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Another broken screw! What are my options??

I will try my best to make a long story short. PLEASE PLEASE any help or insight whatsoever is so helpful. I am freaking out right now.

Car accident a few years ago, lots of treatment, finally last resort of surgery. Neck fusion March 2015, healed great. Back fusion, ALIF, L4-S1 done March 2015. 6 months later, discovered 2 broken screws. I was put on immediate bedrest when this was discovered (risk of spinal cord injury), and they did a revision PLIF, with huge rods and bone grafts on each side of my spine, in October 2015. I have had trouble healing since. Very limited bone growth, continued pain....they were thinking that my SI joints were screwed up and determined I needed 2 SI joint fusions as well. I have had one rhizotomy done so far to help with pain. I was doing relatively well with my recovery, UNTIL THIS WEEKEND. Out of nowhere, I was in excrutiating pain, like the intensity of a Charlie horse - I cannot even shift my weight in bed without screaming and crying. Steroids, pain meds, a joke - not touching it. Went in yesterday and discovered that now ANOTHER screw - a huge one at S1 area, is broken. I have to get an MRI today and discuss options with surgeon on Thursday. I am beyond upset. I don't know if I have the strength to do this all over again.

Questions:
1) Is my only option surgery? What will they do? ANOTHER PLIF revision?
2) Why in the hell are these screws breaking so much??? I am 150lbs, normally healthy female, non-smoker. Is the hardware faulty? Is my surgeon an idiot? He told me there was a less than 1% chance of what happening to me the 1st go round happening, and 0% chance of it happening with this new crazy big and strong hardware. Well, here I am.
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Comments

  • MagistraMarlaMMagistraMarla San Antonio, TexasPosts: 217
    See my long post in your other thread.
    I was also told by my first surgeon that 96% of his surgeries are successful.  I'm now staying as far away from him as possible!
  • hvillshhvills Suzhou, ChinaPosts: 971

    Dear Therapistunveiled...

    If you are not fused then the screws are taking stresses and loads that they were not designed to do.    The screws are only designed to hold things together in your back until you fuse... typically 6-9 months... if the screws have to continue to take the loads of your spine longer than that... they will likely break in time.   

    I had to have a second PLIF since one of my joints (L5-S1) didn't fuse... and at 18 months one of the screws at that level broke.  Not much fun... but there was no other option for me as the L5-S1 joint was very unstable.

    If I was in your shoes I would try to seek out another surgeon or at least another opinion.  A failed fusion once is excusable... but a second failed fusion says that something more is going on that is not being addressed.  Do you take NSAIDS for any reason?

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
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  • Hi Harry, yeah, I was showing no bone growth, or very limited. But my surgeon HAD told me that the hardware he put in this time was so sturdy that I wouldn't break and it should be sufficient to hold me. Clearly not. Revision surgery only option from here? I am going to look into a 2nd opinion for sure, even though my surgeon is one of the top docs in the area, I don't get it. I am so upset.


    Oh and the first time around I did take NSAIDs. I was pissed as it was prescribed from that office. Different doc - but still, you would think they would have told me not to take them regularly instead of prescribe 2 naproxen a day! I didn't understand it all the first time around and blamed myself so much for the NSAIDs, and working out too much as I was running and going hard with physical therapy - I thought I was fine, as my restrictions were lifted! But this time around - omg no. I was the perfect patient. I was in pain from the beginning and kind of knew in my heart something was wrong. So I was VERY VERY cautious and did everything right! This doesn't make sense!!!
  • MagistraMarlaMMagistraMarla San Antonio, TexasPosts: 217
    You sound so much like me with my first surgery.  I was sent home from the hospital with a prescription for Ibuprophen 800, three times a day.  I had read about NSAIDS here, so I stuck with Tylenol.  At the six month check-up, when I was complaining of worsening pain, the surgeon was upset at me for not taking the Ibuprophen, so I did.  When I had knee surgery, my knee was terribly slow to heal, so I think that the six month point was exactly the wrong time to take them - probably really messed up my body's slow healing.
    I was in PT at six weeks and water aerobics at eight weeks.  He also lifted all restrictions at the three month point, and like you, I was going hard at the PT and water aerobics.
    My new surgeon says NO NSAIDS for as much as a year, perhaps more, for me.  He also allows only walking for the first 12 weeks before he will prescribe PT.  I love my physical therapist, and I love the pool, but I'll be a good girl and just walk.  My husband has promised to take FMLA this time to help me to walk, and my friends are planning to come by to take me for walks, too.
    I really do wish that the surgeons would be consistent about taking NSAIDS.  Here in Texas, I've figured out that the philosophy about them depends upon which of the big medical schools the doctors took their training.  I recently talked to and rejected a pain management doctor who was trained in the same school as my first surgeon.  She snorted at the idea of not taking NSAIDS after a fusion surgery, saying that it made no difference after the first two weeks.
    My new surgeon was trained at the other big medical school in the state, and he is of the opinion that they definitely can have a detrimental effect on fusion.  The doc who does my spinal injections happens to have been trained at the same school as my current surgeon, and he also warned me about taking them. 
    How are we, as patients, supposed to be able to evaluate the philosophies of competing medical schools and know what is right for us? 
  • hvillshhvills Suzhou, ChinaPosts: 971
    edited 09/30/2016 - 3:58 AM

    Dear Therapistunveiled...

    At this point a fusion revision is likely your only option... but let your doctor confirm that and for sure and definitely get a second opinion.   If you do get the fusion revision the things you can do to help the bone fusion process are to have your surgeon use your own bone matter (typically from your hip) versus the bone matter from someone else. The second is to have your surgeon use BMP at the time of surgery as this will help promote your bone growth.  It can also be helpful to use a bone growth stimulator during your recovery.  Finally stay away from the NSAIDS... despite the fact that some doctors talk it down... there is just too much evidence that shows they inhibit bone growth... it's better to be safe than sorry.

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
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