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Thread: PLEASE! I NEED HELP! [Removing the hardware or not?]

  1. #31
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    Quote Originally Posted by LindaRacine View Post
    Hi Lavenderdeer...

    Sorry that you've got through that experience.

    I haven't had my implants removed, but have known some folks who have. It's relatively rare that someone who has their implants removed has their curves return. At 3-1/2 yrs postop, your risk is probably really low. But, as you say, there's no guarantee.

    I typically tell people to find a surgeon that they like, and then trust that the surgeon is going to choose the best procedure for you. Unfortunately, it sounds like you have no trust in your surgeon. Is it possible for you to go to another surgeon?

    If you can't go to a different surgeon, I'm thinking the best thing you can do is to talk to your current surgeon, and try to get him to tell you why he thinks removing all of the implants is a better option than partial removal. Try to go in with an open mind. It's important to know and remember that surgeons have big egos. You don't want to piss off the person who has to take care of you!

    Good luck.

    --Linda
    I actually had all hardware removed twice. I had partial hardware put back in. It's been 20 years, no increase in curve. Just pain from a rare surgery called. A thoracoplasty which reduced my rib hump. Good luck.

  2. #32
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    Does hardware in the spine cause muscle impingement? I guess it does as there are a lot of muscles involved and the origins of them are in the spine processes ( and the pedicles where the screws are inserted). So the muscles pull in the direction of the vertebrae. For me, it's feeling like I have metal braces for life. I did have them and when they scratch against the oral mucosa they did indeed scarred that inside skin. It was such a relief sensation when I took those brackets and wires off.

    When you rub your back skin against the back of a chair or when you lie down those tissues feel pressed. I think I will have the hardware removed in the next year (at my 2-year mark). Plus, I don't know the effects of the screws on the bone marrow.

    It will be another surgery, there will me more skin incision and scarring, but the bones are fused and I wonder what will grow on the space left by those screws out. The bones are posteriorly fused with pores to be left out empty by the screws. I guess more bone will grow there. Whatever, the muscles won't be more entrapped. And the bones are fused for life. I don't know why surgeons don't counsel patients to take the screws out:- the op is way less expensive so I imagine they can fill up those vacancy spots with more lucrative spine fusions and get those fees from medtronic and spine-hardware companies. I guess this new surgery involves no restrictions in movement as the bones are already fused, and the recovery is smoother.

    The only advantage of not taking them out is that in the case of you having a car crash those rods and screws are like reinforced concrete so the spinal cord and the spinal canal are less likely to have an injury as it is well protected. And where are the rods in all those layers of muscles? Over the spinalis thoracis and those exquisite muscles on the vertebral arch - then comes the rod- then above are the rhomboids, latissimus dorsi and trapezius. Plus the muscles fibers if not perfused by the screws can act in a more natural way. The muscles have upper, medial and lower fibers ( I am thinking about the trapezius here) and the screws and rods are interfering with the muscle functioned as a whole. You know the expression "muscle knot"? What a knot may be created by those screws that once were hit by hammers and burs. I am sure that if you take the hardware out the muscles will stretch farther and the strenghtening exercises will be more effective. So you gain stability and flexibility. Well, flexibility you will gain for sure as muscles will lengthen without the barrier of crossing over the rods and deviate from the screws. Plus, you can rotate all that long fused bone easily and the free space acquired once the hardware is removed may be helpful for the muscles to relax and to accomodate. That extra space and the weight of the hardware taken out of your body should not be disregarded. And if the rods are not cut at the edge of the upper and the lower instrumented vertebrae they can impact the movement above and under the fusion. I mean, the free bones- vertebrae- can beat against the rods, so full range of motion (ROM)is not totally achieved. But truth be told, those longer rods may indeed function as a way for the spine to be bettter balanced and to avoid extra disc degeneration over and under the fusion but as they are placed posteriorly they can't avoid the smashing of the discs once you flex the spine forward, so they can only limit backward extension ( huge drawback) and limit the disc generation caused by lateral flexion on the discs by limiting ROM because the rod will hit the upper or lower vertebrae and this collision impedes further movement so discs are protected of lateral smashing. You can lose stability as titanium is super strong and it may lend extra support when the muscles are weakened or the bone density is low. In case of osteoporosis titanium may be a god-send.

