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Loose Pedicle Screw

gwennie17gwennie17 Posts: 2,912
edited 06/11/2012 - 7:34 AM in Back Surgery and Neck Surgery
I know some of you have commented on having a loose screw, and yes, we will resist all cheap joke lines. :O)

I would appreciate hearing from anyone who had a loose screw in their hardware, how it was discovered, and how the problem was resolved.

Details please!!

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Comments

  • I worked for a spine surgeon for 12 years. Most times, broken or loose hardware would cause a sudden increased back pain. Then x-rays or a CT scan would show the problem. Do you think you are having problems with your hardware?

    Dave Stevens
    living-with-back-pain.org
  • i had 3 level post. fus. of c6,c7,T1,T2 with bone from my hip.
    two of the screws were discovered to be loose as they were not sunk deep enough into the bone. my surgeon discovered this one month after surgery. his opinion was that even though screws were weak i would be ok.
    that was 6 years ago. since then i have had increasing pain in my neck, arms and upper back and chest. the surgery was so difficult i would not have a redo. i would opt for scs.

  • Hi Gwennie,

    How's it going? Do you think your screws are loosening?

    I have two broken pedicle screws at L5 from my ALIF L5,S1 done 7/1/08. This showed on a CTscan November 2008 and my surgeon didn't beleive me because he's never had a screw break on any of the patients he operated on. He ordered xrays and it was clear as day.

    I have one surgeon (the neurosurgeon I went to for 2nd opinion) say that the screws could work themselves loose over time and cause damage elsewhere. He also said that I am not fusing.

    On the other hand my orthosurgeon told me that the screws are serving no purpose at this time and therefore don't need to come out. He assured me that they would stay where they are. He also said that I am fusing.

    Now I am just sitting around waiting to see if I have any new or worsening symptoms and seriously considering going out of area for another opinion.

  • I went to a new doctor for a couple facet injections this past week. He thought one of the pedicle screws looked odd. They took photos and he's sending them and a note to my surgeon, who had ordered the facet injections.

    I do not have any "new" pain. It is just the same old pain I've had since prior to my two surgeries.

    I have nerve pain mainly in my right leg and no one can figure out why. My instrumentation looks "fine" on my recent MRI. I had flexion X-rays, which also were proclaimed "fine." There does not appear to be any compression...and yet I have nerve pain.

    I imagine my surgeon will just tell me the other guy is wrong and everything is "fine!"
  • On CT, sometimes a loose screw is noticed by a lucency around the head of the screw. Once you are fused, there is usually no need to keep the hardware, so if you are having continued pain, some surgeons will remove them. When they do it, they can hook up some magical(I have no idea what it is called) device to check and see if the loose screw is irritating a nerve.

    I think loose screws are mostly discovered through patient complaints of new/continued pain then work up with CT done or direct visualization in surgery. When I finally read my 1st op report(was going to a different surgeon by then), the op report stated that he put in one screw, but felt placement wasn't right so he removed it and put it back in. I guess that's a big no-no. I have my hardware and you can see a screw that is stripped a bit. I don't know if that is the one, but sure could be.

    If you are fused(which of course cannot be fully determined except by direct visualization tho CT and plain films can show some hints of fusion), then why not try removing hardware? While in there, why not look at nerve root responsible for your radiculopathy to make sure no excess growth? In my personal experience, hardware removal was a cake walk compared to having it put in!

    Some say that a doc can do a "hardware block" with lidocaine or marcaine whatever, injecting the numbing medicine in the area of the hardware. Theory being that if pain goes away, then the hardware is the culprit. Well, what keeps the med right on the hardware? Nothing. It leaks around everywhere so not sure you can really say that it determines that the hardware is the culprit.

    Titanium itself, though some will say it is an inert metal and therefore no allergies, is not pure in our hardware. When it is shaped into the screws/rods, it is no longer pure titanium. I read a study where patients who had persistent back pain after fusion for no apparent reason had their hardware removed. During the surgery, many patients had inflamed tissue surrounding the hardware. On lab examination of the tissue samples, it was discovered that the tissue was reacting to the metal and secreting chemicals that was very irritating to nerves and local tissue.

