Painful hardware in the neck. Photo Courtesy (C) Scott Camazine
What is painful hardware?
Patients who have had a prior spinal fusion might have painful hardware as a source of their pain. This hardware might include the screw heads or rods from a fusion and the patient may be labeled with a diagnosis of Post-Laminectomy Syndrome (Failed Back Surgery Syndrome). These patients have usually had a variety of other more conservative measures they tried first without achieving substantial relief of their pain. A Painful Hardware Injection is usually a procedure that we reserve as a treatment of last resort if all other interventions such as Epidural Steroid Injections, Facet Injections, Radiofrequency Ablation and others have already been tried.
How is the procedure performed?
The hardware targets are identified under fluoroscopic guidance (X-ray imaging). First, the overlying skin is numbed with a local anesthetic. Next, a small gauge needle is advanced under that X-ray guidance until the screw head is contacted. Then, there is small amount of local anesthetic injected and the patient is brought to the recovery area. The patient will go home and we will examine the extent of pain relief within the next day or two.
What happens if I have a good response to the hardware injection?
Receiving a significant pain reduction for the time that the local anesthetic (numbing medicine) last would be considered a good response to the injection. You should be better able to do the normally painful activities that the pain was causing. Your pain will come back after the local anesthetic wears off.
We will follow up in the clinic shortly after the injection to discuss the results. If you had a good response, then we will discuss these results with your Orthopedic Spine Surgeon or Neurosurgeon to see if a hardware removal surgery is indicated.
What happens if I don’t have a good response to the hardware injection?
A poor response would mean you don’t have much of a pain reduction for the time that the local anesthetic (numbing medicine) lasts. You would not feel much of a difference in the level of function after the injection.
We will follow up in the clinic a few days after the injection to discuss the results. A poor response means that your pain would not likely improve after hardware removal and we likely would not recommend discussing this with your Spine Surgeon or Neurosurgeon. We would need to discuss other methods for pain and function improvement.
Are there things I should look for after having this procedure?
Of course, you may call our office for any question you might have. However, there are certain “red flag” warnings for which you should call us or if it is after hours you should go to your nearest ER. These “red flag” warnings would include severe or worsening pain, fever over 101 degrees, new or worsening weakness, or injection site redness or drainage.