Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Hardware Removal - Unfavorable Outcome

1994SanFrancisco11994SanFrancisco Posts: 83
edited 06/11/2012 - 8:42 AM in Back Surgery and Neck Surgery
Every so often I read posts from people who continue to have back and nerve pain after fusion then start down the path of determining if it is "hardware related". Many post wondering if their symptoms are hardware related and ask for opinions from others who have had their hardware removed and what their experience was. For what it is worth, here is my experience and outcome of my hardware removal.

I had an MIS-TLIF on L5/S1 in February of 2009. After surgery I experienced nerve pain and difficulty walking. I noticed a gradual improvement in my nerve pain and mobility in the first three months then a continuous decline in ability to walk, sit or stand for longer than a few hours. I had a CT scan and MRI which did not reveal any abnormalities in the fusion or adjacent levels so my surgeon suggested it could be the hardware. At 5 months my surgeon ordered a "hardware block" to see if I obtained any relief. I did experience relief for a few hours so my surgeon felt that the hardware was causing problems. We decided that once I was fused then we would take out the hardware. At 9 months I had a CT scan and my NS said that I was fused enough to take out the hardware. My hardware removal was almost 10 months post-op. I am now just over three months post-op from the hardware removal and I am basically bed-ridden. I have found I can be up for 30-45 minutes about 4 times per day and that is all. My legs alternate between feeling like they have been rolled in crushed glass to just being numb. My lower back pain is so bad that sitting is impossible for any more than 15 minutes. I've recently met with a new surgeon who has ordered an MRI and EMG to see what is going on. He brought up the possibility that the fusion may have failed and I might need to have another fusion. This is obviously my worst nightmare and frankly I am not sure I could endure going through this again. I am fairly sure that my nerves are beyond repair and going back in again would only serve to cripple me beyond belief. I can only hope that the fusion is stable and solid. The surgeon also brought up the possibility that scar tissue is causing the nerve pain. I will just have to wait to see what the tests reveal.

I remember asking my surgeon about the hardware removal and if there were any disadvantages to removing the hardware. He said no, it was an easy 15 minute procedure and that no one he has removed hardware from has ever had any additional pain or issues from removing the hardware. It was supposed to be so straightforward and simple. At any rate, I take the time to post this so that there is yet another "hardware removal" case that others can read and know that if you remove your hardware 1)it is still major surgery (there was no way it was 15 minutes as I know what time I was wheeled in and what time I hit recovery and it was a good 3 hours) 2)it has been said many times before by many people but the more you slice into your body the more risk you run with permanent nerve damage and scar tissue, 3)don't let your cocky, ivy league educated surgeon convince you that his success rate is far greater than the typical fusion "success rate".

I will say a couple things in favor of hardware removal. I do now have more flexibility in my spine since removing the hardware and I did lose a very specific limp that it must have been causing. The hardware did keep me in kind of a locked position that seems to be gone but I am not sure that the trade off is worth it. I wish all those contemplating or undergoing hardware removal a far better ouctome than I experienced --I know there are success stories I am just not one of them.


  • you've been through.
    I'm sooo sorry to hear how bad things have gotten. It is a good reminder that fusion is NEVER to be taken lightly.
    I can only hope that things get better for you and that this new surgeon can help even a little bit.
    Please keep venting here, it will and does help with your mental and emotional well being.
    Take care
  • Kylie,

    Thanks for your kind words. I am not counting on much from the "new" NS, mostly just getting a diagnosis if one can be obtained at this point. I truly never want another spinal surgery. I just hope that my back stanbilizes and I can find a way to cope with what I can and cannot do.

    I like your quote :)
  • SpineAZSpineAZ WiscPosts: 1,084
    If you have more flexibility that worries me. A true fusion means the area fused is one solid unit...even after the hardware is removed. So flexibility increase may mean that the area that was to be fused, did not fuse. It also worries me that a doctor would take out the hardware at 10 months. Seems a bit early unless there are definitive problems with the hardware.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • I too am really sorry to hear of all your problems. I have had problems too ever since my PLIF in Jan of 08 and can understand your frustrations.

    However, I would encourage you to not give up or give in to feelings that how you are now is how you will always be. New techniques are being developed all the time. I would encourage you to pursue other opinions. If you find a surgeon you trust, and he/she feels there is a reasonable chance that with a revision, the situation could be made better, I think you could persuade yourself to try one more time. You are bound to end up better off than if you have a non fusion and all the instability that will result from that.

