Should I undergo removal of the spinal plate from my lower spine?

Spinal Plate Removal from Lower Spine: Risks and Recommendations

Hardware removal from your lower spine is generally not recommended unless there are specific complications such as infection, hardware failure, or significant pain directly attributed to the hardware itself.

Decision Algorithm for Spinal Hardware Removal

Indications for Hardware Removal

• Hardware removal is appropriate only in specific circumstances:
  • Painful hardware when solid fusion has already been achieved 1
  • Hardware infection requiring debridement 1, 2
  • Hardware failure or breakage
  • Significant pain directly attributed to the hardware itself 1

Risks of Hardware Removal

• Removal of spinal hardware carries significant risks:
  • 47% complication rate associated with locked plate removal 3
  • Technical difficulties with screw removal, including cold-welded screws in up to 22% of cases 3
  • Risk of major vascular injury during anterior plate removal 2
  • Potential for creating spinal instability if fusion is not solid
  • Need for specialized equipment such as high-speed metal cutting burrs and screw removal sets 3

Evaluation Before Considering Removal

1. Confirm solid fusion status:

   • Standing lumbosacral X-rays to evaluate spine structure and alignment 1
   • MRI or CT to assess fusion status and rule out other causes of pain

2. Rule out other causes of pain:

   • Adjacent segment disease
   • New disc herniation
   • Recurrent stenosis
   • Pseudarthrosis (failed fusion)

Recommendations Based on Current Evidence

For a 70-year-old male patient considering spinal plate removal:

1. Confirm the necessity: Hardware removal should only be performed if there is a clear clinical indication such as infection, hardware failure, or pain directly attributed to the hardware with confirmation of solid fusion 1.

2. Surgical expertise: If removal is necessary, ensure the procedure is performed by surgeons with extensive experience in spinal hardware removal, as technical difficulties are common 3.

3. Surgical planning: Complete preoperative planning should include:

   • Availability of specialized equipment for hardware removal 3
   • Fluoroscopic guidance during the procedure
   • Preparation for potential complications

4. Risk-benefit assessment: The risks of surgery (including anesthesia risks in an elderly patient) must be weighed against the potential benefits of hardware removal.

Important Considerations

• Age factor: At 70 years old, surgical risks are higher and recovery may be more prolonged.

• Technical challenges: Removal of locked plates can be particularly difficult, with reports of cold-welded screws requiring specialized removal techniques 2, 3.

• Alternative approaches: If pain is the primary concern, consider less invasive pain management strategies before proceeding with hardware removal.

• Recovery expectations: Even successful hardware removal may not completely resolve all symptoms, and recovery will require rehabilitation.

The decision to remove spinal hardware should be made only after careful consideration of all risks and benefits, with confirmation that the fusion is solid and that symptoms are directly related to the hardware itself rather than other spinal pathology.