Feeling Hardware After Spinal Fusion Surgery (Another Surgery Required?)

Feeling the hardware and noticing weird metal sounds on your back after spinal fusion surgery could be normal except when you feel pain and sensation like metal is protruding underneath the skin of your surgical site.

If imaging results show any loose, broken, or shifted hardware, you must get another surgery for hardware removal or replacement to avoid further complications in your spine.

To avoid such a thing from happening, don’t do any activities that may strain or hurt your back. It would take 4-6 weeks before you can do simple motion exercises and about six months to get a full recovery. 

What is spinal fusion surgery?

People who suffer from recurring back pains due to spinal problems receive spinal fusion surgery.

Although there are non-surgical treatments for your back problems, surgery is your last option if you haven’t found any relief from previous treatments.

It involves implanting a bone graft or substitute bone material between the tiny spaces of the small bones in your spine, known as the vertebrae. Surgeons then add screws, rods, plates, cages, or wires to stabilize and stimulate fusion between the two (or more) bones.

Spinal fusion will reduce movement or instability in that area, thus relieving the cause of your back pain

This procedure treats back pains due to particular spinal disorders such as:

  • Degenerative disc disease (DDD). Depending on the severity of your condition, your surgeon may or may not have to fuse your bones after removing the damaged disc in your spine.
  • Herniated discs
  • Scoliosis. Spinal fusion will help correct the curvature of your spine, which will prevent the deformity from worsening.
  • Fractured spine, tumors, and infections
  • Spondylolisthesis
  • Spinal stenosis. Problems in the stability of multiple levels of your spine need urgent spinal fusion surgery.

Why am I feeling the hardware on my back?

Like any bone surgery, tools like screws and rods stabilize the bone while undergoing crucial healing. It keeps your bones intact as it heals.

It is common among patients who received spinal fusion to feel the hardware in their backs 1 or 2 weeks after the surgery. It isn’t enjoyable, but it should be nothing more than that.

Often, you will significantly feel the metal in cold weather or right after you wake up or during long periods of sitting down. It may take time to get yourself used to this feeling. Unless any pain or other significant symptoms occur, you shouldn’t worry much. 

To reduce discomfort in the area, you may place heating pads or warm water bottles over it, but do not overuse nor put them on when sleeping. 

Most people also notice weird metal clicking, squeaking, cracking, or popping sounds on their backs when they’re moving. It can happen because the surrounding tissues or other parts near your vertebrae may have rubbed against the attached hardware.

Though this can pass over time, it may last longer unless your hardware is removed.

When will the “hardware feeling” be a problem?

You may wonder if the sensation of the hardware in your back may be normal or if it needs another medical intervention. Well, it could be possible that the metals in your spine may have gotten loose, broken, or even shifted.

Although experienced experts developed hardware used for spinal surgeries through extensive research, there are still possibilities that it may fail to support your bone over time.

You should tell your surgeons if you’re experiencing the following:

  • Sudden, excessive pain in the back
  • Discomfort or feel like metal is protruding on the site of the incision
  • Numbness and tingling sensation exacerbating on your back, legs, and neck

It is kind of hard to know if the pain in your back is due to hardware failure or some other complications from your surgery. If you have these symptoms, your surgeon may perform imaging tests to see problems in your hardware. 

Types of hardware complications

There are several reasons why the hardware may fail to support your spine as time progresses. But, before we go through them, let’s talk about the common types of hardware failure.

Hardware failure refers to when the screws, rods, or other artificial bone materials attached to your bone detaches, break, or shift before it can heal completely. 

1. Loosened hardware

After your spinal fusion, your bone needs time to heal, like when you’re recovering fractured bone. But, many people don’t complete this process and develop pseudoarthrosis.

This condition refers to the failure of your bone to join or fuse correctly together. Once this happens, your bone causes stress in the hardware on your spine, losing its hold over time.

If you did develop pseudoarthrosis, you may suffer new neck or back pains which, could be much worse than before you had your surgery, or feel intense discomfort in your legs or extremities. 

2. Broken hardware

Following the unsuccessful fusion of your bone may result in hardware to wear, tear or break especially, in very unstable spines.

People who had a fusion in several segments of their spine, commonly in larger-sized individuals or those with spinal stenosis, are at higher risk of experiencing this hardware failure. 

3. Shifted hardware

If a patient has weak bones due to osteoporosis, there is only minimal support to sturdy the hardware.

Over time the screws or rods may shift or move out from their proper position. 

