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.