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Loose screws AND pseudoarthosis at the interbody fusion cage

edited 06/11/2012 - 7:48 AM in Back Surgery and Neck Surgery
I haven’t posted with any real news in quite some time. There really just hasn’t been any news to post. As most of you know this journey is a long one, filled with doctor appointment after doctor appointment, test after test, scan after scan and procedure after procedure. Eventually we figure out that not everyone gets a diagnosis and for the spine patient or the chronic pain patient, even a diagnosis doesn’t guarantee a cure. Along the way someone gets up the nerve to tell us we may have to work on ACCEPTANCE. Then we must decide can we do that? Should we do that? Have we really tried everything? Is acceptance really our only option left? Bite your tongue.

After a lost count of MRI’s, scans, procedures, surgical opinions, and getting my hopes up for naught I recently had a Bone Scan with spect and Hawkeye done. I just got the results. I won’t bore you with all the details and I’m certainly not asking you to interpret but I will share a couple highlights.

Among other things the report showed findings for pseudoarthrosis at the L4 L5 interbody fusion cage and L4 and L5 pedicle screw loosening, most pronounced along the right L5 screw. (It only took almost 2 years to figure this out!) Sarcasm intended!

For a refresher, my fusion was a TLIF with instrumentation in Jan of 08. Despite my repeated complaints of pain, a year after the fusion I was told I was fully fused and I could resume all activities. I tried to do just that. It wasn’t until about 15 month after the fusion I hit a brick wall. My symptoms became impossible to ignore, increased to other levels, and have only gotten worse. I have MRI’s and a Myleogram that show new problems above and below the fusion as well.

Has anyone else had these findings after a fusion? Something Similar? What was your surgeon’s advice? Some thing tells me it’s not going to be as easy as just removing those loose screws. Considering the area around the cage is showing non fusion I'm wondering if a revision will be necessary. My dream of getting rid of this Hardware is not looking so good is it?

Evidently the back is fused it’s just the area around the interbody cage showing lack of fusion.

I have read plenty on here about removal of hardware but nothing really about loose screws AND pseudoarthosis at the interbody fusion cage.

Needless to say I am quite interested in hearing all the advice/personal experience I can. (With the full understanding that I must consult with my own physician.)

If and when I’m going to let them back in I want to get it all done right, once, and for the last time! I went into the fusion with blind faith. Not asking enough questions. I don’t want to make that same mistake twice so I’ll take all the thoughts on this anyone is willing to hand out!

Thanks in advance,


  • So sorry you are going through this! I just underwent a PLIF a few weeks ago because of loose hardware and non-union at L4-L5...

    I too was intense pain. I knew something was wrong. I had the worse pressure in my back and legs. My right hip was very painful. Never new what position or turn would be so excruciating! My legs would give out.I basically had to sleep on ice each night along with pain meds.

    The Dr said when they went in for the revision he couldn't believe how loose all the hardware was. He said it was worse that what the scan said.

    I know what you are going through both emotionally and physically!

    Did the Dr recommend surgery? If so which way are they thinking?

    In 09" I had the 360 this time it was a PLIF and he had to make 2 6inch incisions one on each side of the back. If your Dr isn't listening to you find someone who will. A non union is very painful and you shouldn't have to live like this!!

    Please let me know who you make out.


    spondylolisthesis at L4-5; stenosis,
    Lumbar surgeries 1999 L4-L5
    Lumbar staph infection 1999-2000"
    Meningitis x5 in 1999-2001
    Brain shunt 2000"
    Brain shunt removed 20001"
    ALIF/PLIF fusion 8/5/09
    Failed fusion and Failed Hardware
    PLIF Fusion scheduled for 10/29/10
  • Matia,
    Thanks for your response. I'm sorry you had to go through it yourself but am thankful you can tell me a bit about your experience. I haven't actually spoke to the new surgeon yet that ordered the scan. I got the report back and spoke to my physiatrist about it. The surgeon is out of town until next week.

    Who would have thought it though? Honestly. My fusion was almost 3 years ago. This relentless pain in my hip and groin? Deep Deep pain in my leg? Those sudden jolts out of nowhere in my back that no doctor could explain. I was actually starting to buy into the, "it's all in your head" theory...Well not really, but If not for the constant cheering from a dear friend, I can say I was getting close to giving up! I am happy to finally be getting some answers. Now I just need to be prepared for how to handle them!
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  • It's not in your head!! I have been told that by a Dr before and I actually had meningitis!If a Dr ever tells you that then I would suggest to move on!! We know our bodies. I'm not sure were you are from and I know we are not suppose to name the Dr on the sight. It you want to private message me I can tell you were I'm from and where I go. It's a great Orthopedic Hospital rated #1 in the country. I live on the east Coast.

    Just so you know all the symptoms you mentioned is what I was experiencing...I really hope you find answers soon!!

  • First off, *HUGZ* So sorry this is happening. I am glad you stuck to your guns and am finding out what is going on! As you know, my surgeries have been cervical and arm/hand. My fusion isn't working, still have a cracked vertebra, and looking at more surgery plus two more levels total (for now grr).