    It is all still fresh for you. I think as a little more time goes by, if you are offered the hope of a revision, you will see that it is a chance worth taking.

    Good luck with your appointment with the new surgeon.

  • The newly found flexibility is more in my hips which I know sounds odd but I can't seem to pin point it further than that. It is not more flexibility in 'flexion and extension'.

    When I saw my NS at 5 months and we discussed the hardware and possible removal he said he could remove one side of my hardware at 6 months but not all of it until I was completely fused. I said no thanks I will wait until it can all come out. When my surgeon read my 9 month CT scan he said I was 'fused'. I was cautious and distintly remember telling him the day of the surgery that if he "got in there and discoverd that I was not fused solid then to remove the left side as most of my pain was on the left side". The VERY first thing I said to my surgeon in recovery was "did it all come out"? He said yes. I certainly hope that he made the right decision and that it is not a stability issue but understand that it could be.
  • I have to agree with SpineAZ on the flexibility issue. My hardware was removed at the 10 month mark also about a year and a half ago. I did not get any more flexibility without the hardware. As my doctor explained it to me, the hardware is like a cast that can be surgically removed once a solid fusion has been achieved.

    Unfortunately, the problems with my legs returned several months after my hardware was removed. Through all of my trials and tribulations, I have developed Adhesive Arachnoiditis. You may want to do some research on this in the event this is your problem. This disease progresses at different rates for everyone, some slow and some very aggressive. I hope your problem is just pseudarthrosis and can be corrected with a new fusion surgery that would re-stabilize your back.

  • Gwennie - Thanks for your thoughts. On one level I agree with you on not giving up but this last surgery was a huge wake up call. The fusion itself was a breeze but the removal was excruciatingly painful and EVERY single day since the surgery has left me with nothing but pain and dysfunction. I don't often have regrets but I regret removing the hardware. The destruction was just too great. Today I can stand and move around my house but not much more, what if an additional surgery took that away from me? I would never have even thought about that before either one of my spinal surgeries but I do now.

    In terms of trusting another surgeon, well that is tough. Prior to my fusion I hunted down the best surgeons I could find (strong reputation, knew others who had success with them, used latest MIS techniques, attended top schools, fellowship trained blah, blah, blah, etc..) and went with who I thought was 'the best'. It is daunting to go back through that process especially when I thought I had already found the top dog. The new NS I went to has already said many, many things that are contrary to what the NS who did the fusion has said. It leaves you wondering who is correct? I get tired of sifting through the varying opinions. I am sure you can relate.

    At any rate, all I can hope is that the fusion is fully stable.

    I wish you all the best Gwennie. I have read that you are working to get insurance approval for what will be a 3 level. I hope you can move forward with a solution soon. Take care and thanks for your post.
  • Hi Dave,
    Thanks for your post. May I ask how you arrived at your diagnosis of Adhesive Arachnoiditis? I know what it is and have read previously about it and suspect I could have the same thing as the nerve pain increases weekly. Did a CT myleogram reveal this finding? The new NS wanted me to get one but I will not. I am factor XI deficient (rare bleeding disorder) and while it has never presented a problem I have no desire to get my spine punctured only to have a leak that requires a blood patch.

    I am sorry to hear your diagnosis. It is no fun to feel like you are on fire, or being rolled in crushed glass - and never mind the loss in muscle fucntion. My heart goes out to you.
  • I was diagnosed from a CT Scan. As someone with AA, I would never submit to a myleogram and anyone suspected of this dx should avoid that test. The clumping of the nerves can be identified in the scan combined with your symptoms should be more than adequate in determining the dx. My symptoms are progressing slowly, but every several months they seem to make a small jump. All I can do is live my life. I recently had an SCS implanted 4 months ago to aid in my battle with this condition.

    My loss of motor control is minor at best but the cramping in my legs can be relentless at times. The upside is that I'm pretty sure that most body builders would kill for the definition in my legs below my knees because of the fasciculation. It sure would be nice if I could get some of the action in my abs for a couple months, wouldn't mind having a six pack.