    I am not against the rise of a bionic man as I believe it is a natural step in human progress, I am just trying to find the usefulness of screws and rods inside the body when the work they have done is finished (i.e. stabilize the bones in the correct position while fusing)

    Here is my final take-home message:
    when hardware is removed:
    - body is less prone to infection ( and I know that titanium is hypoallergenic)
    - bone and screws won't mesh and grow out in a mess. Does titanium oxidize? even stainless-steel battle with the exterior environment. So I wonder what a battle, I mean, ongoing reaction, bones and titanium will endure.
    - muscles will be less prone to inflammation and soreness ( the attachments of the muscles won't have screws and rods as next-door neighbours). More trigger points and myofascial pain can arise from harware messing with the movements of muscles and thus the movements of the body per se.
    - skin will be smoother as titanium has a rough surface and bones are more skin-friendly.
    - surgeons don't care if one rod is longer than the other, what matters is the shape that the bones will get once fused into one as a whole in 3D format. So that may indicate that they think that harware is just a mean to a thing. I believe that some who do this may believe that to take the hardware out is the best choice, so why wouldn't they care to cut and left the rods with the same length and as symmetrical as possible in both the sagittal ( juxtaposition of the rods) and coronal plane ( parallel rods in vertical position)? And I am not gonna mention the screw placement in the axial plane (they should assume a kind of a triangle shape if you take an axial slice in a CT scan. If you don't see the head and the tip of the pedicle screws ( in both the left and right screw) in a AP standing x-ray (i.e. both screws have to converge medially in the center of the body of the vertebrae, so you can see the head on the screw away from the spine and the tip well centered) that means full derotation was not achieved.

    These are just layman assumptions, I would be glad if someone contradicts me with scientific information. I am not taking part for the removing "team" or not removing "team". I am just trying to think things through.

    And yes, contrary to what some say in this forum, scoliosis is a deformity so that means that some bones of the spine are deformed or incorrectly shaped ( even if on one of the three planes, coronal, axial or sagittal). Otherwise, all bones being correctly shaped the spine would be straight. It is as simple as to put one brick over the other and so on. If one brick is out of shape we get into the engineering of the leaning tower of Pisa. Bricks are not the best metaphor as the spine needs sagittal balance and coronal balance, and the center of gravity needs to be well-centered axially and vertically speaking, as well. No one knows the cause, but one thing is for sure, some bone or bones are badly shaped (deformed). The cause is unknown that is why they call it idiopathic.

    What do you guys think? Be humble in your response. I am still undecided but I am leaning to the take-out option as of now.

    I will keep you updated once I ask for advice to my surgeon on my 1year follow-up appt.

    PS: I do have one doubt though, before scoliosis surgery muscles on the convex side are lenghtened and the ones on the concave side are shortened. So, is there such a thing of a muscle deformity or is it just plain muscle imbalance? I think the latter is true because when the weight is evenly distributed over the body, muscles of each side will share the weight 50/50 like scales with the same weight to carry on each side, and thus reaching horizontal equilibrium.

    PS2: My surgeon applied the follwing technique:
    T3- two screws, right and left
    T4- one screw on my right side
    T5- one screw on my left side
    T6- one screw on my right side
    T7- one screw on left side
    T8- one screw on my right side
    T9- one screw on my left side
    T10- two screws, right and left

    Two rods tightened by those screws.

    Less screws, less damage and speedier recovery, but muscles must find it odd to have fibers of muscles overcoming that screw on one side without no screw to overcome on the opposite side and muscle.
    Last edited by richardis; 01-28-2017 at 09:26 AM.

