Most people with rods and screws from scoliosis surgery never need the hardware touched again. In a multicenter database of 5,144 patients who had fusion for adolescent idiopathic scoliosis, 2.7 percent developed an instrumentation-related complication, and fewer than half of those needed revision surgery. When hardware does fail, it usually shows up as pain or as a finding on routine X-rays, often at the lower end of the construct.
I am Dr. Justin Dick, and at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC, I care for adults who had fusion years or decades ago. This post covers what the hardware does over time and which findings belong with the surgeon. It does not cover whether to have surgery; my post on avoiding spinal fusion addresses that.
What the Hardware Is For
Rods and screws hold the spine in its corrected position while the vertebrae fuse into solid bone. Once fusion is complete, the bone carries the load and the hardware mostly stays in place as an internal splint. If the bone does not fuse, a condition called pseudarthrosis, the hardware keeps carrying load it was not designed to carry forever, and that is when it can loosen or break.
How Often Hardware Problems Occur
Plachta and colleagues reviewed 5,144 patients in a multicenter prospective database. Of those, 141 (2.7 percent) developed 148 instrumentation-related complications, grouped as broken instrumentation, loss of fixation, prominent hardware, or other. Sixty-eight (46 percent) had revision surgery and the rest were managed without surgery. Pain strongly predicted revision. At five years, patient-reported scores were comparable between the revised and observed groups. The authors concluded that asymptomatic hardware findings can often be observed, and that revision is appropriate for symptomatic patients. The timing varied widely, with a mean of about 21.5 months after surgery.
La Poche and colleagues looked specifically at pseudarthrosis in 3,532 patients from a multicenter registry and found 22 confirmed cases requiring revision, a median of 2.5 years after fusion. Just over half presented with pain and the rest were found on X-ray. Implant failure most often involved the lower end of the construct, with screw loosening in 41 percent, rod fracture in 32 percent, and screw breakage in 27 percent of those cases.
What a Broken Rod Usually Means
A broken rod is often a sign that the fusion did not fully heal at that level, because a solid fusion takes the load off the rod. It is a finding for the surgeon, not something to treat around. Tanida described three adults whose implant failure went untreated for 5 to 25 years and who eventually needed more extensive revision surgery because the deformity worsened and stiffened in the meantime. That is a case series, but it argues for prompt surgical review.
Problems Next to the Fusion
Some problems develop at the levels just above or below the fused segment. Theologis and colleagues found distal junctional kyphosis, a forward collapse just below the fusion, requiring revision in 6.3 percent of 79 patients with thoracic fusions, associated with higher body mass index, lower postoperative thoracic kyphosis, and where the lowest instrumented level was chosen. The 2025 JBJS review by Serhan and colleagues found that fusions ending at L3 or lower carried a higher risk of low back pain during pregnancy, covered in my post on pregnancy and scoliosis.
Metal in the Blood
Titanium, cobalt, and chromium levels in the blood can rise after spinal instrumentation. Li and colleagues found that early postoperative metal levels were associated with later revision surgery in 154 patients from one center. Sixty of those patients had revision-related surgery, a rate far higher than the multicenter data above, which suggests the cohort is not typical. The authors stated the model needs external validation. I would not use metal levels to make decisions based on this study.
Symptoms That Belong With the Surgeon
This list is my clinical guidance. New or worsening pain at the fusion or the levels next to it, a new shift in posture or trunk balance, a palpable or visible hardware prominence that is sore, any sensation of clicking or shifting, wound changes, fever, or new leg or arm neurological symptoms should go to the operating surgeon or a spine surgeon for imaging review.
How Dr. Justin Dick Cares for Patients With Prior Fusion at Clear Life
At our Charlotte office, patients with prior fusion get imaging review of the hardware and the levels around it before any care plan. Fused segments are not manipulated. Care focuses on the mobile segments, hips, and trunk endurance, and any hardware concern goes back to the surgeon. Our page on care after spinal fusion covers mobility and ongoing care.
Comparison
| Finding | How often | What it usually means | Source |
|---|---|---|---|
| Any instrumentation complication | 2.7% of 5,144 | Fewer than half needed revision; pain predicted revision | Plachta 2026, multicenter |
| Pseudarthrosis requiring revision | 22 of 3,532 | Failed fusion, often with distal implant failure | La Poche 2026, multicenter registry |
| Rod fracture | 32% of those pseudarthrosis cases | Often signals incomplete fusion | La Poche 2026 |
| Distal junctional kyphosis requiring revision | 6.3% of 79 thoracic fusions | Collapse below the fusion | Theologis 2024, single surgeon |
Research and Evidence
Evidence tiering: Plachta and La Poche are large multicenter registry analyses, the strongest data available on hardware outcomes. Theologis is a single-surgeon series. Li is a single-center prognostic model with an unusually high revision rate that needs external validation. Tanida is a three-patient case series. The symptom list is clinical guidance.
