Post-Surgery Complications: Broken Screws in Spinal Fusion

Postoperative screw fracture after spinal spondylolisthesis surgery?

Hello, doctor.
I previously underwent surgery for spondylolisthesis, during which four steel screws were inserted for stabilization.
Post-surgery, everything seemed normal until six months later when an X-ray revealed that two of the screws had broken.
Since then, I have started to experience the pre-surgery pain again.
The doctor advised me to monitor the healing of the bone, stating that if the bone heals properly, the broken screws would not pose a problem.
A year later, I still felt pain, and upon returning to the doctor, I was informed that the position of the bone had slightly shifted due to the broken screws, but it did not affect the nearby nerves, so there was no need for excessive concern.
The doctor suggested waiting for the bone to heal completely, or else consider another surgery to replace the screws.
I would like to ask the doctor:
1.
I inquired about the materials used, and the doctor mentioned that they were high-quality materials from abroad that I paid for out of pocket.
Is it normal for screws to break after just over six months, or could this indicate a surgical error?
2.
If I undergo a second surgery, will it provide substantial benefits? Will it cause significant harm to my body? The doctor mentioned that another surgery would only increase support, but I am worried that the screws might break again after the surgery.

3.
If there are no nearby nerves, why do I continue to experience pain? Should I continue to monitor the situation to ensure the position does not shift further?
I have many questions, and I appreciate your assistance in answering them.
It has been a year and a half since the surgery, and I am feeling quite anxious.
Thank you.

Xiao Yi, 20~29 year old female. Ask Date: 2020/01/31

Dr. Cai Shanglin reply Orthopedics

1.
No matter how strong the bone screws are, they will eventually break if the bone does not heal.

2.
Whether it helps or not depends on the severity of your symptoms; if the symptoms are unbearable, a second surgery may be necessary.

3.
The term "not touching nearby nerves" refers to the nerves that exit from the spinal foramen; any soreness or pain is likely caused by instability.

Reply Date: 2020/01/31

More Info

Post-surgical complications, particularly after spinal fusion surgery, can be a source of significant concern for patients. In your case, the discovery of broken screws six months post-operation, followed by a return of pain, raises several important questions regarding the integrity of the surgical procedure and the materials used.

1. Material Quality and Failure: It is indeed concerning that screws made from high-quality materials would break within such a short time frame after surgery. While it is possible for any surgical implant to fail due to various factors, including excessive stress, improper placement, or even manufacturing defects, a breakage within six months is not typical. It is essential to consider whether the screws were appropriately sized and positioned during the initial surgery. If the screws were under excessive strain due to misalignment or if the bone did not heal properly, this could lead to premature failure. Discussing these concerns with your surgeon is crucial, as they can provide insights into whether this is a common occurrence with the materials used or if it indicates a potential surgical error.

2. Reoperation Considerations: If your surgeon recommends a second surgery to replace the broken screws, it is essential to weigh the potential benefits against the risks. A second surgery could provide additional support and stability to the spine, especially if the bone has not healed adequately. However, every surgical procedure carries risks, including infection, bleeding, and further complications. Additionally, if the screws were to break again, it could indicate an underlying issue with bone healing or mechanical stress that needs to be addressed. It is advisable to have a thorough discussion with your surgeon about the expected outcomes of a second surgery, the risks involved, and whether there are alternative treatments, such as physical therapy or pain management strategies, that could be explored first.

3. Persistent Pain Without Nerve Involvement: The fact that you are experiencing ongoing pain despite the absence of nerve involvement is not uncommon. Pain after spinal surgery can arise from several sources, including muscle strain, inflammation, or even scar tissue formation around the surgical site. The healing process can also lead to changes in how the body perceives pain, sometimes referred to as "central sensitization." This means that even in the absence of nerve compression, the body may still signal pain due to previous injury or surgery. Continuing to monitor your symptoms and discussing them with your healthcare provider is essential. They may recommend imaging studies or other diagnostic tests to evaluate the healing process and rule out any other complications.

In summary, while the situation you are facing is understandably distressing, it is essential to maintain open communication with your healthcare team. They can provide the most accurate assessments based on your specific circumstances. Regular follow-ups and possibly seeking a second opinion from another spine specialist may also be beneficial in ensuring that you receive the best possible care moving forward. Remember, your health and well-being are paramount, and addressing these concerns proactively can help you achieve a better outcome.

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