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Removing screws and rods...

katejs90kkatejs90 Posts: 14
edited 06/11/2012 - 8:48 AM in Back Surgery and Neck Surgery
Hi all,
I had L1 and L2 fusion in march 07 due to severe slipped disk (cause by kyphosis which was mainly corrected by bracing). after the surgery the pain was a whole lot better, almost completely gone even, for about 6 months. it then started to go down hill to the point where i am in constant pain again and living on painkillers. In the last few months it has got a lot worse and i am struggling with day to day life.
My surgeon has decided that he thinks one of the screws (i have 3 screws, a rod and a cage surrounding the fusion) used during fusion may have moved (or is moving) and pressing on or damaging a nerve or even the spinal canal. He said that if this is the case he would like to operate to remove the screw. he also said that while this operation could minimize or completely fix the problem and get rid of the pain for good, it could also go the other way and cause a lot more problems. I think if he offered it to me i would probably have the surgery as I am only 19 and can't do much with my back as it is at the moment, i don't really have much to loose, especially as it is getting worse quickly.

Does anyone have any experience with removing fusion metal work? or know what the risks may be? or have any advice even?



  • Kate,
    I'm currently 8 weeks post op hardware removal with no positive results, but the doctor only gave me a 50-60 percent chance that it would help my symptoms. We are waiting until late December to see if there are any results. Prior to my removal I had 3 opinions and a discogram to see if it was the hardware causing my problems. Could a discogram be done? It's an uncomfortable test but they do sedate you. I would really want to be as informed as possible before going back in. I'm so sorry you're going through this so young. I pray that you have a good support network. Good luck in all your decisions!
    Surgery 1/07/2009:
    1. L3-4 decompression laminectomy and foraminotomy
    2. Left complete L3-4 discectomy with decompression of L4 root.
    3. Posterior lumbar interbody fusion, L3-4 with 10-mm Capstone cage and autograph.
    4. Posterior spinal fusion L3-L5 with iliac bone graph and BMP
    5. Legacy instrumentation, L3 to L5

    Surgery 10/4/10
    Hardware Removal
  • yesterday and he is going to remove my bone stimulator in a couple of weeks. I had double fusion in L 3/4 & L 4/5 in June. I also have rod, screws and cage. I too have been in pain every day. He was going to remove the screws and rod, but after talking with my Orthopedic doctor who was the second surgeon in my surgery, he decided not too. The reason is that if he removes cage rods, and screws everything could collapse, and I would be in worse shape. So, he's going to see if removing just the bone stim. will help because the battery is dead anyway. He said if he were taking out any of the metal he would do a CT scan first. Don't know if any of this helps or not, but just be sure the screws need to come out first.
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  • I just went through this conversation with my neuro regarding risk/reward. He is dead set against removing hardware unless it is absolutely necessary. For me the hardware is annoying and causes me issue from poking my muscles and sometimes nerves. He feels that is not a good enough reason. In your case, if it has moved and is the cause of your new issues then it's different. You need to make absolutely sure that it is what is causing you problems. I'm very leery of these "hardware tests" and would love to know how your surgeon will determine it is the reason. At the very least a CT scan is a given.

    The risks are;

    1. It is a surgery again. It is not minor.
    2. You will get scar tissue, muscle and nerve cuts again.
    3. The screw(s) could break. The tops aren't that strong.
    4. There could be bone growth in the way that causes extra work to get at the screws and rods.
    5. It doesn't fix your problem because the hardware is not the problem.
    6. You end up worse because it is what is holding your spine together.
    7. The same risks anyone runs entering the OR and doing surgery.

    I would be pressing the surgeon pretty hard on how he is getting that hardware out. Come Mar/11 that hardware will have been in for 4 years. Between existing bone growing around it. The BMP he used for your fusion growing around it.

    Screws and rods are scaffolding that can be removed if you fused properly. For some it is the reason they are fusing and staying together. Pull it out too soon and the new fusion may not be strong enough to stand on its own. I have been told 1-2 years. Preferably 2 years before attempting it. Several years and it might be too late. The structure could be so well formed that the hardware will next to or impossible to remove without damage.