  • Hi,
    I also had my hardware removed at 9 months due to continued pain last Oct from my 2 level PLIF on Dec 2008. It was a relatively uneventful surgery and didn't hurt even remotely close to what the fusion was. Unfortunately, it didn't decrease my pain, even though the block showed it would.
    When I had my fusion, I had 3 torn discs and only had 2 fused, as the L-3- L-4 wasn't as painful on discogram. My surgeon wouldn't do a 3 level due to increased risks of non fusion or problems with each additional level you do at once. So on Friday I am having my 3rd discogram to determine if it is indeed the problematic disc.
    My surgeon did a CT before he removed the hardware and then in surgery tested the strength of the fusion before removal. I don't think you should have more flexibility or increased pain to that extent if it was correctly fused. Just my opinion.
    At this point I am not happy to hurt after all I have gone through, and will continue to see if I can find the pain generator. I hope that you do as well. I think it is in your best interests to get another opinion and see what an Ortho Surgeon would suggest. If you do not have quality of life right now,with the pain you are in, I guess I feel like u don't have much to loose.
    I wish you well in what ever you decide. I hope you go on and get it checked out though. I went to 8 different Nueros, Othos, and such to find what the problem even was, and after two years and Ortho found the tears by a discogram, as they don't always show up on MRI and Ct's. SO, I guess what I am telling you is, think about how good you might be, given you have the right Surgeon. I know you checked your first one out, but, everyone makes mistakes and if you are not fused, I would think you are inviting more serious problems. Good Luck and sorry if I rambled on. If I can help, please feel free to ask any questions. Take Care, Robin
  • Please don't take the following question wrong. Have you ever wondered that maybe the 8 different Nueros and Orthos were correct in that there was no surgical solution to your problem? There is a point where the disc dries up and no longer puts any more offending material upon the surrounding nerves. The disc itself is not really painful but the material within the disc is what irritates the nerves causing severe inflammation and pain. Is it possible that after several years of constant irritation on your nerves that maybe you developed Adhesive Arachnoidits?

    I suspect my AA was present prior to my fusion surgery. The surgery may have been the catalyst to kick things off in a new direction, the proverbial straw that broke the camels back.

  • I am not taking it wrong, but rather explaining to you that the 8 Drs I went to couldnt find anything wrong. THey didnt find anything on the MRI and CTs so they said to to PT and take meds. I finally went to a Ortho in a Spine Clinic that said all disc tears do not show up on MRIs and had the discogram done, which showed 3 discs with issues. 2 tears and one with issues.
    I am having a discogram done on the one not fused to see if it is the pain generator on Friday. I am also looking into the AA. And thank you for your info. I hope the disc is the problem because I could tell a difference after surgery. My surgeon thinks the other has finally torn, due to the pressure of fusion, due to the fact that I was doing better and have since gone downhill again. Thanks and take care, Robin
    PS Sorry San Fran, didnt mean to invade your post.
  • I am more than happy to share my thread with you :) and thanks for your thoughts. Your challenges have been far beyond what anyone should ever have to endure and I will be waiting to read about your discogram results. I hope it is not too painful and you can comfortably get there and home without too much additional pain.

    I am not sure if I am having a particularly bad day or if something significant has changed in my spine but I got up this morning and was shocked at how weak my legs are and have had to stay in bed the entire day. I can hardly shuffle across the floor. I also noticed a new soft lump near the center of my spine parallel to one of my incisions. It seems to only protrude when standing and not laying down. The new NS ordered an MRI so I am going to get a move on that and get it done ASAP.

    Anyway, I hope your week goes well as you wait for your test. Take it easy and save your energy for Friday.
  • I am sorry to hear of your latest developments. I urge you to contact your new NS and tell of your latest developments. I think that the lump is something that definently should be relayed to him. Good Luck and hopefully you will get your MRI done soon.
    I would like to hear of your progress. And if you have any questions or concerns, please feel free to contact me at any time. Take care, Robin
  • Robin,

    You went to 8 DRs and had multiple MRI and CTs Scans. Then the 9th docotor, an ortho, had you get a discogram test? Am I reading this right? If so what were those 8 Drs? PMs? Primary physicians? I've gone through 4 surgeons. 2 I fired. The 1st did my micro. After seeing the MRI he said that the disc was herniated but didn't seem bad enough for the pain I was getting. He wanted a discogram followed by CT Scan. He reproduced the pain with no problems. He also said the tear was worse than they initially thought on just the MRI. Like Dave said. He felt leaking fluid was causing much of my pain also. He ended up doing a microd and it helped. Only reason I had a fusion when I did was from being in an MVA shortly after the micro.