    When I see things like this, my heart goes sooo out to you. I can't give you much advice for the back, as mine are cervical...but to say stick with it, and find the best surgeon and team you can get! I will keep you in my thoughts, and send you positive energy to face the as yet unknown answers to come! *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hi Frog,
    Sorry to hear from your problems, but remember your not the only one.
    I have also pseudo-arthosis (non-fusion) at L4L5. L5S1 is also fused and this level there is a steady fusion developed, luckely. So it not my body. Do you have fusion at L5S1 alwell. The reason of mine non-fusion at L4L5 is the surgeon have used a to big cage/block between the vertebrae's so gap to create the bone bridge is to big. And a another problem is also that when L5S1 is also fused there will be more bending at the level L4L5, so there will be always micromovement there till the bone bridge is created. My symtoms are: when I have pain, its a deep pain, sort of painfull pressure in the middle of my spine at L4L5; I can point the spot. There are days or hours of no hardly pain, but when I move to much, more then laying on my back, its creates a pain breakthrough (level 8 to 10). I have also radical pain, tintling, arching, to my left butt, backside upperleg, outerside underleg and foot. But the hardest to handle is the deep painly pressure in the middle of the spine. Especially sitting (max 3 min.)will often create this pain. I have already had a revision; 2 screws were loose and between the cage/block and the vetrebrae bone was a cap of mm's. Also the bone which was laid on the facetjoints was totally degenerated and loose. The surgeon has replaced the screws by thicker ones and laid new bone to facetjoint to create a bone bridge.
    But now one year later I have still the same problem, probably because the cage/block is not yet grown fix (non-fusion). But the surgeon could not fix this because there was no space enough to do something there. Now I have to wait and hope. But it is very hard to handle.
    Are your symtoms simular which I have describled? When you see your doctor ask him to only to revise the posterior hardware, but also what I is planning to do with the cage between the vertebrae's. This is the most important.
    Take care. Renos
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  • Brenda,

    Thanks for the kind words and the HUGZ! Right back at ya! It helps you know. It really does! We’ll see where it goes from here. All I can do is pray that God leads me to the best Surgeon and that he has given him the talents he needs to handle the task at hand. Now there is a tough one for me!

    I know you said you couldn’t give much advice….Lumbar or Cervical? Yeah there are some technical differences but in the end don’t you think it’s a “Been there done that?” It’s all just a mess. We just start crumbling. At least that is the way I feel. LOL!

    Seriously, you keep your chin up too! (You do realize that’s a figure of speech cause with neck problems like yours you have no choice.) Thanks for the support!


    Thanks for the advice. I did not have a fusion at L5-S1. According to the report, all 4 screws are loose as well as the non union area around the cage. It does say the posterolateral area is fused.

    The back pain I experience is mostly just sharp pain usually for no apparent reason. A sudden movement or bending will bring on sharp intense or stabbing pains that I can exactly put my finger on. I can hear a “thunk” in there. Sounds silly I know. The doctors always dismiss it when I bring it up or tell me the thunks are normal. Pops and cracks may be normal, thunks to me, are not. Of course, these are the pains that wake you each time you move in the middle of the night.

    The deep pain is felt in my right leg in my hip, groin saddle area and down the leg into the foot and occasionally on the left leg. It is usually brought on by movement and activity. I can get some relief by lying down and using ice or heat but once it gets flared up… I have a hard time distinguishing between the deep pain and nerve pain. Sometimes I can tell them apart. Sometimes I just can’t. As I said before, I am not convinced how much is related to the loose hardware and non union by the cage and how much is related to problems now at other levels.

    Thanks again for the responses! Now I wouldn’t wish my problems on anyone but confirmation helps and it has helped to read that I am not the only one that has had a problem getting surgeons to admit there is an issue. I have received a few PM’s as well I thank those who chose to reply that way!

  • FROG,

    I have lumbar issues, but no surgery down there (yet) hence the "no advice." I do know that the pain can be something else! (Yeah, I've been bad - overdid..paying the Piper!) Crumbling, grrr.... Nodding, been there, done that...whoops, still doing that! It is a slippery road FROG, but I will keep my fingers crossed for you that all will turn out well! Yeah I know, I'm an optimist!! Warm and supportive *HUGZ* as always!!! :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • just some thoughts... im wondering what causes the screws to loosen

    my understanding is the surgeon should use the appropriate width/length for the individuals anatomy/vertebra/problem

    and correct placement

    why do they become loose? think ill add this to my questions for my NS

    Frog im so sorry you are going through this

    i hope you get some good info from your surgeon
    and that your surgeon can help you 'handle" to process it all
    coming to terms with this stuff is difficult

    take care and good luck and hugs
  • What causes them to loosen indeed!

    Maybe the lack of fusion? You know I really don't know.

    What happens to the rods when the screws are loosening?

    If I could reach maybe I could just reach back there with a screwdriver and tighten those bad boys up!

    Thanks Flower,
    If I find out anything first I'll let you know.

  • Explanation why screws loose. The screws are temporary, just to keep it with each other. Its like broken leg, you can have a gypsum brace or a construction with screws and rods. For torso its a bit difficult to fix it with gypsum, but this is done in the past at fusions of the spine. So when the fusion is ocurred, and the vertebrae's are grown together, there is no micro-movement anymore at the screws and have no function anymore. There is also no force on the screws which can loose them. Its like a screw in plasterboard; when there is a variable load on, it will make the hole of the screw wear out. So the problem is that the vertebra's will not fuse. This can be cause by to much (micro) movement so its hard to create a bonebridge. And by nature there is always bending on the spine due to sitting and bending the torso. If the spine is already a bit stiff, the movement of the bending will also occur at the fixed level which not fused already. My Neurosurgeon have for that adviced my not bending, not rotating, not sitting. Only laying and walking. But whem sitting is inevitable, your butt have to be higher then your knees, so the angle of the torso and the upperlegs is as big as possible.
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