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Broken screw in recent lumbar fusion L-4 to S-1

AnonymousUserAAnonymousUser Posts: 49,607
edited 06/11/2012 - 7:25 AM in Back Surgery and Neck Surgery
I am 45 and have degenerative Lordosis in my lumbar region. In 8/08 I had L-4 to L-5, L-5 to S-1 fusion surgery. During that surgery he tried to straighten my back but couldn't because of my nerves that were firing a lot he said, but succefully eleviated the disk pressure on my nerves. I went back for my 6 week x-ray and visit, everything was going well. 2 weeks later started to hear and feel a grinding sound on my right side and pain around my right buttock area and right hip. My pain management doc and my physical therapist said that is was probably just my back because it hadn't fused yet. 3 weeks ago went in for my next surgeon visit and x-ray and it showed I have a broken screw on my right S-1 area. I am now going in for surgery again to replace the broken screw on the right and he is going to put 2 more screws below it to stabilize my back. I don't smoke, haven't fallen or done anything strenuous, nothing to make the screw break. I am in pain and need the surgery soon, but don't want the screws to break again. My regular doctor said he never heard of anyone having more screws put in below the S-1. Also everyone I have talked to said they haven't heard of titanium screws breaking. Any thoughts?


  • My Dr told me there is the possibility of a screw breaking.

    He said he had one patient that had repeat breakage.

  • I have to say that I have only heard of it a couple of times here.
    Does the surgeon think the screw broke due to the lordosis and that is why he is putting 2 in its place?

    I am sorry you have to go through this now, especially after a pretty big op already.

    It probably has nothing to do whith what you ahve or haven't done, like fusion or non-fusion sometimes it just happens.

    Blessings Sara O:)
  • me too about screws breaking, said was quite common. (??)

    I am sorry you are in pain. I can only suggest not to do anything too strenous as you are not yet fused either and don't want to put added pressure on the good side.

    Take care.
  • Hi justlynn and welcome to spine-health.com

    Broken screws are not common, but it does happen. In two years on these boards I have not seen more than a handful of cases.

    I am interested about your doctor placing more screws below S1 - obviously to transfer some load from the end screw at S1 and thus reduce the load on S1 so it wont break again.

    All the best and keep us posted with your progress... Bruce

    Keep positive!


    ...an old timer here and ex-moderator

  • My Dr. said it was nothing I did that made the screw break, if anything I should be mad at him because he underestimated the amount of weight, force that was put on the screws because he could not straighten my back and correct the lordosis during the surgery, or he said it could be a faulty screw. So now he wants to put in two more screws below in the S-2 area on the right and left side to stabilize my back. My P.T. person said they have never heard of a screw breaking, and my regular doc said they have heard of screws breaking but very rarely, and never heard of screws put in the S-2 area. I am so confused and don't know what to believe. Still on pain meds and want to get off them.
  • S2? I thought there was no movement between S1 and anything below that... And don't only SOME people have mini discs there? Or is it just that position that they want to put the screws in?
  • i had back sugrey about a yaer ago did not work now have broken scerws and it hurts bad he wants me to louse 40 pounds . thats hard to do when it`s hard to walk around the block. thanks billy
  • Hi,
    My screw broke in S1 inside the bone. My doctor said it shows the strength of the back. He is leaving the broken screw in me since fusion has occurred and removing it would be life threatening.
    These 2,000 dollar a piece screws or more should be warranted since mine broke within the first year. I want my money back!!!! lol
    Hope you get the help you need.
  • I am 33 years old have had 2 spinal fusion surgeries in the last 8 years. Yesterday I went to the doctor to figure out why I has again having so much pain. Plain film X-rays reveled that I have broken yet another titanium screw.
    My first fusion was in 2001. Six months post-op I broke a screw and as a result never formed a solid fusion. This surgery was to fuse L5-S1.
    My second surgery was in March 2007 and was set to fuse L2-S1. The surgery was much easier to recover from as I didn't have to have a bone graft taken from my hip. The surgeon used BMP (bone morphogenic protein) instead.
    When I broke the first screw, my doctor told me that it is such a rare occurrence, and equated it to being struck by lightning. So now that I have broken 2 separate screws I am beginning to wonder if I am just very unlucky or if I should go buy a lottery ticket.
    I am very frustrated and in quite a bit of pain. During my second surgery, the doctors were able to remove a portion of the first broken screw, but were not able to get the rest as it is embedded in bone. This broken screw has caused me to have a non-fusion at L5 and the doctor says my next option is yet another surgery, would be my 3rd and I am only 33, an for him to put in cages and new screws.