  3. #33
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    https://www.ncbi.nlm.nih.gov/pubmed/20032526

    Ortop Traumatol Rehabil. 2009 Nov-Dec;11(6):501-12.
    Does instrumentation removal cause curve progression in patients with adolescent idiopathic scoliosis?
    [Article in English, Polish]
    Potaczek T1, Zarzycki D, Tesiorowski M, Jasiewicz B, Smetkowski A.
    Author information
    Abstract
    Adolescent idiopathic scoliosis (AIS) is usually instrumented using a posterior approach. Hardware removal may be performed for specific clinical reasons. Little data is available on whether removal influences curve magnitude. The aim of the paper is to evaluate the impact of instrumentation removal on curve progression, and the safety and efficacy of the procedure. We analyzed 59 patients who underwent instrumentation removal. Curve types, reasons for removal, period between procedures, and Cobb angles: at baseline, immediately after correction, after removal and in follow-up were evaluated. Clinical symptoms were also assessed. The mean follow-up period after instrumentation removal was 2.2 years (1-5 years). The mean age at primary surgery was 14.5 years (12-25 years) and the mean Cobb angle after surgery was 24.9 degrees in the thoracic spine, and 17.5 degrees in the lumbar spine. The period between procedures was 46.6 months (11-192 months). The reasons for removal were: fistula (38.9%), pain (35.6%), rib hump removal (13.6%), and hardware failure (11.9%). At the final follow-up, mean thoracic curve was 35.4 degrees and lumbar curve was 26.2 degrees , corresponding to 13.3% and 17.5% curve progression after removal, respectively. Patients with infection had the highest loss of correction (21%). In symptomatic patients, pain subsided in 70% of the cases. In cases of hardware removal > 2 years after fusion, loss of correction was lower than in the < 2 years group. The course of surgery was relatively uneventful.
    PMID: 20032526
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #34
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    Hey, Pooka!

    I edited my previous post again so you may want to read it again. But yes, you can't have it all. And loss of correction is always a concern especially if the curve was poorly corrected. But, anyway, if that occurs you can always reconstruct the spine again. You have nothing to lose as the bone is already fused, but you may have to extend the fusion and that is scary. But ideally, I would like to have the hardware removed. But we do not live in an ideal world so it could be a better choice to keep the hardware.

  5. #35
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    New data on whether to remove surgical hardware

    http://insurancethoughtleadership.co...ical-hardware/


    Just wanted to point out that with the second case, “Rapid weaning” was recommended......Wow!


    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  6. #36
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    Quote Originally Posted by titaniumed View Post
    New data on whether to remove surgical hardware

    http://insurancethoughtleadership.co...ical-hardware/


    Just wanted to point out that with the second case, “Rapid weaning” was recommended......Wow!


    Ed
    Thanks, titaniumed. Informative, indeed, but I am always suspicious and skeptical about insurance companies chipping in because it all ends up being a business.

    I am curious about one thing, what happens to the muscles in-between the fusion that you can't stretch or strengthen ( I think you can tense and strengthen them using isometric force, but stretching is impossible, isn't it?). Will these muscles atrophy and cause pain? What do you think?

  7. #37
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    Quote Originally Posted by lavenderdeer View Post
    Hello everyone!

    Has anyone of you removed your hardware and what was the outcome? I have been experiencing a lot of pain because of my hardware and my surgeon wants it all gone. I am freaking out about the downsides: that if my spine isn't fully fused it will start curve again. (3,5 year post-op.)

    I was scheduled for surgery in June 2016 because my new doc found out in March that a screw is wrongly placed and my rods were poking me (he saw it on the x-rays.) I said I was okay with removing it and shorten the rods. It felt like a great idea. Finally someone who found something ''wrong'' so they could fix it. When I got hospitalized the day before the surgery, I was very nervous for removing the screw but I stayed calm because I kinda looked forward to it. 2 hours before surgery, my doctor changed in last minute that he was gonna remove everything instead of just shorten the rods and removing that screw. I panicked and refused to be put to sleep until I had further information. I wanted a real consultation about the pros/cons and information etc. The doctor didn't have time so the surgery got canceled.

