Surgical instrumentation is defined as any plates, screws, rods, wires, or devices used to stabilize the spinal column during the healing process. This is also referred to as hardware.
Various types of instrumentation exist to treat spinal disorders. These devices have had thousands of improvements and modifications over the past decade. We now have increasing knowledge about 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 and cheap but relatively large and heavy. This makes 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), surgical hardware has improved strength with less weight. This allows for a lower profile and implantation of smaller devices. These medical innovations allow improved comfort for the patient without sacrificing hardware strength.
Because instrumentation is designed with simpler, lower profile metals internal hardware is more effective than external bracing for the healing spine. External bracing can lead to a loss of muscle function due to inactivity and isn’t as effective. Recent advances have minimized the need for external braces.
Once a fusion has healed, instrumentation can sometimes cause local irritation and pain. Hardware removal decreases local irritation from the screws and lessens the stress on adjacent normal spinal levels. A hardware removal operation is done under general anesthesia and typically takes less than an hour to complete. Most patients go home in the afternoon on the day of surgery or stay overnight, but it is considered outpatient surgery. When the instrumentation is removed, we carefully inspect the fusion and place donor bone into the screw holes to minimize scar tissue. After placing sutures and a bandage, the patient is given an anti-inflammatory medication to decrease soreness and swelling. This removal process is much easier than placing the instrumentation. People quickly return to full function in a few weeks.
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