    Has anyone begun to think that there might be a problem with these screws and the manufacturer??
  • One thing that I learned about titanium, is that although it is a lightweight and strong metal, if bent too much, it becomes brittle and snaps. Not knowing you and not knowing your specific situation, I can only guess. Is it possible that you are so active, that you bend and stress areas of your spine where the screws are snapping? Has your doc presented any possible solutions or alternatives to these screws, to stabilize your spine?

    Welcome to Spine Health.

  • Screws come from different manufacturers and are made slightly differently, so it cannot be a matter of poor design or poor materials. Also, pedicle screws have been in clinic trials for at least 25 years, probably longer. When I had my fusion two years ago, I discussed this with my surgeon. First, he said that breakage is rare (which is the answer most surgeons give, I think). He told me when he did his fellowship in the early 90s, they were doing clinical trials on new, completely redesigned pedicle screws...because the first design that was originally used had too high a breakage rate.

    I wonder if any clinical studies have been done to analyze if screws break at one level more than any other level....
  • Any specific metal or alloy is bound by the laws of physics as to how malleable it is as well as tensile strength. Depending on design or the way it was formed, can potentially increase or decrease the point at which it will crack or fracture. Titanium is known to be a brittle metal, especially when cold.

    I am simply bringing up the possibility that certain metals can and do break, titanium being one of them. I have used titanium in 2 different professional careers and watched it break consistently in different applications.

  • I just found out at my 12 week appt that a screw on rt side was bent or broken- Dr. to order CT scan to check fusion progress and then, either plans to let the whole thing fuse to avoid repeat surgery - or, if causing problems, he will remove screw and replace. I gather from other readings that another option would be let fuse entirely for about atyear, then remove screw. I recall 3 incedences in which I heard a popping sound, one, laying on my stomach for first time, 2nd = putting tennis ball under rt. butt check to massage deep muscles, I used to do it presurgery and being muscles in hip had been sore, I decided to try that, stopped quickly, no pain, and lastly, - yes, bending over and pulling laundry basket w. rt. arm, heard sound of pop and also felt pain and was in pain for the rest of the night. I am now struggling w. right leg where post op, the pain has usually been nerve recovery / numbness and pain but was only numbness by the end and only just after waking up, but anyway, now, to have rt. sided pain in the low back and hip area is upsetting and weird and I am frustrated. In addition, I actually got the fusion L4-S1 b/c of bladder problems worsening, and they actually had been totally decreased, no more spasms, leakage, and emptying was also improved. However, just yesterday and today, I have had some emptying issues and frequency and a spasm or two w. leakage. So, While I was hoping to make it and not get a revision, if the bent screw is having a trickle down impact into rekindling old symptoms b/c nerves are now being impacted again, I am not even going to mess around. I have been out of surgery for 12 weeks and to have these things return is insane- it is ultimately, very depressing. I have the best dr. around, he said he hasn't had this happen to him before. He doesn't think it was the laundry basket, that it coudn't have been enough. Perhaps it was the icing on the cake if the screw had been under enough stress.
    I was born w. spondylolisthesis and it was unstable at L5, finally took the fusion plunge, now revision is on the table.
    Freaked out. Anyone else out there with this going on? Anyone out there who had this happen and has had successful revision??
  • I'm not sure on the bent screw having an impact - except that I was experiencing some little flashes of sciatica recently that I thought was my next disc telling me it was getting ready to go - but my NS, after my hardware removal, suggested that the hardware could have been causing that, not the disc. we will have to see if this removal also removes those pain flashes.
  • I had a L5-S1 lumbar fusion nov 09. With in 3 months post op I had 1 broken screw at my L5 with in 7 months post op I had broke a 2nd screw. I'm military and on strict orders not to lift anything over 10 lbs. sit or stand for periods of more the 10 mins. and PT at the pool. I followed these orders to a T. The Nero surgeon told me that this is rare to happen. I have not yet fused and it has just been over a year post op. I go in for my 2nd surgery in 2 weeks to do a re-fusion and to fix the broken screws. He also talked about putting 2 more screws in for more stabilization as well as a plate. I have 2 rods and 4 screws as of now. I'm with you about buying a lotto ticket. But if I'm this unlucky then whats the point. If you may have suggestions or info. that can help, please let me know. thank you!