My own published work includes patients with prior spinal surgery. The refractory lumbar pain case, Refractory Lumbar Pain Following Motor Vehicle Collision in a Geriatric Patient With Prior Lumbar Surgery (Cureus, 2026, PMID 41694169), describes a 66-year-old with prior lumbar and cervical fusion whose symptoms resolved with a multimodal conservative program. It is a single case and does not address hardware outcomes.
References
- Plachta SM, Samdani AF, Pahys JM, et al. In adolescent idiopathic scoliosis, do all instrument-related complications require revision surgery? Spine. 2026;51(16):1171-1177. doi:10.1097/BRS.0000000000005523
- La Poche A, Benes G, Hariharan A, et al. Pseudoarthrosis after posterior spinal fusion in adolescent idiopathic scoliosis: a multicenter analysis of revision strategies and outcomes. Spine. 2026. doi:10.1097/BRS.0000000000005779
- Tanida S. Three cases of revision surgery for exacerbated deformity due to long-term neglect after failed corrective fixation of adolescent idiopathic scoliosis. Spine Deform. 2026;14(1):129-138. doi:10.1007/s43390-025-01180-2
- Theologis AA, Wu HH, Oeding JF, Diab M. Costs of revision operations for distal junctional kyphosis following thoracic posterior spinal fusion for adolescent idiopathic scoliosis. Eur Spine J. 2024;33(6):2504-2511. doi:10.1007/s00586-024-08160-6
- Serhan KA, Abraham VM, Shirley ED. The impact of adolescent idiopathic scoliosis on pregnancy. J Bone Joint Surg Am. 2025;107(7):771-777. doi:10.2106/JBJS.24.00850
- Li T, Alonge E, Ye F, Liu L, Li S. Early postoperative serum metal profiles and subsequent revision-related surgery after instrumented fusion for adolescent idiopathic scoliosis. Int Orthop. 2026. doi:10.1007/s00264-026-07021-9
- Dick JM. Refractory lumbar pain following motor vehicle collision in a geriatric patient with prior lumbar surgery: clinical resolution after multimodal conservative spinal structural rehabilitation. Cureus. 2026;18(2):e103540. doi:10.7759/cureus.103540
Frequently Asked Questions
How long do scoliosis rods last?
Rods are generally left in place permanently. In a multicenter database of 5,144 fusion patients, 2.7 percent developed an instrumentation-related complication, and fewer than half of those needed revision surgery.
What happens if a scoliosis rod breaks?
A broken rod often signals that the fusion did not fully heal at that level. In a registry of 3,532 patients, rod fracture appeared in 32 percent of the 22 pseudarthrosis cases that needed revision. It should be reviewed by a spine surgeon.
Do all hardware problems after scoliosis surgery need another operation?
No. A 2026 multicenter study found that 46 percent of patients with instrumentation complications had revision, and outcomes at five years were comparable in those managed without surgery. Pain was the main predictor of revision.
Can problems develop next to a spinal fusion?
Yes. Distal junctional kyphosis, a collapse just below the fusion, required revision in 6.3 percent of 79 patients in one series. Fusions ending at L3 or lower are also linked to more low back pain during pregnancy.
Can a chiropractor treat someone with scoliosis rods?
Care can address the mobile segments, hips, and trunk, but fused segments should not be manipulated and hardware concerns belong with the surgeon. Dr. Justin Dick at Clear Life Scoliosis in Charlotte, NC reviews hardware on imaging before any care plan.
Where can I get care after scoliosis fusion in Charlotte, NC?
Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, provides imaging review and care for adults with prior fusion with Dr. Justin Dick, DC, who holds CNMT and ARRT(N)(CT) imaging credentials. Call 980-368-0766.
Service Area
Clear Life Scoliosis and Chiropractic Center sees patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, Fort Mill SC. Families from across the Charlotte region and the South Carolina border communities come to the Rachel Freeman Way office for radiographic scoliosis evaluation with Dr. Justin Dick.
Related Pages
- Scoliosis Care After Spinal Fusion
- What Does a Chiropractor Actually Do?
- Avoiding Spinal Fusion
- Scoliosis Surgery Risks and Outcomes
- Scoliosis Surgery Considerations
- Pregnant With Scoliosis
- Spinal Stenosis Exercises With Scoliosis
- Scoliosis Treatment for Adults
- Scoliosis Second Opinion
- Dr. Justin Dick Research
Schedule an Evaluation in Charlotte
If you have rods from scoliosis surgery and something has changed, the first step is imaging review of the hardware. Dr. Justin Dick can do that at our Charlotte office and refer you to a surgeon when it is warranted.
Dr. Justin M. Dick, DC
8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278
Phone: 980-368-0766 · Email: office@clearlifescoliosis.com
clearlifescoliosis.com · Book online
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