    The reward is obvious. To get out of this pain and off the drugs and back to your life. YOU have to weigh in the risks vs the reward.

    Good luck. Please let me know what tests they want to run to insure this will work. I'm very curious.

  • I worry about the screw that might be pressing on your nerves - it sounds to me like the removal really could go either way, just like your surgeon has said.

    But - I am a very successful hardware removal story.

    It's been almost 11 months since my removal. I had my hardware for 18 mo. After the surgical healing - I started to do a lot better. I've had a summer where I only had an occasional back ache - I've gone DAYS with no back pain!!!

    I am getting some pain back again, but I'm pretty sure it's L4/3 that is going,

    I had no nerve impingement though - not from the screws. Just a leg that would collapse if you pushed on the screw heads. Also, before the removal I had constant BACK pain, not sciatica (nerve pain).

    We waited 18 mo. post fusion to verify that I was really fused. After a full fusion the hardware becomes redundant and unnecessary. That said, there is always risk with every surgery. Be wary, and good luck
  • thanks for all your replies and advice.
    I have had my results back today (after waiting 3 months since the scan!!) and thought you might like an update.

    The scans show that there are no problems with the fusion or the metal work and that the screws are all secure and not causing my pain.

    It's left us at a bit of a dead-end. My surgeon said that if the pain was stable then he would put it down to nerve damage and scar tissue and refer me to pain management.

    But it's not. It's getting worse by the day, I take a lot of meds and cannot live a normal life at the moment.

    We're not sure what the next step is, he's going to run more tests and examinations to try and figure it out.

    I am just so frustrated, I have had back problems for 8 years (since the age of 12) and its 4 years since surgery. I'm bored of it! It just feels like we're going round in circles and not getting any answers! I don't know what to do about it really. Mainly because it's getting worse so quickly, I don't know when it's going to stop getting worse which is really scary as we have no answers to why!

    I wonder if anyone out there knows what else it could be?

    Thanks again for all your help before
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  • I just had my hardware removed March 4 and I am hurting as much as ever. I had the original surgery Oct 2010.

    All of my harware had come loose, Doc said he took one of the screws out with just his fingers! I could feel the hardware move around in my back.

    I am sorry I ever had any back surgery now. My hips hurt (he took bone out of both of my hips) cut me in front as well as the back a day later, and I am still hurting. walking with a cane now. I would certainly hope your age would be on your side.
  • Sharon - thank you for your reply. I really hope things start looking up for you. We have decided to leave the hardware alone as my dr doesn't think that is what is causing the pain, and as it has been in there for four years it would be very risky to move!

    Just back at square one trying to find a diagnoses. Not sure about age being on my side - it started when I was 12 and has just gone down hill - a lot! But never mind, I'm trying to stay positive and hope that they will figure it all out.

    Take care, hopefully your surgery pain will settle down and then maybe things will be more manageable, sorry to hear it's so horrible for you though.

  • How disappointing! To go so long and to not have any solutions or answers!

    My heart goes out to you, I hope these new tests show something... good luck.
  • I had an Anterior lumbar interbody fusion (ALIF) surgery and fusion in July 2005 for a completely torn L5-S1 disc that was sliding out and causing my lower body to go numb. After 2-3 months of recovery I returned to normal everyday activities. For the 5 years following surgery I played basketball, golf, softball/baseball, rode and raced quads, and was quite active. I was pain free until August of 2010 when pain started in the area around the fusion. I spent 5 months with a horrible doctor that just wanted to give me pain killers. I was finally able to change medical insurance and doctors. The same neurosurgeon that did my ALIF and fusion checked me out and found that my screw heards and rods were hitting the nerves in my back causing my pain. On April 7th. 2011 the screws and rods were removed. It's pain almost 3 weeks and I am as close to pain free as I can remember being. I am 35 and back to playing sports already after my surgery on April 7th. My word of advice to anyone before getting surgery is check out the neurosurgeon and make sure he is liked by patients and other doctors.
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