Should Your Spinal Hardware Be Removed? Here’s How to Tell

Many spine procedures use hardware to stabilize your spine. But what happens when hardware breaks or gets infected?

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Sometimes your spine needs a little something more than the bone, collagen, ligaments and other tissue from which it’s made.

When you have spinal surgery, your surgeon may use certain hardware to stabilize your spine or help it to heal. From plates and cages to rods and wires, there are many types of these devices, and they’re employed across a wide array of operations.

“Many common spine procedures involve the use of hardware,” says Isador H. Lieberman, MD, MBA, FRCSC, President of the Texas Back Institute and Director of the Scoliosis & Spine Tumor Center in Plano, Texas. “A surgeon will rely on hardware to complete any procedure that involves realigning the spine or fusing the spine.”

Though numerous patients undergo spine surgery without any complications, some experience problems with their hardware. It loosens or breaks, for example, or a painful infection develops. In these cases, another surgery to remove the devices may be necessary.

Spine hardware removalMany procedures use hardware such as plates and screws to stabilize the spine, but when they break or become infected they may need to come out.

Common Spinal Instrumentation and How It’s Used

Spinal hardware is used to keep your spine stable while you heal from surgery. It’s comprised of a variety of plates, rods, cages, wires, spacers, hooks and screws that are designed to be left in the body for a long time. While some hardware is made of cobalt-chrome or stainless steel, “most of the contemporary instrumentation is made of titanium,” says Dr. Lieberman.

Spinal fusion is a common type of surgery that involves this hardware, and may be performed if you have a spinal deformity, degenerative condition, fracture or breaks, and or other issue causing back pain. During the procedure, your surgeon grafts bone between two vertebrae (the small bones that make up your backbone). Then, they use a mix of hardware to hold those vertebrae together, eliminating motion between them. This helps the vertebrae fuse into a single bone, reducing or getting rid of pain. Spinal fusion complications can include hardware failures.

Why Your Spinal Instrumentation Might Be Removed

Rods, screws, and cages are typically implanted with the intent of them being permanent,” says Dr. Lieberman. But if that hardware loosens, becomes infected, or feels prominent under the skin, he explains, your surgeon will likely recommend removal.

Often, excessive pain is a symptom of a loose screw after spinal fusion or other hardware complication. “If the hardware is prominent under the skin the patient may feel a painful bump,” Dr. Lieberman explains. “If the hardware loosens or is irritating the surrounding tissue and nerves, the patient may feel pain or may feel and hear crepitus—a crackling sound or popping sound.”

Loosening of instrumentation frequently occurs when the bones of the spine don’t heal or fuse correctly; this poor healing my also cause hardware to shift or break. Patients who lift heavy objects, take part in high-impact activities or suffer trauma shortly after surgery may be more prone to this hardware failure, as well. Certain health conditions—including osteoporosis (weak bones) and its precursor, osteopenia—can also increase the risk of loosening, breaking or shifting.

Though relatively uncommon, some people develop infections right after or in the weeks following device placement. “If the hardware becomes infected the patient may feel pain and may also develop a draining incision accompanied by fevers,” says Dr. Lieberman. Redness, swelling or tenderness around your incision are also key indicators, as are the chills.

Occasionally, a patient will have an allergic reaction to the hardware itself—but those have become increasingly rare in recent years, says Dr. Lieberman. “This was a common phenomenon with stainless steel hardware prior to the use of titanium,” he adds.

It should be noted: Unless your nerves or spinal cord are at risk of being damaged, hardware removal isn’t usually considered to be an emergency.

Spinal hardware X-rayThis X-ray clearly depicts spinal hardware.

How Hardware Removal Is Done

If spinal instrumentation needs to be taken out, it typically involves surgery, says Dr. Lieberman. The exact procedure will depend on your individual situation, but it will likely be easier than the first operation. “Removal of hardware is usually nowhere near as extensive as the initial placement of the hardware,” he explains.

In the days and weeks leading up to your procedure, there are steps you can take to prepare. “As with any surgery, in an effort to optimize the recovery, patients should ensure they are in the best possible state of health,” advises Dr. Lieberman. That means quitting smoking, getting adequate exercise, and performing breathing exercises “to optimize lung function.”

“In addition, patients should not start any new medications immediately prior to the surgery,” he adds. “And they should ensure that all medications are known to the surgeon and treatment team.”

During the procedure itself, your surgeon will likely go in through your original incision and remove scar tissue around your hardware. Then, Dr. Lieberman says, “depending on the circumstances, hardware may be reinserted or left out completely.” When the surgery is complete, your incision will be closed and you will be taken to a recovery area.

After Your Spinal Instrumentation Removal Surgery

As with your operation, the length of your hospital stay will largely depend on your individual situation. Some patients go home the same day—but many don’t. “Most people require an overnight hospital stay,” says Dr. Lieberman. “If the hardware removal involves an extensive procedure for instance, for an infection, there could be a multiple-day hospital stay.”

After you arrive home, you should avoid activities that could strain or injure your back and follow any directions given to you by your healthcare team. These may include detailed instructions about sitting, sleeping, showering, taking medication and even having sex.

Your surgeon will check your progress during follow-up appointments. Although most patients feel better within a few weeks, recovery from surgery to remove hardware depends on the extent of the surgery itself,” explains Dr. Lieberman.

Like all surgeries, there is a risk of complications with spinal instrumentation removal. Get in touch with a healthcare provider right away if you experience new or unusual symptoms following the procedure, including fever, excessive pain, numbness, weakness or tingling. Reach out regarding problems around your incision area, too, such as bleeding, redness, swelling or drainage.

The Bottom Line

The use of spinal hardware helps many patients heal, ultimately easing their back pain and improving their quality of life. But if these devices are causing you discomfort or other difficulties, report it to a provider. Your doctor can assess the issue and decide if you need removal surgery, which could save you from greater problems down the line.

Need spine surgery? Find a spine specialist near you who can help.

Updated on: 05/01/20
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