    I've read a number of posts on here where people have had hardware removed. Most seemed positive and it alleviated muscle spasms and nerve pain. I know when I go see my neuro for my 6 month visit. I will be asking about removing the 4 screws and 2 rods. I'm having muscle issues with them. I was told if I was fat it wouldn't be so bad. Being slim build doesn't help. Well we are not solving this problem by me getting fat. I put on 30lbs with that danmed Lyrica that I have to work off. So I'm going to end up thinner, not fatter...

  • The others were Orthos, Neuros, and Neuro Surgeon. None of them were other than above. I went to a University Clinic that wanted me to go through a program they had for 2 weeks. It involved everything I had been trying for 2 years.
    My discs were also bulged, and deranged. Not just torn. After 2 1/2 years of pain with no change except increase in pain, I was willing to do anything that would ease it. My Ortho Surgeon, removed the discs. Which should have relieved the pain. But not if this other disc that has issues is still the probelm. Take Care, Robin
  • I just had my thoracic T7-8 screw and rod hardware removed last week. I am waiting to see how this improves. They went in a removed more of the disc and inserted some bone in T7-8. I had C3-6 repaired a few years ago. The first T7-8 did not relieve the spine compression, as was seen in a mylegram. Fortunately, I did not have issues with the mylegram. I did resort to constant rest throughout the day which allowed me to have some activities. I am interested in looking into the AA more. I can only say that mine is a constant maintenance problem. I have gotten to the point I want to quite, but I pick it back up again and move on. I want to know how to improve this so I can help others. My recent surgery was done at clevelanc clinic. I assume you are in CA. I have read some about cedar sinia. Take care.
  • Hi,
    I am very confused by the procedure you had. Do I understand that you had a microdisectomy on T7-8 and then they stabilized it with hardware? It was not a fusion right? Then they went back in to remove the hardware last week? I've not heard of this so I am curious why they would do a microdisectomy and then use hardware (if I have understood this correctly).

    Since you were at the Cleveland Clinic I can only assume you were in very capable hands. I hope you find relief from your pain and that this latest procedure was the last for you.
  • This is not completely unheard of:
    1994SanFrancisco said:

    I am very confused by the procedure you had. Do I understand that you had a microdisectomy on T7-8 and then they stabilized it with hardware? It was not a fusion right?
    JGandee may have had a posterior fusion. Basically they build a bridge between the vertebrae and leave the disc intact with a little trim here and there for space. Once the bridge is solid, the hardware becomes superfluous. I personally have an inter-body fusion and a bridge on one side. When I had my hardware removed, they knew that half my fusion at one level had failed but the bridge was solid, hence I was able have my h/w out while still receiving a revision at that same level.

    Of course I could be totally off base here cause I'm sure not a doctor.

  • The first attempt at T7-8 was to remove part of the disc and then use hardware to try to lift some of the compression off the disc. The result was still compression on the spinal cord and condition was worsening. After 1 year, they wanted to remove more disc at Cleveland C. They first wanted to do the lung deflation, but then changed it to try a micro approach. They went in and removed all of the disc that was on the spinal cord and created a little room to insert some bone between the vertbraes. This will keep the disc space open. They were not sure it would work, but the surgery was only about 3 hrs and it was successful. The main part of the disc is still there.
  • Just a general note -- surgical techniques at the thoracic level are different from those used on cervical and lumbar segments. There are different issues involved at the thoracic level and surgery is more complicated as a result.
  • Hi,
    Thanks for explaining your procedure. I have problems in my neck/thoracic area too but I can't bear to go get a definitive diagnosis/pinpoint the exact level.

    It is very interesting and informative to read about what treatment options are being used. If you don't mind sharing, what keeps the bone in place if the hardware was removed? Is the bone placed there to start a fusion process even with the disc intact? I am curious about the rationnale for such a procedure and what they are trying to achieve. It is very nice to hear that it was successful. How is your pain now? I hope this is a long lasting solution and so nice to hear that they could achieve this without deflating a lung.
This discussion has been closed.
Sign In or Register to comment.