4. Subsidence of cage or interbody device

Patients with weak bones who underwent a spinal fusion in their cervical and lumbar vertebrae areas are at risk of experiencing this complication. 

Causes of hardware failure

Knowing the root problem of your hardware failure will help doctors develop the best treatments for your condition.

Below are some of the common causes, which include:

  • Pseudoarthrosis or the inability of your spinal bones to completely heal or fuse
  • Lifting heavy objects
  • Engaging in strenuous activities
  • Experiencing traumatic injury shortly after surgery
  • Use of standard pedicle screws. Older version of these screws gradually loosens or breaks in the long run.
  • Osteopenia or, in worse conditions, osteoporosis
  • Wrong choice of hardware that is not an ideal fit for your spine
  • Improper installation of the hardware
  • Smoking. Though this doesn’t directly cause hardware failure, it slows down your healing progress, slimming down the chances of bone fusion.
  • Medications such as steroids

How do I treat hardware failure?

As stated before, telling your doctor should be your first resort in solving a hardware failure.

Please don’t ignore any symptoms associated with the sensation of the hardware in your back because hardware failure may cause new intense pain which, could develop into a Failed Back Surgery Syndrome (FBSS) or cause damage to your nerves and spinal cord. Unless this is the case, surgery for hardware removal is less likely an option.

Otherwise, if imaging results show hardware failure, your surgeons may have to remove the hardware. Depending on your situation, you show no signs of hardware infections, or your bone needs more stabilization; they may implant new ones.

Hardware removal won’t take as long as your previous spinal fusion surgery, but you may have to undergo another spinal fusion surgery if you’ve developed pseudoarthrosis. 

What to do before hardware removal surgery?

Your doctor should give you a list of things you must do before your hardware removal surgery. You should be in good health to ensure an optimal and speedy recovery.

It will most likely involve you to:

  • Quit smoking. You should already quit smoking even before your first spinal surgery.
  • Exercise. Ask your doctor or a physiotherapist for exercises you can do as there are some activities you have to avoid to prevent further damage to your hardware.
  • Do breathing exercises. Research shows that getting enough oxygen to your lungs will increase your healing progress.
  • Let your surgeons know about your medications. It will ensure that the medicines you’re taking won’t cause complications during and after the surgery. 
  • Tell them what’s wrong. Telling your doctors about other occurring symptoms will let them decide if you’re suitable for another surgery.

How to care for my spine after spinal fusion?

It takes a lot of patience and a positive mindset to heal quickly from any surgery. So, getting out of the hospital while feeling okay is already a big step to recovery.

But, don’t ever think of going back immediately to your usual activities or even simply bending your back as it may cause your hardware to fail.

Below are some tips you can follow to ensure a safe and speedy recovery. Of course, your doctor will probably give you a few things to avoid as well.

During the first 2-4 weeks of your healing time, you must be very careful not to strain or hurt your back. 

  • Do not lift heavy objects nor twist or bend your back
  • Avoid strenuous activities including bicycle riding, jogging, weight lifting, or aerobic exercises
  • Do not drive yet or ride in a car for more than 30 minutes
  • Try changing your position when standing or sitting
  • Take a break for a month or two from work
  • Avoid sex positions that can strain your back

Other medical tips for your recovery include:

  • Eat a regular and balanced diet.
  • Drink plenty of fluids unless your doctor advises not to
  • Drink fiber supplements or fiber-rich foods when having unregular bowel movements or constipation
  • Eat bland and low-fat foods such as plain rice, broiled chicken, toast, and yogurt if you experience an upset stomach
  • Take pain medicines as your doctors have prescribed.
  • Strictly follow prescription and doses for antibiotics
  • Clean the incision site regularly as per the doctor’s advice
  • Start moving or doing simple motion exercises as soon as your doctor approves

Conclusion

It is common among patients to feel their hardware following spinal fusion surgery. Along with the sensation, they also report hearing metal clicking, squeaking, cracking, or popping sounds on their backs, especially when they move.

You shouldn’t worry if you experience the same thing unless you feel pain and sudden numbness or tingling sensation in your legs, arms, neck, and shoulders. 

Any unexpected recurring pain after a spinal fusion surgery may indicate complications such as hardware failure due to pseudoarthrosis leading to a failed back surgery syndrome (FBSS).

A common symptom of hardware failure includes the sensation of metal protruding on your skin at the incision site, along with intense pain or numbness in your back. 

Please visit your doctor immediately if symptoms occur. Depending on the severity of your case, you may need to undergo another spinal fusion surgery or hardware removal.