Back Surgery Hardware Failure

In spinal fusion surgery there is an element of competition between the recovery processes of the body and the resilience of the hardware used in fusion.  Most spinal fusion surgery will make use of pedicle screws to stabilize the spine as the bone graft forms a solid union, along with metal plates, rods, and cages in some cases.  If a spine is particularly unstable then it presents a higher degree of risk that the hardware will fatigue and snap before a strong fusion occurs.  Patients may experience the movement of hardware prior to fusion occurring, particularly where back support has been neglected initially.

Pedicle Screws

Pedicle screws are used in most fusions to stabilize the spine

The initial recovery period following spinal fusion is extremely important as vigorous activity, bending, twisting, and lifting movements can all increase the risk of hardware failure and failed back surgery syndrome.  Whilst it is inadvisable to remain bedridden or inactive for too long after back surgery, patients are commonly prescribed a physical therapy regime that incorporates appropriate stretching and strengthening exercises to facilitate a good recovery.  A back brace is usually worn for a short period of time following surgery, particularly when traveling in a car or other vehicle in order to prevent sudden jolts to the spine.  Eventually, following the formation of a solid union, the patients’ bones will provide the appropriate spinal stability and support with the hardware shouldering the burden in the meantime.

People more at Risk for Hardware Failure

As well as smokers, patients at particular risk of hardware failure include those who are overweight and who have a larger number of vertebral segments fused. Both of these things can put extra pressure on the hardware prior to a solid fusion being formed from the bone graft.  Additionally, those who are overweight may be at risk of poor blood sugar homeostasis which can cause an increase in inflammatory reactions in the body and poor endocrine regulation (including increased cortisol levels).  Impaired circulation due to peripheral vascular disease can further compromise healing, which is also a consideration for smokers as this habit can cause dysfunction of the blood vessels.  Single level fusion in optimum weight patients rarely results in hardware failure and can be very effective at achieving stability in the spine with the patients’ leg and back pain relieved successfully.

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