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A structured questionnaire.The purpose of this study was to determine whether material rod composition and its imaging characteristics can determine patient perceptions of pain, outcome, and need for revision surgery in the context of the failure of spinal instrumentation following lumbar arthrodesis.Patient perceptions of radiographic images in the context of failed spinal instrumentation may influence clinical outcomes and patient satisfaction. Due to radiolucency, failed polyetheretherketone (PEEK) rods may be perceived differently by patients than more traditional materials.Patients presenting primarily with chief complaints of back pain completed a 2-page, 22-question questionnaire containing 3 alternative radiographic images of failed rod instrumentation following posterolateral lumbar arthrodesis. The images represented failed rods composed of either PEEK, PEEK with a longitudinal radio-opaque marker, or traditional titanium. Statistical analysis with the Cochran Q test was performed to determine whether there were statistical differences in the responses.The responses suggested a preference for the images representing PEEK instrumentation as being associated with superior clinical outcomes, the least pain, the most comfort, and the least likelihood of required revision surgery.PEEK rods possess radiolucent properties that can alter patient perceptions of clinical outcomes when compared with images of other equally unfavorable scenarios. The significance of these patient perceptions must still be demonstrated. However, they may play an important role in clinical outcomes and patient satisfaction.