Late Complications of Displaced Thoracolumbar Fusion Instrumentation Presenting as New Pain in Individuals With Spinal Cord Injury

J Spinal Cord Med, 2005 · DOI: · Published: July 1, 2005

Spinal Cord Injury Pain Management Surgery

Simple Explanation

Spinal fusion with rods is common for scoliosis or spinal cord injury (SCI), but late complications causing new, localized pain in SCI patients are underreported. Displacement of hooks and rods can cause back pain, potentially needing hardware removal. Two cases show thoracolumbar fusion rod removal due to displaced hooks, protruding rods, and associated pain.

Study Duration

Not specified

Participants

2 individuals with SCI

Evidence Level

Level IV, Case Reports

Key Findings

1
Both individuals experienced back pain from proximal hook displacement, without neurologic decline.
2
Rod removal resolved muscular back pain in one case, though neuropathic pain persisted.
3
In the second case, hook and rod removal resolved pain at the T1 to T3 levels.

Research Summary

This paper presents two cases of individuals with spinal cord injury (SCI) who experienced late complications from thoracolumbar fusion instrumentation, specifically displaced hooks and protruding rods causing new, localized back pain. The cases highlight the importance of differentiating between different types of pain in individuals with SCI, as neuropathic pain can mask new pain sources. The study suggests that physiatrists should be aware of these potential late complications and consider them in patients with SCI who present with localized back pain and a protruding mass.

Practical Implications

Improved Pain Differentiation

Clinicians should carefully differentiate types of pain in SCI patients, as neuropathic pain can obscure new sources of pain related to instrumentation.

Awareness of Late Complications

Physiatrists managing SCI patients need to be aware of late complications like hook displacement in spinal fusion hardware.

Prompt Radiological Evaluation

Localized back pain and protruding masses in SCI patients with spinal fusion should prompt radiological evaluation for hardware displacement.

Study Limitations

1
Small sample size (two case reports) limits generalizability.
2
Lack of long-term follow-up data on spine stability after hardware removal.
3
The surgeons did not indicate whether the patients’ spines appeared to be fused or not at the time of the surgery.

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