Jeffrey R. Carlson, MD
As surgery advances and becomes more commonplace, more patients will have spinal hardware (i.e., screws, rods, plates) used to stabilize the bones of their spines. The hardware has great advantages over the older techniques of providing spine stability with an external brace. This difference can be equated to having surgery for a broken leg that puts a plate or rod into the bone vs. an external cast. The internal instrumentation provides immediate rigidity to the bones, so the patient may be able to walk and go to work much more quickly than if using a cast. The internal hardware also keeps the bones in position so they will heal correctly, which many external casts cannot do effectively.
With so many patients having surgical spine hardware placed, I get questioned about having the screws, rods or plates removed at some point in the future. I tell patients that the hardware is intended to stay in for life. The only reasons to have it removed would be for a complication related to the metal, such as a loss of fixation or an infection. There have been surgeons who routinely removed spinal hardware when they felt the fusion was completed or if the patient felt the hardware was causing pain. Most patients don’t want a second surgery, especially if they have done well with the first surgery and don’t have pain.
A recent study from The Journal of Bone and Joint Surgery (August 16, 2021) brings some clarity to removal of orthopaedic hardware. These researchers evaluated more than 13,000 surgeries for removal of bone-securing hardware. They found that this was a very common procedure in orthopaedics, but had significant complications related to the surgery itself. Almost 10% of patients who had this relatively minor surgical procedure had complications, including: from the anesthetic, wound healing issues, infections, continued pain, nerve injury and fracture. There were even several life-threatening complications.
Before you request to have your hardware removed, you should ask if it is worth the trouble. There are a significant number of patients that end up worse or need another surgery after this type of procedure. Just like any surgery, there are always risks and benefits; make sure you understand what they are before you proceed.