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Old 06-17-2008, 10:24 PM   #1
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Broken Pedicle Screw - Hardware Removal

Hiya everyone,

I had a fusion T12-L2 12 months ago to stabilise a burst fracture of L1. Things have been going great but today when I went in for my 12 month check up the Neuro tells me that i've broken a screw (Titanium 0, Me 1!!!)

This is probably due to extremely physical lifestyle i've regained post-fusion, I've been stepping up the intesnsity of my yoga and I guess this may have contibuted to the failure of the hardware. As a result he is keen to have it all removed.

The only reason for the fusion was to stabilise my fracture. I think I'm fusing nicely but the surgeon wants to put down some more bone graft with the removal just to be sure.

Given that I want to regain my young fit life as soon as possible (I'm only 22!), what sort of time frame do people expect to recover from hardware removals? Also, will the fusion now be weaker and more prone to breaking because the titanium reinforcements are gone - if i snapped titanium will i just as easily snap the new bone?

I know there are no such thing as definitive answers with back problems, but any opinions would be great,

Cheers,
Dave
__________________
18June 07 - L1 Burst Fracture
08July07 - Spinal Fusion & hemilaminectimy T12-L2
18June08 - Discover broken screw
24June08 - Hardware removal

Last edited by aussiedave3; 06-17-2008 at 10:31 PM.

 
Old 06-18-2008, 03:39 AM   #2
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Re: Broken Pedicle Screw - Hardware Removal

Recovery time for just hardware removal is 6 weeks to a few months, depending on your situation. Mine was imbedded, so my recovery was longer, as it had to be wrenched out, causing quite a bit of trauma to the tissues and nerves.

My question for your doctor would be about putting in more bone graft. Does that mean that you'd need to be extra careful again, no bending, lifting, or twisting for a few months until the graft grows solid bone?

If you already have a solid fusion, the hardware no longer has a job to do. Removing it shouldn't be a problem. You shouldn't be any more likely to snap your bone than you are with the hardware in there. I would be curious to know if there was a defect in the screw. I know hardware can break, but I agree that metal should be strong enough not to snap during yoga or physical activity.

Hopefully some others will chime in who have hardware break and have been through that kind of removal. Mine didn't break, it was protruding. Just the part that was protruding was removed.

I hope this was helpful,
Emily

 
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Old 06-18-2008, 09:08 AM   #3
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Re: Broken Pedicle Screw - Hardware Removal

I ddint find out i had a broken screw until last may and found out then my fusion never healed so i went in March 28 this year and had the 360 surgery they took out all the hardware and refused it and put more hardware. They took out the broken screw but left the part that is in the bone they probably would have had to do the same as they did to emily they just said it would be more trouble to get it out then leave it. I am hopeing they see the fusion soon. We are hopeing it will take doing the 360 this time they did a PLIF last time.

Good luck and wishing you well.

 
Old 06-18-2008, 11:40 AM   #4
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Re: Broken Pedicle Screw - Hardware Removal

Are you totallt fused ? I hope so if the Dr. is removing the hardware and not replacing it.. If you are totally fused your bone would be stronger than the titanium screws back there . I broke a screw during PT. I had everything replaced again . Recovery takes so freakin long .. a few months

He must be adding more protien where the holes will be after he removes the screws ?? Good luck

 
Old 06-18-2008, 04:56 PM   #5
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Re: Broken Pedicle Screw - Hardware Removal

I highly recommend that you have a second opinon before moving ahead with the surgery. You want to make sure you are fused by either CT scan or myleogram to determine whether or not additional hardware needs to be added. It is so important that your fusion has taken completely and is solid before all the hardware is removed. good luck and please keep us posted.

 
Old 06-22-2008, 07:13 AM   #6
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Re: Broken Pedicle Screw - Hardware Removal

Thanks for the replies and well wishes, apologies for not replying sooner, I've have been away for the weekend enjoying stretching pain free for the last time in a few months.

I believe that my fusion is going well, I had CT's the day before my 12 month check up and I'm sure my Neuro would have been cautious to suggest a removal over a replacement if I wasn't fused. I'm a non smoking young fit healthy type so I guess I've given myself the best chance for a good fusion. I'm with the military and he knows that being a young fit soldier I will be putting my back through its paces over the coming years so I have confidence (he is also one of the best in Australia.)

It would seem that the only reason he is putting any more BMP down would be because my back is open and he can strengthen the fusion more so why not. oh, and he did say that they pack the holes left from the removal of the screws (much like gap-filler i guess!).