    On the afternoon that day he came and told me that my spine was healed. It looked completely fused. I didn't need to worry about anything because he said it wouldn't move. He asked me quite rude if I had read about people re-curving on the internet, like it was something negative and he didn't understand why I was sad or worried. He told be to stop sobbing and just make a decision. He told me that I had 3 options:

    1. Remove the screw and shorten the rods, but he didn't like that alternative (so why did he even recommend that in the first place?) because of the risk for infections and he believed I would return in 2 years and want more hardware removed because of discomfort.

    2. Remove everything (this is what he wanted.)

    3. Think about this during summer and do option 1, 2 or nothing in autumn.

    I felt so betrayed and angry for him not telling me at least a week before I got hospitalized. So I left the hospital. I couldn't make that decision in a couple of hours. I felt like he didn't tell me the truth. Because some people I have talked about told me that their doctors told them that this kind of surgery is not risk-free. While my doctor told me that there is no risks whatsoever, which I feel is bullshit. I completely understand that only I can make this choice. But it's very difficult, which is why I am asking other people as well.

    Today, I got a letter in the mailbox telling me that I have an appointment with this doctor in October. But I don't know what to do.

    For now I am in daily dull pain, with some burning/stabbing/pinching moments when it get's really bad. Some days are definitely better than others. But on the worst days I take morphine pain killers. I cannot have a full-time job and some days even house chores becomes challenging. I feel the hardware really well when I'm sitting, laying or leaning against things which causes me discomfort as well and makes it difficult for me to get a good nights rest. Besides from the physical pain, this makes me very depressed aswell. Not knowing how the future will be. There is not an easy decision to make, because it feels like a gamble since there is no 100% insurance that it will be fine and I don't know if I could cope with another curve and another spinal fusion surgery.

    I am considering waiting maybe one or two years. Just wait until the pain gets unbearable, but I feel like I am just pushing the problem further away because I know I will not be able to live like this forever. What would you do in my situation? I really need your advice!

    Edit: I am fused from T8 - L4 if that does matter. I had a 70 degree curve post-op and I am below 20 degrees now. I am 20 years old btw.
    I think you made the right decision to "stop" right then and there. If I were you I'd be interviewing about 4/5 other surgeons. I think there are many good ones in the northern California area and of course you couldn't make such a decision in a rush! I would have turned it around on HIM and asked him why he suddenly changed his mind at the VERY last minute!
    Susan
    XLIF/Posterior Surgery 6/16/08. Fused T10-L5 in CA by Dr. Michael Kropf (don't go there unless it's simple, I hear he's at Cedar's now). Very deformed, had revision w/5 PSO's, rods from T-3 to sacrum including iliac screws, all posterior, 5/23/16 with Dr. Purnendu Gupta of Chicago.


    Owner of Chachi the Chihuahua, So Cal born and bred, now a resident of 'Chicagoland' Illinois. Uh, dislike it here....thank God there was ONE excellent spine surgeon in this area.

  8. #38
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    titanium dioxide is a byproduct of titatium.

    How reliable is this? https://www.scolistrongbones.com
    why do they claim no titanium dioxide?

    The oxygen I breath is interacting with titanium. That seems obvious. Still not sure if removing the implants is worth it. What do you think?

  9. #39
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    Quote Originally Posted by richardis View Post
    titanium dioxide is a byproduct of titatium.

    How reliable is this? https://www.scolistrongbones.com
    why do they claim no titanium dioxide?

    The oxygen I breath is interacting with titanium. That seems obvious. Still not sure if removing the implants is worth it. What do you think?
    May you help here, Ed?

  10. #40
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    On the main page it states.....

    These statements have not been evaluated by the Food and Drug Administration

    These products are not intended to diagnose, treat, cure or prevent any disease.

    Save your money.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  11. #41
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    Quote Originally Posted by titaniumed View Post
    On the main page it states.....

    These statements have not been evaluated by the Food and Drug Administration

    These products are not intended to diagnose, treat, cure or prevent any disease.

