spinal hardware removal question

[postfusion]

I had a arthrodesis 360 anterior/posterior lumbar two level fusion l-5 S-1 and the level above with screws, rods and two cages.

When they do a hardware removal, do they also remove the cages? Cages were inserted during posterior surgery (two cages). The hardware removal will be posterior removal only.

I was just found to have a metal allergy, and would like to know if the cages will also be removed, or is it possible during hardware removal going in posterior?

[Dr. Kokil Mathur]

Hi!

Yes, hardware removal including cage removal is possible. If the cage and screws are of the same material that you are allergic to then yes, all will be removed. However, if screws and plates are being removed then cage may also need to be removed if is not a stand alone device and has been held in position by the screws.

However, whether cage can be removed or not depends on many factors. Anterior cage removal is easier and less dangerous than posterior cage removal as there is less risk of injuring the cord. Also, the earlier the removal is done post surgery, the easier will be the removal due to fewer adhesions. The type of cage, its length, position or mal-position if any, condition of the vertebra, level of adhesion, strength of vertebra etc are also considered before removal. Also, the risk of removal will be weighed against risk of allergy.

If the allergy is not severe and can be managed with medications then in all probability no removal will be done.  In general, posterior approach for cage removal is risky compared to anterior cage removal. If it cannot be achieved then your doctor may remove the anterior hardware and leave the posterior one. However, you need to be assessed by your specialist before any decision can be taken.
I sincerely hope you will find this information useful in your discussions with your specialist. Good Luck and take care!

[postfusion]

Thank you for your help.

It is not clear if my cages contain nickel, as I am having difficulties finding the manufacturer. My medical records only list the distributor, and they have not provided any information. I have been able to find out the screw and rods manufacturer and content, but that manufacturer said they are not their cages, due to sizes and codes.Nickel is a binder in some implants, but not all.

My next question, I hope you do not mind, is cage removal from the back standard during a hardware removal? I have seen doctors and they told me most of the hardware will be removed but not all. I did not ask them about the cages, but now I am concerned they may be left in if it is not standard procedure to remove the cages through the back. I was told removing anything from the front is too dangerous due to I have previously had front and back fusion and general they will not go in from the front again. It is unknown if the metal I am allergic to is in the cages.

My question is cage removal going in from the back standard in lumbar spinal hardware removal, when patient also has rods and screws?

If you had a patient with nickel allergy and it was unknown what her cages contained, would you also take out the cage, if you could only go in through the back?

Have a great weekend, Dr Kokil Mathur