    Important: My comments here and comments from other members reflect personal opinions only. You should not act on any advice or opinion posted in these forums without seeking proper medical advice from a qualified doctor. Please, ALWAYS check with your personal physician before taking any action regarding your health!
  • My screws at bottom of three lvl fusion l4 to s1 are both broken in half 1 yr post op. Horrible nerve pain bladder spasms. Dr found my body has been producing bone.spurs so.nerve is all blcked up again. Need 2nd surgery. Plan is to actually anchor into hip area.. iliac bolts. Even got 2nd opinion to confirm this was best choice. Lordosis and movement of vertebrae from sponylolisthesis ..i was born w. This condition. Anyway the iliac bolts will not let the vertebra move so fusion can take place and screws wont break. Apparently pull of the bones was too much for bottom screws. Top two sets fused.2nd.opinion guy said.he.woulda.done iliac bolts to begin with. It all sounds so thrilling. Just kidding. Id.jump up on the table tho tomorrow if i.could to fix.this.... good.luck. ask about iliac bolts. Instead... laura
  • Cameron,
    wow, we are almost identical! My surgery was Oct 09. I broke first screw around week 7, it bent actually, I heard it,w hich was weird. I thought it was impossible. Anyway. Ask if the second set of screws are going into iliac crest area or something like that. My guy was also a neuro guy. Ortho guy said he woulda anchored in stronger area to begin with. What was the nature of your problem out of curiosity. PLEASE keep me posted on your second surgery. i really hope you are okay and I knwo you can do this. Anyone who underwent one and that anticipation can go in for a revision- I know you will be okay. I really would love to hear about it so I can learn also. Laura
  • I had a fusion of L5-S1 and a lamenectomy back in August 2009. I started hearing a weird noise coming from my back (I refer to it as an old door hinge)about 6-7 months post op. I called my doctor to advise of what was going on and he of course never wanted to take any responsibility. I had lost my insurance so I went a few months without knowing why my back was making that sound. A friend of the family completed xray for me for free, and come to find out I have one, possibly two, broken screws in my fusion on the right side. My pain is progressively getting worse each day. My sciatica is worse than ever. There is something sticking out of my back to the rigth of my lower spine (you can feel it & see it), I have no clue what it is. It is very painful to the touch. I am going to get a CT scan done tomorrow morning. I am pretty sure I am going to have to get surgery done again. The last surgery was the worst experience of my life, and I do not want another surgery. Has anyone thought of suing the manufacturer of your hardware in your back? Or even malpractice!? In my situtation, I never had any pain relief after my surgery. There was always something wrong. When I finally got ANY relief after surgery was when I started hearing that noise coming from my lower back (which I am guessing is when the screw broke). Although, now I am progressively getting into more pain. Does anyone know any of the risks of walking around with a broken screw not knowing where it is or what it could be by in your body? I just want this to be over with! I am a 25 yr old female, and I feel like I have a back of a 80 yr old! HELP! I am hoping that I get good news tomorrow from the CT scan, but I am preparing myself for bad news, the pain alone is telling me something is definitely wrong. Anyone else have similar situation? If so, anything corrective to fix? I had my surgery at UAB in Birmingham, AL and I do not recommend them at all! Absoulutely horrible from check in, to check out. The doctor was the worse! Every check up I went to and advised him I was in horrible pain and couldn't go back to work... he wouldn't take responsibility for anything, all he would say is go see your general physician. I mean, something is fishy here!
  • I assume all the surgeons use titanium because it's the best out there. Is there any other alternative metal to look into?
  • I had c567 fused in 2002. I was lifting a stuck door on an 18 wheeler and felt something pop 2009. They had to get a forklift to open the door. Not only did the screw break but both fusions also. The Dr. in the ER missed the broken screw witch caused me so much mayhem. I almost settled with the workers comp for $1200 when a radiologist called me from the VA hospital on a incidental cervical x-ray and said the screw was broke. F/U C/T confirmed the screw and fusions broke w/ slight herniation and thecal sac impingement. When I talk I can sometimes feel the screw head vibrate and it makes me cough. I am 52 years old and recently had a soar throat that I was coughing up mucus meat. I hope it was tounsilitis. I dont know. The radiologist has put me in the poorhouse as a single parent. I pray dailey that this will be resolved. After I was told that it broke It all made sense to me. The ER xrays show it but I cannot get a single Doctor to admit to this being missed. My symptoms have been so sparatic. One day I cant get out of bed, the next my hand is numb. I guess it is from the instability. I compare it moving to crepititus but like it is squshy. Like muffled in a gel and not like poping your knuckles. I didnt have insurance and the w/c insurance thinks i am faking it because their Dr. said there is no way that a titanium screw could break. I will be seeing a top notch neurosurgeon that is a straight shooter and also one of the best in the world and head of nuerosurgey at the local university(LSU). He is the standard. He has already said that it was possible but I am sure he will say it happened when I lifted the door. I am not going to forget what my son and I have been put through either.