    Save your money.

    Ed
    Yes, it seems snake oil, but they are fishing consumers from a half-truth when they cite no titanium dioxide. They know this is a selling point, although it may be bad science. But that made me think and I did some research.

    From here https://en.m.wikipedia.org/wiki/Titanium_dioxide

    "The body of research regarding the carcinogenicity of different particle sizes of titanium dioxide has led the US National Institute for Occupational Safety and Health to recommend two separate exposure limits. NIOSH recommends that fine TiO
2particles be set at an exposure limit of 2.4*mg/m3, while ultrafine TiO
2 be set at an exposure limit of 0.3*mg/m3, as time-weighted average concentrations up to 10 hours a day for a 40-hour work week.[78] These recommendations reflect the findings in the research literature that show smaller titanium dioxide particles are more likely to pose carcinogenic risk than the larger titanium dioxide particles.
    There is some evidence the rare disease yellow nail syndrome may be caused by titanium, either implanted for medical reasons or through eating various foods containing titanium dioxide.[79]
    Dunkin' Donuts in the United States is dropping titanium dioxide from its powdered sugar donuts after public pressure.[80][81][82][undue weight? ] However, Andrew Maynard, director of Risk Science Center at the University of Michigandownplayed the supposed danger from use of titanium dioxide in food. He says that the titanium dioxide used by Dunkin’ Brands and many other food producers is not a new material, and it is not a nanomaterial either. Nanoparticles are typically smaller than 100 nanometres in diameter, yet most of the particles in food grade titanium dioxide are much larger.[83]"

    you can look wikipedia articles about titanium, titanium biocompatibility and metals in medicine. Some persons have allergy to titanium and there are mounting evidence that titanium implants are far from perfect, but they are the a necessary evil.
    Last edited by richardis; 05-25-2017 at 05:46 AM.

  12. #42
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    1. This product is nonsense.
    2. The study cited has a chiropractor as a lead author.
    3. Chiropractors are neither trained nor qualified to be dealing with bone physiology and metabolism.
    4. Chiropractic school is a joke compared to medical school.
    5. Chiropractic school has the lowest GPAs admitted compared to the all the allied medical schools (podiatry, etc.).
    6. Few if any chiropractors would ever be admitted to any accredited medical school.
    7. Titantium dioxide, because it occurs in the other products, has been shown to be safe that those levels. The chiropractors are scaring you with this ignorance. It either has or hasn't been shown to be toxic, mutagenic, carcinogenic, or teratogenic to humans. If it is in those other products then it is not any of those things and is safe.
    8. Toxicity assessment is not something chiropractors or lay people should be delving into without a net. That's why we have the FDA.
    9. Chiropractic as it deals with scoliosis is ALL scare tactics and no evidence of efficacy.
    10. If you have questions ask a real doctor.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  13. #43
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    Quote Originally Posted by Pooka1 View Post
    1. This product is nonsense.
    2. The study cited has a chiropractor as a lead author.
    3. Chiropractors are neither trained nor qualified to be dealing with bone physiology and metabolism.
    4. Chiropractic school is a joke compared to medical school.
    5. Chiropractic school has the lowest GPAs admitted compared to the all the allied medical schools (podiatry, etc.).
    6. Few if any chiropractors would ever be admitted to any accredited medical school.
    7. Titantium dioxide, because it occurs in the other products, has been shown to be safe that those levels. The chiropractors are scaring you with this ignorance. It either has or hasn't been shown to be toxic, mutagenic, carcinogenic, or teratogenic to humans. If it is in those other products then it is not any of those things and is safe.
    8. Toxicity assessment is not something chiropractors or lay people should be delving into without a net. That's why we have the FDA.
    9. Chiropractic as it deals with scoliosis is ALL scare tactics and no evidence of efficacy.
    10. If you have questions ask a real doctor.
    I am talking about titanium dioxide, not the product itself. The product claims to give you calcium. Calcium exists, whether the product works or not. We all know that. Titanium dioxide is real, and it requires titanium to take that chemical shape. Is is beyond my point to ask for the efficacy of that product ( it is quite clear that the product is a scam). The product also claims no-GMOs. Any well versed-person knows that GMOs are not a bad thing and may indeed be a legitimate solution to some problems. I would genetically modify me so that I could get a normal spine, just to give you an example.

    your 7th bullet hitted the point.
    Last edited by richardis; 05-25-2017 at 06:28 AM.

