“I Heard Something Click”: When Spinal Fusion Hardware Fails

Spinal surgery and stimulator guides · 15 min read · Published 10 November 2026 · Reviewed 10 November 2026 · Next review May 2027

By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates

If you are reading this because your pain came back after a fusion, or because you’ve been told your screws are loose or a rod is broken, I want you to know your questions are reasonable. Some fusions don’t take, and some hardware fails, even with excellent care. But persistent pain after a fusion deserves a proper look, not just patience.

This guide is for anyone who has had a spinal fusion with screws and rods. It covers how fusion and hardware work, what failure looks like, how it should be investigated, a rare problem called metallosis, what your records should show, and how the law looks at it.

Start with your question

• Why does spinal fusion hardware fail?
• What are the symptoms of spinal fusion hardware failure?
• What if my spine didn’t fuse?
• Will an X-ray show if my screws are loose?
• What is metallosis after spinal fusion?
• When is back pain after fusion an emergency?
• Could this be medical negligence?

How fusion and hardware work

Before surgery: what you should be told

One Australian health fund’s patient information lists failure of the bones to fuse properly in about 5 to 14 per cent of cases, wear or failure of the metal parts as a long-term complication, and degeneration of the levels above or below at about 3 per cent a year. It also says only about 62 per cent of people are happy with the result, that non-smokers do better than smokers, and suggests asking your surgeon about their own complication and satisfaction rates.¹

Questions to ask before surgery

• What are the alternatives to fusion for my condition?
• How often does the bone fail to fuse, and what happens then?
• How many levels, and why?
• What are your own rates of complications and revision surgery?
• What can I do to improve the chance of fusion, such as stopping smoking?
• How will you check that the fusion is healing?

The first months

Fusion takes time, often many months. The first months matter for the hardware too. In one study of 100 patients whose lumbar screw-and-rod hardware failed, 90 per cent of failures happened within six months of surgery, and none were reported after a year. Screw fractures made up about a third of failures, followed by rod fractures, rod loosening and screw loosening. Of the patients who were operated on again, 70 per cent had a non-union.²

The same study linked failure to longer constructs over several levels, screw positioning, rod shaping and poor bone quality, alongside patient selection, surgical experience, implant choice and technique.²

The signs

Hardware failure and non-union can cause pain that returns or worsens after a period of improvement, back pain on particular movements, a new click, clunk or sensation of movement, or new or returning leg pain. Sometimes there are no symptoms at all, and the problem is found on a scan.

When pain comes back

Pain after fusion has many possible causes, and not all of them are hardware problems. But returning or worsening pain, especially with a new mechanical sensation, should be investigated rather than put down to slow healing. Our guide to what to do if you still have pain after spinal surgery explains the broader picture.

Investigation: why a plain X-ray may not be enough

Judging whether a spine has fused can be difficult on imaging.² Plain X-rays can show a broken rod or a displaced screw, but loosening and non-union can be subtle. If your pain is unexplained, it is reasonable to ask whether a CT scan would give a clearer picture, and to ask the surgeon to explain what they see.

If the bone hasn’t fused

A non-union doesn’t always need more surgery, but when it causes pain or hardware failure, revision is often considered. Revision surgery is a bigger undertaking than the first operation. Ask what will be done differently, what the chances of success are, and what the alternatives are.

Metallosis: a rare complication

Metallosis is a reaction to metal debris from implants. A 2016 systematic review described it as a rarely reported complication of spinal instrumentation, which can appear weeks to years after surgery, with both titanium and stainless steel implants, and can occasionally cause neurological symptoms by pressing on nerves.³ If you have unexplained pain or swelling near your hardware years later, it is one possibility your surgeon can consider.

Expected, worth a review, or emergency

A general guide only. Your surgeon’s instructions come first.

Numbness in the saddle area with bladder or bowel changes can be a sign of compression of the nerves at the base of the spine. Our guide to cauda equina misdiagnosis explains why speed matters.

If you felt brushed off, see when being dismissed by a doctor becomes a legal issue.

What to look for in the records

Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.⁴ Our step-by-step guide to getting your medical records in Australia walks you through it.

How the law looks at it

Non-union or hardware failure after a fusion is not, on its own, negligence. It can happen even after excellent surgery. The legal questions are whether the care, from deciding to operate through to follow-up, met the standard expected, and whether any shortfall caused harm.

A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))⁵, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)⁶, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)⁷⁸. Our guide to how a medical negligence claim works explains each one in plain terms.

In a fusion case, the questions might be: was fusion an appropriate operation for you? Were the screws and rods placed in accepted positions? Were concerns on post-operative imaging followed up? When your pain returned, was it properly investigated, including with a CT scan if needed? Was revision planned and performed appropriately?

In plain terms, the question is whether better care would probably have avoided the failure, or found it sooner and spared you further harm.

For spinal fusion, that would usually include the chance of non-union, hardware failure, further surgery, nerve injury and adjacent-level problems, as well as the alternatives to surgery.

Who can claim, and when

The person who had the surgery can claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.

More: complaint or claim? · how a claim is paid for · what a claim can cover

In my practice

When I read files about failed fusions, I often find that the warning was there early. A radiologist notes something subtle on a six-week X-ray. A patient mentions a click. Pain returns at four months. Each time, the response is reassurance: fusion takes time, be patient, backs make noises. None of those statements is wrong on its own. But together they can mean that a broken rod or loose screws are found at ten months rather than three, after months of lost work and family life. What strikes me is how often patients blame the moment they bent over or lifted something. In the files, the question is rarely the bend. It is what happened after they reported it.

Both things can be true

Your surgeon may be highly skilled, and your fusion may still have failed. Patience may be part of recovery, and your pain may still have needed investigating sooner. You can be grateful for the relief you had in the early months and still want to know why it didn’t last.

The bigger picture

In Australia, the Spine Society of Australia and Monash University set up the Australian Spine Registry, which began collecting data in 2018 with a focus on patients’ own reports of their outcomes.⁹ Better data on how fusions go over time should help patients and surgeons make decisions. For now, it remains worth asking your surgeon directly about their own results.¹

You can check your surgeon’s registration on the Ahpra public register,¹⁰ and complaints about care in NSW can go to the Health Care Complaints Commission.¹¹ If an implant itself is faulty, our guide to medication, drug and device harm may help. Spinal cord stimulators, sometimes offered after failed spinal surgery, are covered in stimulator lead migration.

Support

You don't have to work through this alone. These services can help:

• Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)¹²
• Beyond Blue, anxiety and depression support: 1300 22 4636
• Medicare Mental Health, help finding mental health support: 1800 595 212
• healthdirect, 24-hour nurse advice: 1800 022 222
• Health Care Complaints Commission (NSW): 1800 043 159

A sparky who slept on the lounge room floor while his daughter brought him her pillow found a surgeon who sat down and explained the scan. You deserve that too.

With care,
Rosemary

Frequently asked questions