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Help!! L5-S1 pedicule screw fusion op. now one of the screws have broken

From: ltk20pink - on 07/25/2011 11:14pm

Never written on anything like this before so please excuse!

I Had spinal surgery in Sept 2009 to fuse L5-S1 with pedicule screw. " rods and 4 screws were inserted. I had the op due to Siacatic pain for 18 months previous. The op was a success and my pain down my left leg was completely gone.

However, 12 months ago I started to experience terrible back pain (pain was right at the bottom of my spine and I can only describe it as after walking, standing so long it felt like "my back was going to break with the pain!"

My surgeon has x rayed and one of the pedicule screws has now completely snapped. His recommendation is to replace the screws via another op, but this time using bone from my hip. He will after 6 months re examine it and if the screws are holding then fine, if not then he is suggesting another op to go through the abdom0n and place a cage in??)

Anyway, its the pain that I am currently experiencing that is the problem. I can now only stand/walk for 15 mins then having to sit down to relieve the pain. I now have to lie on my back at lunch time to "give it a rest". If i dont follow this then i am constantly in agony. Medication is 10mg Oxycotin twice a day and am currently taking 400mg ibrofen 3 times (as this seems to help a little) I am trying not to take any more oxycotin so that if the pain is relieved then i wont do too much to put pressure on the 3 remaining screws.

My question is to anybody that has had the same symptoms, operations etc I would appreciate how successful the 2nd op was and was the pain as bad as I am feeling, or kust your experience (so I dont feel like the only one!)

Secondly is there anything else that i can do to be mobile, or take prescriptions to aid in the pain relief.

I Am currently not sleeping and sitting here at 04.10 am!

ps Apologies if this post is too long winded!

Thank you xx

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23 Responses

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on 07/25/2011 11:53pm

Sorry to hear ur in pain. I'm going to have surgery in sept. I'm gonna have a fusion at levels l4-l5 and l5- s1. My surgeon is going thru my abdomen, but he may have to flip me on my back and put screws in only if he feels that the bones are to wobbly or unstable. My question for u is why did the screw break. Was is due to surgeon error or a hardware malfunction. Do u know if this is something that happens often? What were ur screws made out of? Please post how u r, and I will follow up on ur post! Good luck and feel better.

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on 07/26/2011 7:19am

Hi Wendy, Thank you for your response. Firstly, its uncommon for the screw to break and personally I think the surgeon underestimated the amount of slippage and therefore the screws can only take so much friction. Obviously I have had a lot of friction so therefore the screw broke!! They are going to use my own bone this next time for grafting.

The operation can be either through the abdomen or via the back I think it depends on your surgeon and also your symptoms. I only had 2 bones to fuse whereas you have 2 sets.

What sort of medication are you on? Does it help with the pain? This is the thing I am more concerned about just to get through the day without having to up my medication.

I was completly satisfied with the operation first time round and would recommend to anyone I just think i was unlucky for the screw to break. After the op you will be sore for a couple of weeks but each day there is improvement and you will get through it!! The operation Did get rid of the pain its just that with the screw fracturing then breaking its caused be the a different type of back pain.

I hope that you are ok and the operation is nothing to worry about, you just need to focus on the "No pain" being the end result. I will answer any questions you have, to help you.

Thank you for getting back to me its nice to know I am not the only one and researching on the computer didnt give me any answers so hopefully this will.

Kind Regards

Lisa

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on 07/26/2011 8:00pm

Dear ltk20pink
The symptoms you are describing are very common and often associated with a failed fusion.
If you recall, the pedicle screws are placed to stabilize the spine while the healing process occurs. If healing does not occur properly, the screws will often break due to repetitive bending stress.
If a 2009 fusion hasnt healed yet, do not wait any longer to seek treatment. Fusion is well on its way by 6 months post op, and essentially will not heal much more after 1 year. Hip bone grafting is associated with chronic incisional pain in one-third of patients. Look for an ALIF (anterior surgery) to repair this problem.
Good luck,
BRS