    Advise to others, Never squat lift anything to one side or using one arm with ACDF. This canders the plate and puts the screw on that side, top dead center as you will counter balance with your head in the opposite direction. All the energy from that lift is concentrated to the screw with a twisting on the plate. The location of the top of plate and anchor ligaments of the trapizius muscles causes this concentration as well as a lever action that increse the force on the screw somewhat 5 to 6 times. A 150lb squat lift results in 800 to 1000 lbs on the screw. The screw acts as a fulcrum and the multi vertabrae plate and the legnth to your shoulder acts as both sides of the lever. An example is grab the bottom of your chair and turn your head opposite of that hand and pull. You will feel the pressure in your neck at the level of c 5. This motion is usually spread out over all the vertabrae but because of the fusion it is misaligned and concentrated. Add the strength of your legs and you will feel what I did. If both fusions and the screw break you will know it and regret it.
  • I underwent my first surgery in 2008 for Spondylolisthesis repair and thecal cyst removal. 2 rods, 6 screws. 10 days later I was trying to pull myself into a more comfortable position and heard a pop. Then severe headache and panic attack (my first). After weeks of mis-diagnosis, I demanded to see the surgeon and he said you have a CSF leak. I had a second surgery to repair and haven't been the same since. I am in more pain than before my initial surgery. Lower back, sacrum and tailbone. Went for a 3rd surgery to remove a Tarlov cyst after doing a lot of research. That did help with reducing the tailbone pain, but sacrum and lower back are always in pain with activity making it worse. I have tried many courses of pain relief to no avail, but did find out (2 years after my first surgery) that I have a broken screw in my sacrum. I believe that is what popped at the 10 day event and was wondering if this is what is causing my pain. Has anyone reported pain relief after having a screw removed this late after initial surgery?
  • Dear Anonymous!!!
    I was sorry to hear about your process and hope that everything is okay with you now as to the screws breaking I had a spinal Fusion don on my L-4, L-5 and S-1 When I was 16 years old I then broke the screws on the right side. My brother took the screws to be analyzed as it is not normal for titanium screws to break because once titanium is set it should hold however I was told that if the screws are fastened to tight or to loose it could cause some pressure and cause it to break I then had another operation to remove the screws as it was broken there was not much they could do and could not remove the broken screw there after I had another back and after that broke the other side as well in the interim everything had to be removed and only the two broken parts of the screws in each side where left as they could not be removed. I have 4 back operations if I did not have the first one I would have landed up in a wheel chair. However the body tries to heal it self and when it finds foreign object the body send bone fragments to form around the screws the problem now is that with the broken screws still there the bone is forming around it in the wrong way I am suffering terribly with pain and now not sure what the next step is but basically I have a huge block of bone fragments around my L-4 I am currently getting it seen to and will soon go see another specialist as I moved to Portugal it is new doctors and new processes all together my doctor told me that she worries because my Spin is so bad that not many doctors will want to touch it and to be honest I am not quite Sure if I would be able to handle yet another back op. What I do know, from my experience that sometimes yes it is the only option but once you go for one you will go for more then that. I am only 29 and already had 4 back operations.

