descibe the procedure/ apparatus utilized ).  The doctor may have treatment options that are safe, effective, conservative and noninvasive.

Your family DC may also help with natural nutritional approaches that could be anti-inflammatory, anti-pain.

As always, this article is for discussion purposes only.  Bringing information and education to the public.  Specific evaluation, DX, TX, RX, PX an only be given by an in-person treating health professional.

Good Luck, and Good Health Naturally!

Dr. Victor Dolan, DC
Staten Island Chiropractor
http://www.GoodHealthNaturally.info
http://www.DocDolan.net
http://drvictordolan.chiroweb.com  (email newsletter)