The Nuts & Bolts of Spinal Hardware
Spinal surgeons have the option of using external support for the spine as opposed to implantation of instrumentation, also referred to as hardware. Much like a cast is used for a broken arm, braces are used for the spine, but are often uncomfortable, ineffective, and typically worn for prolonged periods of time. Internal hardware on the other hand, has become increasingly refined and sophisticated over the years and is the optimal choice for use in spinal surgery.
What is Surgical Instrumentation?
Instrumentation is defined as any plates, screws, rods, wires, or devices used to stabilize the spinal column during the healing process.
Various types and configurations of hardware have been developed to treat spinal disorders such as scoliosis, traumatic injury, cancer, or severe degenerative arthritis. Initially large, bulky and difficult to insert, these devices have undergone thousands of improvements and modifications primarily due to advances in metallurgy (the science that deals with procedures used in extracting metals from their ores, purifying and alloying metals, and creating useful objects from metals) and biomedical engineering. For example, the rods used to shape and correct the alignment during scoliosis surgery were initially made of stainless steel. Steel is strong, malleable (permits bending and contouring), and cheap but relatively large and heavy, making it difficult to work with and often uncomfortable for the patient once implanted. With the development of materials such as titanium (commonly known for its use in golf clubs) and metal alloys (mixtures of metals), the improved strength to weight ratio allows for a lower profile and implantation of smaller devices. These medical innovations translate to more comfort for the patient without sacrificing strength of the hardware.
Simply put, internal instrumentation is more effective than external bracing for the healing spine. Though the effects of bracing are primarily positive, they can lead to a loss of muscle function, due to inactivity and can sometimes lead to psychological addiction, so that even when the patient is healed and ready to be taken off the back brace, he or she feels dependent upon it for physical support. Recent advances in design and metallurgy have made it possible for surgeons to stabilize the spine internally with simpler, lower profile hardware that can often eliminate or minimize the need for external bracing.
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