Spinal Fixation Screw Breakage: Challenges and Solutions

Q: Spinal Fixation Screw Breakage: Challenges and Solutions

Hello： According to what you mentioned, L5-S1 spondylolysis has led to spondylolisthesis... <br>Upon follow-up, it was found that both screws at S1 have broken in half... <br>We will wait for the bone fusion to complete before determining the next steps... <br>However, I do not h

Lumbar spine fixation device fracture?

Hello Dr.
Lai, last year I experienced a vertebral slip due to L5-S1 spondylolysis, which caused nerve compression and resulted in numbness and tingling in my right lower extremity.
After undergoing my first decompression and fixation surgery in June, I noticed unusual sounds at the fixation site two weeks later.
Upon returning for imaging, it was discovered that the fixation screws had become loose, leading to a second surgery in July.
I initially thought I could relax and wait for recovery, but by the end of September, I began to feel impacts from the screws again.
In early October, I experienced a twisting sensation, and upon returning for a follow-up, it was found that two screws at S1 had fractured.
After discussing with my attending physician, we decided not to intervene for the time being but to be cautious in my movements and wait for bone fusion to complete before determining the next steps.
As of today, while there is some protrusion at the bone graft site, I do not have any neurological symptoms.
However, as I am not yet middle-aged, I hope to maintain an active lifestyle, but the broken screws make me hesitant to exercise.
I have sought assistance from physical therapists but am reluctant to proceed with further treatment (manual therapy).
After consulting multiple physicians, I have only received ambiguous responses, and no one can provide a definitive answer on whether I can start exercising in my current condition or if I should simply remove the screws.
My family is also concerned about my situation and disagrees with continuing treatment from the same attending physician.
I am unsure how to navigate this dilemma and would appreciate any guidance you could offer.
Thank you!

Penny, 30~39 year old female. Ask Date: 2016/01/12

Dr. Lai Zhaokang reply Neurosurgery

Hello: According to what you mentioned, L5-S1 spondylolysis has led to spondylolisthesis...
Upon follow-up, it was found that both screws at S1 have broken in half...
We will wait for the bone fusion to complete before determining the next steps...
However, I do not have any neurological symptoms...
I haven't seen your imaging, but if you have an interbody fusion cage and the imaging confirms that fusion has occurred, the screws can actually be removed.
However, it is still important to monitor the imaging to ensure fusion has taken place.
This is the key point.
Wishing you a speedy recovery.
Director of Spine Neurosurgery, Changhua Hospital, Dr.
Lai Chao-Kang.

Reply Date: 2016/01/12

More Info

Understanding spinal fixation screw breakage is a complex issue that involves multiple factors, including the nature of the spinal condition, the surgical technique used, and the patient's individual healing process. In your case, you have experienced a series of complications following surgery for L5-S1 spondylolisthesis, including screw breakage and concerns about your ability to engage in physical activity. Here’s a comprehensive overview of the challenges associated with spinal fixation screw breakage and potential solutions.

Challenges of Spinal Fixation Screw Breakage
1. Mechanical Failure: The primary challenge with spinal fixation screws is mechanical failure, which can occur due to various reasons such as inadequate bone quality, improper screw placement, or excessive load on the fixation system. In your case, the screws broke after the initial surgery, which may indicate that the fixation was not stable enough to handle the stresses placed upon it.

2. Bone Healing: The success of spinal fusion surgery largely depends on the ability of the bone to heal and fuse properly. If the bone does not heal adequately, the screws may not have the necessary support, leading to breakage. This is particularly concerning in younger patients or those with active lifestyles, as the demands placed on the spine can exceed the stability provided by the screws.

3. Patient Activity Level: After surgery, patients are often eager to return to normal activities. However, engaging in high-impact or strenuous activities too soon can jeopardize the healing process and increase the risk of complications, including screw breakage.

4. Psychological Factors: The fear of re-injury or exacerbating the condition can lead to anxiety and reluctance to engage in physical activity. This psychological barrier can hinder recovery and overall quality of life.

Solutions and Recommendations
1. Close Monitoring: Given your history of screw breakage, it is crucial to have regular follow-ups with your orthopedic surgeon or a spine specialist. Imaging studies, such as X-rays or MRIs, can help assess the status of the screws and the healing process of the bone.

2. Activity Modification: While it is understandable to want to return to an active lifestyle, it is essential to modify activities to avoid excessive strain on the spine. Low-impact exercises, such as swimming or cycling, may be more suitable during the recovery phase. Consulting with a physical therapist who specializes in spinal rehabilitation can provide tailored exercise programs that promote healing while minimizing risk.

3. Consideration of Revision Surgery: If the screws continue to pose a problem or if there is significant concern about the stability of your spine, discussing the possibility of revision surgery with a different surgeon may be beneficial. This could involve removing the broken screws and potentially using alternative fixation methods or techniques that may offer better stability.

4. Bone Health Optimization: Ensuring optimal bone health is critical for successful healing. This includes maintaining adequate nutrition, particularly calcium and vitamin D intake, and possibly engaging in weight-bearing exercises as tolerated. Discussing bone health with your healthcare provider can help identify any underlying issues that may affect healing.

5. Psychological Support: Addressing the psychological aspects of recovery is equally important. Engaging in counseling or support groups can help manage anxiety related to physical activity and recovery.

6. Second Opinion: If you feel uncertain about the advice you have received, seeking a second opinion from another spine specialist can provide additional insights and options for your treatment plan.

Conclusion
Navigating the complexities of spinal fixation screw breakage requires a multifaceted approach that addresses both the physical and psychological aspects of recovery. It is essential to maintain open communication with your healthcare providers, adhere to recommended activity modifications, and consider all available options for managing your condition. Your desire to return to an active lifestyle is valid, and with careful planning and support, it may be achievable while ensuring your safety and well-being.

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