What sort of restrictions are people placed on post-removal? After fusion I was in a brace for about 4 months but this time he says it's not necessary (fractures are completely healed)
I'm in for surgery on tuesday so wish me luck!
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18June 07 - L1 Burst Fracture
08July07 - Spinal Fusion & hemilaminectimy T12-L2
18June08 - Discover broken screw
24June08 - Hardware removal

 
Old 06-22-2008, 03:17 PM   #7
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Re: Broken Pedicle Screw - Hardware Removal

I had no new restrictions, just the usual resting so I could heal. Being young, fit and healthy will be a big help to you as you recover!

Blessings,
Emily

 
Old 06-22-2008, 03:47 PM   #8
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Re: Broken Pedicle Screw - Hardware Removal

A Broken pedicle screw is a sign of a bigger problem. THe instrumentation used in spine surgery is very strong. When a screw breaks, you have to consider the screw has gone through cycles of motion causing it to break. Imagine taking a wire and bending it back and forth. Over time that wire will break. Make sure, the problem you have isnt whats known as "pseudarthrosis" or "Non-union". It can best be assesed through CT scan Imaging or through direct visualization. If that is the problem, be sure to seek the advice of a surgeon who deals alot with this problem. You may need additional surgery or augmentation of your fusion.

 
Old 06-23-2008, 11:10 AM   #9
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Re: Broken Pedicle Screw - Hardware Removal

Before my second fusion, my surgeon told me that he is planning to remove my hardware from the first fusion. He said that due to not 100% accuracy of MRI or CT, he can't say for sure if I fused or not. Tests showed I did, but he says sometimes they go in and see that tests results were wrong.

Thankfully, I was 100% fused, but if not, he was planning to do another graft and rod /screws to re-fuse old fusion with a new levels. So they do have a way to do in case of sucessful fusion and in case you did not fuse.

Best of luck to you!

 
Old 06-24-2008, 04:48 AM   #10
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Re: Broken Pedicle Screw - Hardware Removal

You are very lucky to be able to serve your country with hardware in your body. I cannot get back in the US Army because of my fusion . They will not allow it here .. My best friend is a recruiter and I ask him If he could get me back in doing an office job and he said no way...Discrimination if you ask me . Good luck with your situation my hero[QUOTE=aussiedave3;3618418]Thanks for the replies and well wishes, apologies for not replying sooner, I've have been away for the weekend enjoying stretching pain free for the last time in a few months.

I believe that my fusion is going well, I had CT's the day before my 12 month check up and I'm sure my Neuro would have been cautious to suggest a removal over a replacement if I wasn't fused. I'm a non smoking young fit healthy type so I guess I've given myself the best chance for a good fusion. I'm with the military and he knows that being a young fit soldier I will be putting my back through its paces over the coming years so I have confidence (he is also one of the best in Australia.)

It would seem that the only reason he is putting any more BMP down would be because my back is open and he can strengthen the fusion more so why not. oh, and he did say that they pack the holes left from the removal of the screws (much like gap-filler i guess!).

What sort of restrictions are people placed on post-removal? After fusion I was in a brace for about 4 months but this time he says it's not necessary (fractures are completely healed)
I'm in for surgery on tuesday so wish me luck![/QUOTE]

 
Old 06-24-2008, 06:50 PM   #11
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Re: Broken Pedicle Screw - Hardware Removal

It is an honour to be able to srve - I did my initial injury parachuting on the Army's time so here in Australia they are responsible for everything it takes to get me back into shape.

Pre-op I asked how things were and he said the same - that the CT can only show so much and that you get your best indication of fusion after opening me up. I haven't spoken to the surgeon post op yet, but he'll be coming for a chat tonight. The operation notes say that he removed hardware and then gave me a fusion (as he said he would) so I am confident things are going well.

I was up walking a few hours post-op and will only be in here for a day or two, a walk in the park compared to the initial fusion.

Wireless internet rocks, I love that I can sit here and chat with people from all around the world, right from my hospital bed!

Thanks all for the responses, sharing is caring!

Dave
__________________
18June 07 - L1 Burst Fracture
08July07 - Spinal Fusion & hemilaminectimy T12-L2
18June08 - Discover broken screw
24June08 - Hardware removal

 
Old 06-24-2008, 09:01 PM   #12
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Re: Broken Pedicle Screw - Hardware Removal

Dave, how wonderful that things went well for you. I pray that you continue healing well and are home soon.