  • Hello everyone, an update, I got my second surgery to remove the broken screws. In addition, the surgeon found a part of my sacrum had broken and was sitting right on the S1 nerve root. Time of surgery was longer than expected and he also removed the bone spurs. I am at day 17 of recovery, wearing my brace and bone growth stimulator. I was in a lot of pain right after the surgery b/c of nerve pain in the left hip and I could not bear weight, came home using a walker. The nerve pain required a few doses of steroids in the hospital IV and then a round at home medrol pack to calm it all down. Unclear why the sacrum broke in the first place but it def. explains the extreme pain and loss of bladder control at the end there, it was horrible. I am walking a lot and am on about half the pain meds at this point, just 1 muscle relaxer or 2 a day and 3 single pain pills, sometimes only 2. I also had a mattress change which helped immensely - I got a very firm one for Macy's on a dday they had like double sale or something. i couldn't believe what a difference it made. So, definitely check out your mattresses people! I used to be at a 10 in the morning until I changed that out - it was fairly new too, A sealy posturpedic Barryton I think it was- the old one. Just not firm enough. Anyway, it is something to look at but I am doing much better this time, the nerve has calmed down so my pain level at this point varies from 0-4 throughout the day a four is rare now. The healing and pain in the nerves was DEF. way harder the first time, so I am glad to be out of that degree of nerve pain. I think this one will do it, OH, they also used BOLTS and put them into my iliac crest to assure NO movement of bones between L5 and S1 and They packed the area with Human donor stem cells which promotes faster fusion. It was FDA aproved instead of BMP for spinal fusions in January, so I am hoping for a speedy fusion to move on with my life. If anyone wants to email outside of this chat space let me know, I would be glad to email back and forth. I think I am going to leave the blog for now but wanted to leave you all with good news and motivation to go back in and get things checked out. Things were so unstable part of my sacrum actually broke off! It means that even now your body could be reacting and doing things to compensate since your last xrays that are causing pain. Go get the studies, the myelgrams, the CT scans, the flexion/ extension x rays, whatever it takes to find out what is happening. Best of luck to all. Laura (Janesaiz)
  • I had a spinal fusion surgery at L5-S1. After having the surgery I felt worse. I stayed with my doctor for six years following believing he had my best interest at heart. I thought that since I still had problems after the surgery that I was basically screwed for the rest of my life. I just thought well the doctor tried but it did not help...that my back was just in bad shape? A few years later I went to get physical therapy with a pain management doctor. On my first visit with this doctor he decided to do an x-ray to see what was going on with my back before we got started with therapy. The x-ray showed that I had a broken screw from my fusion surgery. Here about 6 years had gone by and not once did the doctor that did my fusion surgery (who's treatment I was still under) ever think to do a simple x-ray to check the work he had done? Why? I continued to state to him in the the years that followed that I actually felt worse. I admit now that I was way too trusting of this doctor. He kept telling me that my problems were the result of bad disc's up higher & that he could fuse them too. I believed him because I did not know any better. Since I had no success with the original surgery I just told him I did not want to do anymore surgery. I went thru hell with the original surgery and it did not work so there