Hollow Formation Around Spinal Surgery Screws: Causes and Solutions

Cavity formation around the screws after spinal surgery?

Hello, my mother is 70 years old, with a medium build, measuring 160 cm and weighing 85 kg.
Since middle age, she has undergone three spinal surgeries, from the 2nd/3rd vertebrae to the 3rd/4th vertebrae.
Last year, the 4th/5th vertebrae became dislocated, and she underwent surgery in September.
Metal fixation rods were inserted between the dislocated 4th and 5th vertebrae, and screws were used for additional support.
Since the surgery, my mother has consistently reported ongoing soreness, and recently, the pain has become so severe that she is unable to lie down or get up from bed, as these movements cause her significant pain.
After being admitted for a CT scan, the doctor determined that there are voids around the screws, which may be causing them to pull on or irritate nearby nerves and blood vessels, resulting in pain.
I have the following questions for you:
1.
I compared the post-operative X-rays with the current ones (6 months post-surgery) and noticed that there is indeed a shadow around the ends of the screws in the current X-ray.
What conditions could cause this phenomenon, and how can it be avoided in the future?
2.
The doctor provided us with two recommendations: the first is to remove the screws, which would eliminate the irritation and pain, but there are concerns regarding her family history; the second is to inject bone cement and then place two additional screws below for support.
Could you please assist in analyzing these options? Thank you.

Una, 30~39 year old female. Ask Date: 2017/02/13

Dr. Shi Guozheng reply Orthopedics

Based on your description, it seems that the bone at the site of the bone screw has become loose, which is why the screw cannot be securely fixed.
Both methods can be considered, but you must discuss with your attending physician to decide which one to pursue.

Reply Date: 2017/02/13

More Info

Hello Una,
Thank you for sharing your mother's medical history and the current concerns regarding her spinal surgery. It sounds like she has been through a lot, and I appreciate the detailed information you've provided. Let's address your questions regarding the hollow formation around the spinal surgery screws and the potential solutions.

1. Understanding the Hollow Formation Around Screws: The presence of a hollow or dark area around the screws on X-ray or CT scans can indicate several issues. This phenomenon is often referred to as "radiolucency" and can be caused by a few factors:
- Bone Resorption: After surgery, the body may react to the foreign material (the screws) by resorbing some of the bone around the screws. This can lead to a lack of bone density in that area, creating a hollow appearance on imaging studies.

- Infection: Although less common, an infection can lead to bone loss around the screws, resulting in similar radiolucent areas. This would typically be accompanied by other symptoms such as fever, increased pain, or swelling.

- Mechanical Stress: If the screws are not properly anchored or if there is excessive movement at the surgical site, it can lead to stress shielding, where the bone does not receive adequate load and subsequently weakens.

To avoid this situation in the future, it is crucial to ensure proper surgical technique, adequate bone quality, and appropriate post-operative care. Regular follow-ups with imaging can help monitor the integrity of the fixation and the surrounding bone.

2. Options for Management: The two options your doctor has suggested are valid approaches to address the pain and the hollow formation around the screws:
- Removing the Screws: This option can alleviate pain if the screws are indeed causing irritation to the surrounding nerves or blood vessels. However, it is essential to consider the stability of the spine after the removal. If the screws are providing necessary support, their removal could lead to instability, which might require additional surgical intervention.

- Injecting Bone Cement: This procedure, often referred to as vertebroplasty or kyphoplasty, involves injecting bone cement into the hollow area to stabilize the bone and provide support. This can help alleviate pain and improve function. Additionally, placing more screws can enhance stability, especially if the existing fixation is compromised.

In deciding between these options, it is crucial to weigh the risks and benefits. If your mother is experiencing significant pain that affects her quality of life, addressing the issue promptly is essential. Consulting with a spine specialist who can review her imaging studies and provide a tailored recommendation based on her specific situation is advisable.

Furthermore, physical therapy and rehabilitation can play a significant role in recovery and pain management. Engaging in a structured rehabilitation program can help strengthen the surrounding muscles, improve mobility, and potentially reduce pain.

In conclusion, the hollow formation around the screws is a concern that warrants careful evaluation and management. Both options presented by your doctor have their merits, and the best course of action will depend on your mother's overall health, the stability of her spine, and her pain levels. Regular follow-ups and open communication with her healthcare team will be vital in navigating her recovery journey.

Wishing your mother a smooth recovery and relief from her pain. Please feel free to reach out if you have further questions or need more information.

Best regards.

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