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on 07/26/2011 10:56pm

My neurosurgeon stated I could have my hardware taken out and I have a three level fusion, L-4, L-5, S-1 and felt great when had it done except I had an auto accident that a guy pulled out in front of me and I jammed on by brake to try and avoid him and was at highway speed.
II tried to tell them I was having different pain and they said my MRI was fine. Well after seven months I went to a myo fascial Physical therapist who measured my legs, hips, and every which way and told me my SI joint was out of alignment and it took us a month to gently get it back in,
I wear a sacral iliac belt to keep in alignment and prevent Sacral Iliac, piriformis syndrome/ and or siatica as when one gets out of line, for me, they all want to act up.
My physical therapist explained that I had hypermobility and I have muscle shearing and severe muscle cramps because of this. She showed me the placement of the piriformis muscle and how the sciatic nerve runs down through there with the Sacral iliac jointhttp://wehelpwhathurts.homestead.com/sacroiliacpain.html is a link that explains it better and gives an illustration. You might find it effective with you sciatic pain.
Needless to say, I have dealt with pain since the auto wreck and started asking for my hardware to be taken out and they stated well, wait until I have an nerve impingement and I don't ever ask for things like this/
I fell last month, of course on my rt butt, and had just gone through trigger point injections had a reaction and I was not up for the pain but I felt I I had to go to the ER because my GP wanted to rule out cauda equin , an emergency condition

I did not have but doc gave me torodol, dilaudid, and phenergan and that was the first time I have been out of pain for six hours in years. This doc says get to neurosurgeon even though MRI looks normal (can't see everything on MRI), PT saw today manipulated my pubic bone, heard it crack, and that groin area feels better but she says the crams and stiffiness down the back of my rt leg and foot swelling, decreased reflexes and weakness, I need to see my neurosurgeon.

My neurosurgeon called me tonight and I could him say, Oh, and Oh and when I told him what my PT stated, he says OH ! Then he says we need to get right in for a myelogram, then right in to see me, YA THINK SO ? GHEEZ, only been over a month and my rt foot is still swollen, my rt leg is stiff, reflexes are weak and muscle weakness.
The point to all this rambling is:
-You know your symptoms. Pain, diagnosied broken screws literally sticking you causing pain, I can't imagine.
-Why is he saying use bone from your hip THIS time (What did he use the FIRST time)
-Why is he going to put another screw in, if you are fused, you should not need it
I belong to another pain group and one girl had her hardware removed to include screws and no problems. The inserts for these rods and instrumentation actually say they are for temporary use.
(Type in Hardware removal on this website and previous thread has over 36 responses.

Another member just had screws that had worked their way out and the doctor told her, we will leave them out just clean up in there and the arthritis and bone growth will fuse you and it did.i

-Bone Growth Stimulators : Check out the Patients Guide to Bone Growth Stimulators on Spine Universe , Bone grafts (I don't know what kind you had in your first surgery.

-I have been told I have a failed fusion, then no, it's just medially not fused, when in fact you can't tell if a fusion is fused unless you are opened up and this is from a Nuero Radiologist and Radiologist (I am a Nurse and X-ray Technician). The white shadows that Doctors point their fingers at, does not represent fused all the way thru and this is true, It is now the consensus I am fused thru and thru and if not, I will just create some friction in there and try a bone stimulator to stimulate growth.

I hope that your surgery goes better and there is no harm in getting a second opinion. If your Doctor is an Orthopedic Surgeon, you might want to see what a spinal neurosurgeon says.

I am sorry for being long winded and so opinionated, I am not a Doctor and you need to do what is best for you but gave my experiences and I know you must be in pain as I am in pain every day 24/7 and this time the pain is injury pain and I want something done.

You certainly need to have something done as that can cause infections, nerve impingement and other stuff. I don't know how you do it.

Be sure to do good nutrition, vitamins plus the Vitamin D and C for healing. Might want to ask your doctor about the amount of Motrin as it states on the bottle,med insert : effects healing and I quit taking mine six weeks before surgeries I had, just a thought. I wish you well with your surgery and I will having to make a decision soon about mine. GOOD LUCK ! BJ

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on 07/26/2011 11:26pm

Hi Wendy, I wanted to comment to you but don't know how to do this, hope you see it.

This site and Spine Health does a good job explaining Spinal Fusion:
The goal of lumbar fusion surgery is to relieve pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in the spine. This is done by fusing the vertebrae together. The lumbar fusion can be done in the front or the back of the spine.

The article also explains the procedures done through the abdomen only, back only, and both.
Mine was done through the back only and glad it was. I had three BAK cages place in between my vertabraes, with rods and screws (titanum) I had the bone graft from my own hip.

This saved me so I could walk as I was getting where I was bone on bone because of herniated discs.Just mentality prepare yourself and do everything you can to enhance your surgery, Nutrition, no NSAIDS etc. I hope the best for you and a great recovery.

My Doctor would not promise pain relief, just functional stability but I got rid of numbness and leg pain.

I did have muscle cramps and they said this was common as I got to the new position of my spine.
BJ

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on 07/27/2011 3:40am

Thank you all for taking the time to respond, I am very grateful and glad that i dont feel that I am the only one coping with these symptoms!