    But, I am rambling here. Does your doc think you are fused enough to removed the hardware?
  • How in the heck can they determine that everything looks "fine" when the hardware causes artifact that can obscure problems?

    For radiculopathy, a selective nerve root sleeve injection at the level they think is responsible for the nerve pain can be diagnostic as well as therapeutic. If it takes away 100% of your pain, then you know that there is some sort of compression on that nerve. Of course, that relief is like an epidural, lasts only a few hours then pain comes back until(if it was done) steroids kick in(which some feel are irritating to nerve roots.)

    These are just from my personal experience and my own readings/research.
  • I have had selective nerve root blocks and I still had the pain. I had a second surgery that had an outside chance of solving the problem. It didn't. I currently have my two surgeons (one from each surgery) telling me I should consider a SCS -- that they can't figure out anything else to suggest. Now I have two pain management guys (one is a physiatrist and the other is interventional pain management) baffled -- telling me my case is "complex" and that the data just doesn't add up.

    The new PM who did the facet injections spent some time looking at my fusion site on the screen of the fluroscope, after he finished the injetions. He's the one who thought there was a "halo" around one of the screws and asked if I had a flexion X-ray recently. I had -- and the radiology report indicated everything was OK. So he took some pictures, wrote a note to surgeon #2 and I will find out more on Aug. 17th.

    All along I have been told the hardware looked fine and I appeared to be fused, but I have had pain since the day I awakened from surgery. None of this is "new" pain...so it is all rather perplexing.

    But thanks for your thoughts on the topic!! I do appreciate all of them.
  • I was told a halo meant loose screw.
  • I had loose screws (noticed by the halo effect) and was not fusing at all. As many of you know, i went to a different doctor, different hospital, and just had a 360 revision of my l-4/l-5 but by ls-5/s-1 also collapsed so he did that also -


    damn am i sick and tired of being sick and tired,,,,anyone else??
  • Definitely...and I'd like to have something wrong with me that someone can figure out!!

    Dina, How are you feeling after your new fusion??
  • I noticed that chronic radiculitis was checked off on a medical form for me, along with other diagnosis. Could it be that the nerve pain can stay chronically inflamed, and is one reason why we keep on having problems? I also have scar tissue seen on an MRI along the medial surface of the S1 nerve root that is causing additional nerve pain in my left leg. It is in the right leg that I have permanent nerve damage of the S1 nerve as well as post op scar tissue. I'm no expert but I believe this two ongoing conditions are the cause of my chronic radiculitis diagnosis.

    Have you ever had this diagnosis before? Maybe the pedicle screw is causing chronic inflammation and irritation of the nerve.
  • jlrfryejjlrfrye ohioPosts: 1,110
    no loose screw but 2 broken cervical and 1 shattered screw
    susan
  • Its such a long process and such a slow process. I am trying to keep my head about me, but it is hard. I had a few issue in the hospital, ended up in ICU for 6 days, 8 days total in hospital. Pain is not too bad, and Im up to walking about 1/2 mile a day.
    The brace is enourmous! They gave me a turtle-shell brace and it also connects to my leg with metal rods so I can not twist or bend. Makes it hard to walk,

    But I feel a little stronger everyday so hopefully this is the road to recovery!!


    thanks for asking!!
  • I too am sick of all this. Like Gwennie mentioned, at times I wish I had something wrong with me so it can be fixed. How can MRI and xrays show nothing significant enough to be causing all this pain. Well, by gosh...I am not making this up! I am sick of this life with constant pain.

    On a more positive note. I had to take my daughter to Sayre,PA Guthrie Center cuz they are the only orthodontists that accepts our insurance and she needs braces. While I was there, I took the time to find the Spine Center becuase I've heard good things about the surgeons there. I spoke to the secretary who informed me of what I need to do to get referred to one of 2 neurosurgeons in that office. They are reluctant to take patients who've already had spine surgery. I'm not going to give up hope though.
  • Long story which I won't go into -- my vet gave up his brick and motor practice and now just makes house calls. He's been following my back travails for years and always wants to know how I'm doing. So today I showed him the photos the PM doc gave me of the fluroscopy screen showing the area where he thinks I have a loose screw. I couldn't see anything...but he studied them for awhile and then showed me what the doctor was talking about.

