the Risks of Spinal Plate Screw Loosening After Surgery

Regarding the patient who previously raised issue 166164, concerning the problem of cervical vertebral plate screw loosening?

Hello Director Chen, I am the patient who previously raised the issue of 166164.
It seems there may have been a misunderstanding regarding my question.
I would like to ask about the comparison between using two screws versus four screws for the vertebral body augmentation plate.
Specifically, I am concerned about whether the likelihood of screw or plate loosening is higher in the future, such as five or ten years down the line, and if that would increase the chances of needing another surgery.
I will definitely wear a cervical collar for three months post-surgery, but I feel that my plate is secured too simply.
I am worried that activities like running or hiking might cause vibrations that could lead to loosening of the plate or screws.
Thank you for your clarification, Director.

Lin Jie Shen, 40~49 year old female. Ask Date: 2021/03/12

Dr. Chen Bochen reply Orthopedics

There are many factors that influence the risk of loosening, including whether there is a combined bone fusion or other fixation methods.
Medical decisions are made based on a comprehensive assessment, and it is not appropriate to compare the risk of loosening solely based on the number of screws.
Ultimately, the surgeon who performs the procedure will have the best understanding of the likelihood of loosening.

Reply Date: 2021/03/12

More Info

Understanding the risks associated with spinal surgery, particularly regarding the loosening of screws and plates, is crucial for patients who have undergone procedures like spinal fusion or decompression. Your concerns about the number of screws used in your surgery and their long-term stability are valid and merit a detailed discussion.

When it comes to spinal surgeries, the fixation devices, such as screws and plates, play a critical role in stabilizing the spine during the healing process. The number of screws used can indeed influence the stability of the construct. Generally, more screws provide better stability, which can potentially reduce the risk of loosening over time. However, the risk of screw or plate loosening is multifactorial and does not solely depend on the number of screws used.

Factors that can contribute to screw or plate loosening include:
1. Bone Quality: Osteoporosis or poor bone quality can lead to inadequate fixation, increasing the risk of loosening. In patients with compromised bone density, the screws may not anchor as effectively.

2. Mechanical Stress: Activities that place excessive stress on the spine, such as running or heavy lifting, can contribute to loosening. The forces exerted on the spine during these activities can lead to micro-movements at the surgical site, potentially causing the screws to loosen over time.

3. Surgical Technique: The skill and technique of the surgeon during the procedure can also impact the stability of the fixation. Proper placement and torque of the screws are essential for optimal stability.

4. Postoperative Care: Adhering to postoperative guidelines, including wearing a cervical collar if advised, can help minimize movement and stress on the surgical site during the critical healing phase.

Regarding your specific question about the likelihood of screw or plate loosening over five or ten years, studies suggest that the risk of hardware failure can increase over time, particularly if the patient engages in high-impact activities. However, the exact risk can vary widely among individuals based on the factors mentioned above.

If loosening does occur, it may necessitate further surgical intervention to correct the issue. This could involve either reinforcing the existing hardware or, in some cases, removing and replacing it. The need for additional surgery can be influenced by symptoms such as pain, instability, or neurological deficits.

To mitigate your concerns about future activities like running or hiking, it is advisable to discuss your specific case with your surgeon. They can provide personalized recommendations based on your surgical outcome, bone quality, and overall health. Engaging in low-impact activities and gradually increasing your activity level under medical guidance can help you maintain spinal health while minimizing the risk of complications.

In summary, while the number of screws used in your spinal surgery can influence the risk of loosening, it is just one of many factors. Maintaining good bone health, following postoperative care instructions, and engaging in appropriate physical activities are essential steps in ensuring the longevity of your surgical outcome. Always feel free to voice your concerns with your healthcare provider, as they can offer the most tailored advice for your situation.

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