  14. #44
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    Quote Originally Posted by lavenderdeer View Post
    Hello everyone!

    Has anyone of you removed your hardware and what was the outcome? I have been experiencing a lot of pain because of my hardware and my surgeon wants it all gone. I am freaking out about the downsides: that if my spine isn't fully fused it will start curve again. (3,5 year post-op.)

    I was scheduled for surgery in June 2016 because my new doc found out in March that a screw is wrongly placed and my rods were poking me (he saw it on the x-rays.) I said I was okay with removing it and shorten the rods. It felt like a great idea. Finally someone who found something ''wrong'' so they could fix it. When I got hospitalized the day before the surgery, I was very nervous for removing the screw but I stayed calm because I kinda looked forward to it. 2 hours before surgery, my doctor changed in last minute that he was gonna remove everything instead of just shorten the rods and removing that screw. I panicked and refused to be put to sleep until I had further information. I wanted a real consultation about the pros/cons and information etc. The doctor didn't have time so the surgery got canceled.

    On the afternoon that day he came and told me that my spine was healed. It looked completely fused. I didn't need to worry about anything because he said it wouldn't move. He asked me quite rude if I had read about people re-curving on the internet, like it was something negative and he didn't understand why I was sad or worried. He told be to stop sobbing and just make a decision. He told me that I had 3 options:

    1. Remove the screw and shorten the rods, but he didn't like that alternative (so why did he even recommend that in the first place?) because of the risk for infections and he believed I would return in 2 years and want more hardware removed because of discomfort.

    2. Remove everything (this is what he wanted.)

    3. Think about this during summer and do option 1, 2 or nothing in autumn.

    I felt so betrayed and angry for him not telling me at least a week before I got hospitalized. So I left the hospital. I couldn't make that decision in a couple of hours. I felt like he didn't tell me the truth. Because some people I have talked about told me that their doctors told them that this kind of surgery is not risk-free. While my doctor told me that there is no risks whatsoever, which I feel is bullshit. I completely understand that only I can make this choice. But it's very difficult, which is why I am asking other people as well.

    Today, I got a letter in the mailbox telling me that I have an appointment with this doctor in October. But I don't know what to do.

    For now I am in daily dull pain, with some burning/stabbing/pinching moments when it get's really bad. Some days are definitely better than others. But on the worst days I take morphine pain killers. I cannot have a full-time job and some days even house chores becomes challenging. I feel the hardware really well when I'm sitting, laying or leaning against things which causes me discomfort as well and makes it difficult for me to get a good nights rest. Besides from the physical pain, this makes me very depressed aswell. Not knowing how the future will be. There is not an easy decision to make, because it feels like a gamble since there is no 100% insurance that it will be fine and I don't know if I could cope with another curve and another spinal fusion surgery.

    I am considering waiting maybe one or two years. Just wait until the pain gets unbearable, but I feel like I am just pushing the problem further away because I know I will not be able to live like this forever. What would you do in my situation? I really need your advice!

    Edit: I am fused from T8 - L4 if that does matter. I had a 70 degree curve post-op and I am below 20 degrees now. I am 20 years old btw.
    My hardware was removed because of infection. I was fused in 1976, then a revision in 1994 with a deep wound infection. The rods remained out until 2013 with out even the slightest change to my curve. The rods were put back in in the lumbar sacrum from problems that are very normal to develop in that area after years of fusions.

    The actual surgery of having the rods out was nothing for me. I have a friend who had a bit of a harder time with it. Your doctor won't do it unless there's a true problem with the hardware. Goodluck

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