Old hardware removal with new fusion above in same surgery

Posted by rmbrooks0103 @rmbrooks0103, 1 day ago

I had an L4-5 fusion 11 years ago and the hardware hasn't given me any problems. I now am preparing for another fusion at L3-4. My surgeon is planning to take out my old hardware, then fuse the new area one level above. I do still have lower back pain and only got temp relief after the first surgery for 2 years. My most recent issue though is my left leg goes completely numb after standing only a few minutes. This has caused me to fall. I was an RN and so know all the complications of this surgery and don't think I want the old hardware taken out. I have osteopenia. I also don't want the extra anesthesia time and added complications that can occur. What do you think?

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gently | @gently | 1 day ago

The surgeon probably has a particular reason why they want to remove the old hardware. In some cases the hardware is from a different manufacturer and isn't compatible for extension to the additional segment.
I have some hope that the replacement will improve the lumbar pain that recurred two years after the first surgery. Your surgeon may have a suspicion that the screw have migrated since the first surgery. By revision he may be thinking there is possible relief for you in removal.
You might ask the surgeon why the original hardware needs to be removed. You could send your images out for a second opinion. Second opinions are something I think every person considering surgery should have, even when completely content with the first opinion.
Though I think it is usual to remove the original hardware with segmental increase, your concerns are intelligent. You might also think about a course of Forteo because it speeds healing and aids in hardware integration.

dlydailyhope | @dlydailyhope | 1 day ago

@rmbrooks0103
Are you currently taking medication and supplements along with dietary changes to treat your osteopenia to prevent it from progressing to osteoporosis? I’m assuming your surgeon knows about this for your first surgery and isn’t too concerned about removing the hardware since that level has already fused. Putting in new hardware to connect to the level above should not require drilling in lower levels if the née hardware is similar in size/measurement. You just need the new level to fuse with the surgery and the connection to lower levels using the same new hardware would give it leverage and control force and motion movements. Some people get hardware totally removed after fusion surgeries once fused and the hardware no longer is necessarily needed. Your surgeon may want new hardware because you have osteopenia.

I am 55 and female and have hardware C5-C6 and L3-L5 but do not have osteopenia. I have a new herniation/extrusion of my disc at C6-C7 and causing symptoms. I see my surgeon soon and need to have a similar conversation about surgery to remove old hardware to fuse C5-C7 together. Not sure if removal is necessary. Tinkering too much in the cervical spine scares me a bit but my spinal cord is being compressed and injured the longer my disc is in the spinal canal and pressing on my spinal cord.

Btw…I just had my lumbar surgery in August 2024 and still recovering. I have a congenitally narrow spinal canal which makes me at risk for having to have many surgeries for the remainder of my life. It is extra hard for me because I am a single parent of a teen son and his sole provider. I have no extended family to help me.

Pray you get the information you need to make the best decision for you. 🙏