    There is a halo around one screw that is not present around the other screws.

    I can't wait to see my surgeon. He's not the one who did my fusion, so I don't know what he'll say about it. We're going on vacation Thursday, so I won't find anything out until the 17th.

    I think removing fluid from my facet joint prior to injecting it might be helping. So far, I feel fairly OK.

    Take care, my spiney friends. I hope you all stay well while I am gone from the board!

    xx Gwennie :)))
  • Have a great vacation!
  • I had rods and 10 screws placed from L2 - S1, 7 1/2 hours in surgery) just over 2 years ago and over the last 5 months have experienced pain that was not there 6 months after surgery. My Neurosurgeon had me to get a CT Scan to verify that the at least the two bottom screws were loose. He saw luminence around the bottom screws but could not rule out other screws being loose. He then had me do another MRI with contrast and I will be seeing him on wednesday the 28th of October. I saw another surgeon that is the replacement for the Dr. that did my surgery, he moved to Florida, I am in California, to continue, he stated that he would try Epidurals before doing another surgery.

    I have questions for the Neurosurgeon on wednesday:

    1. Will the bone grow back into the space between the screw and the vertabrae and should I use the Bone Growth Stimulator that I used for 6 months after the original surgery?
    2. Will I have the same loose screw problem down the road again? The doctor stated he would have to loosen all the screws, pull the rods up and replace the loose screws with larger ones so it would be tight again, then reset the rods and tighten the screw head against the rod.

    I know that there will be more nerve damage and I have yet to have all of my nerves reconnected since the first surgery. I will get a third opinion if surgery is suggested by the Surgeon on Wednesday. My calf and hamstring muscles are so tight, I continually have cramps in the middle of the night.

    I am so frustrated with the whole surgery process. I wish I had not had the surgery...so many unknowns and problems.
  • I was told that these Pedicle screws cost a thousand dollars each...which is hard to believe until I understand how they are made. It seems that they are a screw that has a ball joint type head that a rod can be put through and then they tighten them so they make a solid connection. The ball joint allows for the screws to be placed not aligned or perfect. If someone has seen these screws will you please confirm or refute my understanding of these screws. I worked at a Nuclear Power Plant and have seen parts made of from alloys that are extremely expensive, but never saw a screw this size that costs a grand...I would like to know. My point is at such a high cost, you would think they would not break or bend. I also know enough about tightening bolts and screws in this case that you have a torque value that is critical when you screw into bone...which is so soft compared to the screws.
  • I don't know what the screws cost, but I have a couple of hospital specimens cups full of my old ones? Anyone want to buy them half off??? lol. One is so clearly stripped. If you get any hardware out, I recommend asking the doc if he will save them for you, they really are interesting.
  • I had my spinal fusion March 2005 my L4-S1 was fused due to spondylolisthesis and a spur pinching off the spianl canal and then in Fab 2009 I started to notice numbness and tingling in my feet mainly the left but becasue at the time I had a headache the drs thought it was from that and the medication i was on so in april 2009 when all was settled I still had numbness and tingling the dr decided to send me to a specialist for nerve testing it was done september and oct 2009 and I was told it seemed to be coming from the L5-S1 region. Then November 3 2009 I had a bowel obstruction and had stomache xray that showed a broken S1 pedicle screw I did not find out till Jan 2010 about the break But was already on list for MRI that I had Feb 16 2010 which did not show the break I slipped on ice feb 19th 2010 and exrays still showed the broken pedicle screw I finally saw the surgeon May 2010 who took his own xrays and said the screw was not broken but possible lossend and no surgery waranted but sugested that i see a a rehab specialist My family dr ordered another set of exrays and had me take all my xrays with me to see the rehab specialist who looked at the xray and said there was a difnite brake and wants me to see the surgeon again this time bringing my xrays.I have been getting worse each day and always in pain I have gained weight which prob hasn't helped but anyhow My question is can slipping on ice cause the pedicle screw to break I have slipped a few times over the years since surgery but nothing ever showed in xrays and I was always told it was just soft tissue damage and it settled down or could this be because the grafts did not take completly and strain of walking and standing long hours at work with heavy lifting bending and twisting have caused it. I can not get a definate answer and workers compensation says my slips is what caused the breakage. The other question I have is can an regular mri show metal I been told by 3 doctors it can not and Also told a mri will only show when there is servere nerve pinching.
  • Hi everyone. I certainly am sick and tired of being sick and tired.