was no way I was going to do anymore. He said he did not blame me since I was only 41 yrs old that it was probably best I wait as long as I could. Well it turns out that my other disc's are fine as they were checked by a different doctor. In switching doctors I had the fusion repaired. The new doctor could not remove the broken screw in his repair. Im thankfull for the doctor that did the repair but the fact of the matter is that my back still gives me trouble. I have not worked in years and chances are I will never work again. Does anyone know why these screws break? Is it bad hardware? Or something else? Thanks in advance.
  • I have been reading the blog about the broken screws. I had a fusion surgery on l-3 L-4 back in 1979. I was 29 years old. I still had pain in my back and the sciatic nerve down my right leg. I was a masonry contractor until 2009 so I was involved in a lot of lifting, 100 lb cement sacks, cinder block, bricks, you get the picture. The only thing that really helped me was the inverted hanging machine. It has been the greatest health blessing to me. It took about a year with it before I got relief but my back is better now at 61 than it was at 29. Just thought I would pass that along. I feel for all who have back pain.
  • I know yours was a few years ago so I'm taking a chance that you even look on this site anymore?? I'm curious (HOPEFULLY GOOD) of what your decided to do and what your ooutcome was? Thanks & I wish you Pain free :)
  • this is a beat site it may have been good in it's day but is still good for information on some subjects
    Severe central stenosis L2,3,4,5 Multilevel degenerative disc disease/osteoarthritis.Surgery #1 Decompression,Fusion L4,L5.#2 Laminectomy with hardware L2-S1#3 Ant. fusion at L5-S1. Current pain meds, Exalgo,Oxycodone,Gabapentin.
  • I head operation done 6 mounts ego on my lower back do to accident at work
    head to replace two discs and fuse 3
    After 4 mounts i start hearing niose that's sounds like two breaches rubbing against ech other on the wind. Numnes in my legs and pain in the back its getting worse
    They found two Brocken screws in the fusion I wonder what's next. Should I trust them ???? What should I do next
  • Well both of my screws broke. Doctors always want to act like it's not normal but sounds like it happens quite a bit and obviously they need to do a study on this. I am now in way worse condition than I was before the surgery and preparing for the second one I am only 36 but work in a nursing home my working life 15 years! I do think that part of the screws breaking are my fault as I do smoke and did not have the help that I thought I was going to have after the surgery and plan on going to in patient rehab after or the second surgery
    Shannon perry
  • Had L5-S1 fusion up7 months ago. I was doing so well, then one day got pain in my right leg. Went back to the surgeon and he saw that a titanium screw had snapped just below the head. He suggested a brace, as he thought the bone had fused around the screw, but there was a possibility of a small crack in the fused bone.
    He then showed the x ray to a colleague who noticed that the bone graft had dissolved / been absorbed by my body. I was taking naproxen, which it now transpires that it dissolves bone grafts!! I was prescribed them. I am quite upset about that, as I was on,y taking them because I was told to do so

    I am not sure what to do now, I didn't do anything strenuous to make the screw snap. I suspect it was a faulty one, but how would I prove it?
    My surgeon is brilliant and said he will do anything to rectify the problem.
    Would anyone recommend being opened up again to take the screw out and put a new one in? . What should I do about the lack of bone graft? Will it grow naturally, or do I need more ?
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