Spinal Hardware Removal When Broken or Infected

Different spinal surgical procedures use various types of spinal hardware to stabilize the spine. When this hardware breaks or gets infected sometimes it could have to be removed. The reason for this spinal hardware, whether from injury, disease, or a condition, that area of the spine needs added support other than the bone, collagen, ligaments, and other tissues. Surgeons utilize this hardware to:

• Stabilize the spine
• Correct deformities
• Regain motion
• Height restoration
• Pain relief
• Help heal another area of the spine

The hardware ranges from rods, plates, cages, wires, spacers, etc. There are many types and are employed in various operations. Many spine procedures involve some type of hardware. A surgeon relies on this spinal hardware to complete procedures involving realignment of the spine or spinal fusion. Many patients undergo spine surgery without complications, however, some have problems with the hardware. The most common issues are the hardware loosening, breaking, or the development of an infection. Unfortunately, when this happens it can mean that another surgical procedure may be necessary to remove the hardware/device.  

Spinal Instrumentation

All of these pieces of equipment are designed to remain in the body permanently. The hardware can be made from stainless steel, titanium, and titanium alloy. Spinal fusion is common, involves hardware, and could be necessary to help/correct:

• Spinal deformity/s
• Degenerative condition/s
• Heal fractures
• Other issues causing back pain

The procedure involves the surgeon grafting bone between two vertebrae. Then the hardware is used to hold those vertebrae together. This eliminates motion between them. This is how the vertebrae fuse into a single bone, which reduces or eliminates the pain. Like with any surgical procedure complications can include hardware failure.  

Spinal Hardware Removal Reasons

If the hardware loosens, gets infected, or the patient can feel some of the hardware under the skin a surgeon will likely recommend removal. Intense, excessive pain is often a symptom of a loose screw and other hardware complications. If the hardware is protruding under the skin the patient could feel a bump that could cause pain when touched. Loose hardware could irritate the surrounding tissues and nerves, resulting in the patient feeling pain or hearing a grating, crackling, or popping sound. Loosened instrumentation can be caused by the bones of the spine not healing or fusing correctly. The hardware can also shift and break from the bones not healing properly. Other reasons for hardware failure shortly after surgery.

• Lifting heavy objects
• Participation in high-impact activities
• Trauma from accident, slip, fall, etc.
• Health conditions especially osteoporosis and osteopenia can increase the risk of the instrumentation loosening, breaking, and shifting.

Quite uncommon but some patients develop infections right after or weeks following the surgery. When the hardware gets infected the patient could feel pain along with the site of the incision draining, and fever. Key indicators around the incision site are:

• Chills
• Redness
• Swelling
• Tenderness

Sometimes there are allergic reactions to the hardware itself. However, this has decreased significantly in recent years. This was common with stainless steel before the use of titanium.  

How The Removal Is Done

This type of removal surgery is typically not considered an emergency unless the nerves or spinal cord are at risk of being injured/damaged. The exact procedure depends on the individual’s specific situation and case. However, it will be easier than the first surgery. Removal is typically nowhere near the extensiveness of the initial instrumentation placement. Before the procedure, the surgeon will advise preparation tips, just as with the original surgery. To optimize recovery, patients should ensure they are in the best possible health that they can be. This means no smoking, light exercise, and even breathing exercises for optimal lung function. Patients should not begin any new medication regimen prior to the surgery and should ensure all medications are known to the surgical team. The procedure will go in through the original incision and remove any scar tissue around the hardware. Depending on the situation the hardware could be reinserted or left out entirely.

Post Removal

Hospital stay depends on the individual situation. Some patients go home the same day and some have to wait. If there was an infection it more than likely means an extended hospital stay to make sure the infection is gone and has not spread elsewhere. The healthcare team will give directions just as with the original surgery which can include detailed instructions on:

• Sitting
• Sleeping
• Showering
• Taking meds
• Sex

Recovery from hardware removal depends on the extent of the surgery. Contact the surgical team if experience new or unusual symptoms after the procedure, including fever, pain beyond the surgical soreness, numbness, weakness, tingling, and for problems/issues around the incision area, like bleeding, redness, swelling, and draining.

Bottom Line

Spinal hardware helps the spine heal, and ultimately reduces or eliminates the back pain improving quality of life. Instrumentation and devices can be defective, causing them to break, loosen, etc and need to be replaced. It’s just in this case the replacement has to take place in and around the spine. A doctor will assess the damage and decide if removal surgery is necessary, which will prevent further problems.

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