    If I had a caudal injection in January why didn't the doctor see this halo during the procedure.

    My pain has been increasing day by day and I can no longer tolerate the pain. I went to see the doctor I was assigned to and he checked the flouroscopy image and said he thought there was a halo around the S1.

    Now, I'm scheduled for another injection on the 21 and ont the 15 I see another orthopedic surgeon for his review.

    I am so glad to find someone with similar situations.

    Don't know what to expect at all. At least physical therapy will commence. My first surgeon didn't think it was necessary or to give me med's HELLO
    11/30/2010- 360 bi level fusion L4 L5, L5 S1
    7/5/12-Revised surgery. Remv of loose hwdware, replace 6 pedicle screws and 5.5 titanium rods. Inferior laminotomy R L5 and facetectomy to deep ligamentum.
    2014 MRI indicates L3-L4 disc bulge,
  • I also had a L2-S1 fusion after a failed L4-L5 fusion surgery the previous year, I have been complaining about increasing pain to my surgeon that continues to worsen at six months from the day from hell.(12 hour surgery with major bleeding abrasions on face,chest,stomach,hips and legs) Fortunately the leg pain is much better but the pain at my left rear waist area that was my initial complaint has spread to the right side and now all the way around thru my abdomen area. The Doc sent me for another CAT/MRI & X-Rays with flexing, I got the written results today, the pedicle screws at S1 have come loose? The results didn't mention if the fusion had taken or not so I'm not sure at this point. Soooo If anyone responds I'll continue, this is my second post I signed up before the last surgery as I found so much info about what I was getting into I thought I may be able to add something once in awhile.
    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 just read the report from the CT scan. I had been complaning about pain in my left leg,back and but aarea. Which is all new considering i have never had pain in the left side. This has all been isolated to the right side and middle of the back. Things has gotten so bad at times that i have been roughly awaken out of deep sleep by a sob of a deep stabbing pain like no other. It was so sharp that i jerked so hard it woke my wife up as well and despite the pain pump. So when my CT results stated "Left S1 Screw demonstrates lucency surrounding it which may represent hardware loosening. This appears more pronounced than on the prior exam. The l5/S1 level fusion ode not appear incorporated." After reading many comments here i was not pleased. I had gone 2 years with very manageable pain. WHen will this ever end?
  • hitman48hhitman48 New Jersey Posts: 1
    Hi my name is Harry.  I hope you can tell me what all this mean .plus I had spinal fusion surgery over a year ago. Here my result .[ Examination Lumbar spine in multiple projections including both flexion and extension demonstrate postsurgical changes L5-S1 with indwelling pedicle screws. The height of the vertebral bodies were normal., there is slight joint space narrowing posteriorly at the L5-S1level.In both flexion and  extension there was no significant abnormalities in alignment. The height of the vertebral bodies were normal there is evidence of prior surgery anterior abdominal wall.There is a radiopaque metallic tube 2.3cm in length overlying the lower pelvis that may be within the soft tissues.Please correlate clinical  I hope you can help in so much pain
  • jeff4007jjeff4007 NewmarketPosts: 1
    I recently had removal of all hardware in my back,then had MRI due more pain and MRI showed multiple
    screws still in my back .....severe Pain is coming from right lower side of back
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