Hi---I went to the Mayo to get another opinion, as I am one year post laminectomy and fusion without fusion, and with loose screws. I was concerned that the screws might be doing damage.

I'm glad i went. The key guy to see was Dr Pichelman, who specializes in people who have already been operated on.

He just talked with me. That's all. No exam, no tests besides the films I ahd sent to him. This is what he said:

1. The loose screws make only micro-movements and will not do any damage to the bone or soft tissues, so they are not a cause for worry.

2. Fusion can occur as late as 3 years after surgery, and one must be patient. He suggests the bone stimulator, which I already got, and CT films every 3 months. He'd stop the stimulator when the films stop improving.

3. I should not expect that once I've gotten fusion, if I do, that it will cure the pain. THere is very little connection between fusion and pain. People whose fusion fails are pain-free; people with excellent fusion can have pain.

4. The spine has many potential pain generators, especially after laminectomy and fusion. It oculd be the micromovements of the screws, could be the degenerated facets, ligamentous inflammation, bony inflammation, OR pseudoarthrosis which cause the pain. The only way to know where it is from is to methodically insert needles into very specific locations, observe what happens over time, and see if that particular spot is the generator. The typical blocks to facet joints and joint space are too general to tell exactly what the generator is.

5. If the pain is tolerable, wait another year before really pursuing injections; but if it's intolerable, go for it. There's no evidence one way or another that single injections of steroids into the spine will have long term effect on fusion.

That's what I learned in 20 minutes. I traveled 6 hours out there, spent money on a hotel and meals, and got all I needed from the conversation. Wish I'd had that conversation here; but I hadn't.

I think he's a good man.