 
Old 06-25-2008, 05:14 AM   #13
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Re: Broken Pedicle Screw - Hardware Removal

Your not still jumping are you ???? Like I said before here in the US if you have any type of metal in your body your a NO-GO in the Armed forces... Thats amazing they leave you in , and JUMP ? Gosh I would be afraid to crush my spine again.. Keep your head & butt down and keep safe .[QUOTE=aussiedave3;3621683]It is an honour to be able to srve - I did my initial injury parachuting on the Army's time so here in Australia they are responsible for everything it takes to get me back into shape.

Pre-op I asked how things were and he said the same - that the CT can only show so much and that you get your best indication of fusion after opening me up. I haven't spoken to the surgeon post op yet, but he'll be coming for a chat tonight. The operation notes say that he removed hardware and then gave me a fusion (as he said he would) so I am confident things are going well.

I was up walking a few hours post-op and will only be in here for a day or two, a walk in the park compared to the initial fusion.

Wireless internet rocks, I love that I can sit here and chat with people from all around the world, right from my hospital bed!

Thanks all for the responses, sharing is caring!

Dave[/QUOTE]

 
Old 06-25-2008, 11:12 AM   #14
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Re: Broken Pedicle Screw - Hardware Removal

Hi there,
I went through the exact same thing as you. My first surgery was very complicated and including a number of varuous problems. Anyhow long story short...in the end my surgeon put 4 pedicle screws in and 2 rods. I had a fusion done and all sorts of other stuff. Anyhow. After 2 weeks of doing so well and feeling great, the best I had in 2 years, I was also 22 when I had my first surgery. So after getting a routine xray done at the 2 week post op mark. My surgeon was convinced that everything was fine but I kept saying I knwo that something is wrong, everything was great but now I feel like i did pre op as far as pain. After looking at my xrays a number of times he found that one of my screws were broken. My surgeon told me that he would have to take out all the existing hardware, redo the fusion and put in all new hardware. He ended up going in through my back, took out all the hardware (ended up that 2 screws were broken) I knew that though because I could feel the screws grinding and if you put your hand on my back you could actually feel them move! It was a very odd feeling. So he took out the hardware. Then he flipped me over went through my stomach and re did the fusion from the front and put in new hardware. he also had to replace a disc and fix my nerves again cause they were compressed and so on. Now I have a broken disc! The one that was replaced (cadaver bone) broke! I am currently waiting for another surgery.
I also wanted to say that nothing you do, no matter what it is, nothing should break pedicle screws. It is 100% hardware failure. They should last a lifetime. You should be able to do anything and everything that anyone with or without back problems can do. There is a 3% chance of getting hardware failure over a lifetime (because of faulty hardware). It happened to me within 2 weeks of my surgery and for you it happend closer to the 1 year mark. But really, don't be paranoid going forward because nothing you do should affect your hardware. My surgeon was also sure to put in bigger and stronger screws teh second time around. I will have the hardare in for life. He will never take it out. He says it can't harm me and there is just no reason to go in for another spine surgery just to take out hardware. I agree.

I hope I was able to help you a little bit. Please let me know if you have any questions. Take care and good luck.

Beachgirl

 
Old 06-27-2008, 12:28 AM   #15
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Re: Broken Pedicle Screw - Hardware Removal

Most of the time my unit jumps into water, so I am confident that maybe one day I'll be able to do that again, but as for land-jumps, forget it, not worth the risk!

I finally got on to the surgeon, he says there are signs of fusions and a little bit of bone growth, I was hoping for a more enthusiastic response about how solidly it had fused, but its only just on 12 months so hopefully it gets more solid with time. He says he put down more graft, so i'm sure that will help.

Beachgirl, thanks for your kind words. It sucks that they had to come through the front with you... it sounds much more serious than mine. I have had my hardware removed and not replaced, except for the broken piece which they left in my vertebra!

One more thing, my surgeon has given me the option of wearing a brace for 6 weeks? Last time it was mandatory for 12 weeks then part time for a month. He says it is completely optional, what do you guys think I should be going with? I personally hate the way they destroy your core strength and impede breathing/digestion. I am planning to be very careful with it off and only put it on when I'm out in public.

Cheers,
Dave
__________________
18June 07 - L1 Burst Fracture
08July07 - Spinal Fusion & hemilaminectimy T12-L2
18June08 - Discover broken screw
24June08 - Hardware removal

 
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