Loose Pedicle Screw

Loose Pedicle Screw

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gwennie17
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Joined: 12/30/2008 - 12:07am
Loose Pedicle Screw

I know some of you have commented on having a loose screw, and yes, we will resist all cheap joke lines. Clown

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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pete81241
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hi gwennie

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.

oolbp (not verified)
Title: Member
Hi gwennie17

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

Ming
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loose screws

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.

gwennie17
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Thanks ~

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!"

ernurse
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Last seen: 2 years 1 month ago
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Joined: 06/22/2008 - 9:09am
Loose Screws

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?

ernurse
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Nerve Pain

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.

gwennie17
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Joined: 12/30/2008 - 12:07am
frustrating ~

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.

ernurse
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Halo

I was told a halo meant loose screw.

nursedina001
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Joined: 12/07/2008 - 6:19pm
loose screws

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??

gwennie17
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Joined: 12/30/2008 - 12:07am
Indeed ~

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??

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