To: RBS - Neurosurgeon - thank you for your comments and my orthapediac surgeon is doing another fusion and then waiting to see if it holds within first 6 months, if not the he is going to do ALIF (i think thats what it is called) But unfortunately here in the Uk I have a 32 week waiting list for surgery! Oh the joys of being in the UK! Also I have never been offered to see a Neurosurgeon so will ask if it is possible I can have a consult.

To: BJ Thank you for your comments and here isme feeling sorry for myself and you have gone through so much more. I hope that you are soon sorted and your feeling Pain free! Also thank you for your comments and I cant believe that no one has suggested I see a Neurosurgeon - I think this is my next route to go down. Also your advice to wendy was spot on and you obviously done your homework.

I just think that I would be better if I had the new fusion and then the cage via abdomen which they do a week later here. This, hopefully would solve all my issues as it has now been 5 years from starting to suffer with pain as as you all know 24/7 pain is not the nicest! My surgeon did suggest this procedure then changed his mind - he wants to wait but then i have to go through 2 seperate operations in 6 months instead of matter of weeks.

Thank you to you all for your kind help, feeling much better xxx

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on 07/27/2011 11:45am

well i know the meds you are on aren't strong enough.
i take morphine sul 15mg 3 times a day. plus bacfolene 3 times a day. and a nerve med with pain med in it.
my pain started at a level 10 4 months ago.
now i'm down to a steady level 3.
i have asked for help on my page.
and i see you had the surgery.
i see some were that what happened to you could happen.
did you over lift that caused it to break.
and did your doctor put you on a lift restriction after you healed from the surgery.
ray

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on 07/27/2011 1:51pm

well i know the meds you are on aren't strong enough.
i take morphine sul 15mg 3 times a day. plus bacfolene 3 times a day. and a nerve med with pain med in it.
my pain started at a level 10 4 months ago.
now i'm down to a steady level 3.
i have asked for help on my page.
and i see you had the surgery.
i see some were that what happened to you could happen.
did you over lift that caused it to break.
and did your doctor put you on a lift restriction after you healed from the surgery.
ray

Hi Ray

I agree I dont think meds are enough but I am trying to keep pain to min by limiting my daily routing (basically halved it - which is so frustrating) Worried that if i take more meds then i will do more and consequently do more damage because obvioiusly the screws are still taking the strain? I dont know if my point of view is correct but still in a lot of pain so trying to reavaluate.

I am not a surgeon but my point of view is that maybe either there should of been more screws (or bigger ones) as this might of made my spine more stable? I dont recall one particular point where i could of put myself in danger but x rays 6 months apart was the first xray was slight fracture in the screw and the 2nd it was completely broken and at an angle. They are not going to try and take the broken bit out (just the loose top bit!)
I was told to take it easy (in which i thought i had done - but maybe not enough?) and i dont really lift anything that heavy anyway (i am a manager so my job is mainly office/shop floor stuff) and the only other things i lift are general household cleaning duties!!
I dont think it can easily happen and my surgeon has only had 3 breakages before (me being the 3rd).

Are you having the operation? If so I can reassure you that it can be fairly painful recovery for the first few weeks but the instant pain relief from the op encourages you to take things step by step.

Thank you for your reply and am grateful for your comments and if I can be help in any way just let me know.

Lisa xx

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on 07/29/2011 1:26am

sorry to hear your in so much pain.
ray.

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on 07/28/2011 1:31am

forgive my writting i am on meds that make it hard for me to think and consentrate

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on 07/29/2011 2:47am

HI, I have just joined this forum and thought I might be able to help with my experience. My son then nine was diagnoised in 2009 and underwent surgery at Standmore by inserting bone morphogentic bone protien in to his back and pedicule screws basically the same instrumentation as you. Things improved for a while but then six months later the pain returned. I was told by the surgeon that it was sucessful but a CT scan showed that one of the screws had broken with indicated non union. As my relationship with the dr was not good as I felt his had mislead me. I found another fanastic surgeon who in December carried out another operation to remove the BMP which had overgrown and was pressing on my sons spine, he took part of my sons hip and used metal rods. The fusion has been sucessful so far we are six months post op.

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on 07/29/2011 3:43am

Thank you debsben, I feel more confident that the 2nd operation could be a success. They say by using your own bone there is greater chance of fusion, so I am hoping this to be the case! I am so sorry that your young son has had to go through the pain and operations and hope that he is now happy and fine.

Kind Regards

xx

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on 07/29/2011 12:49pm

Oh,my dear!

Would that you had declined the surgery!

I refused it - because I saw the long-term outcome of two pals who had it. Both are currently, up to ten years after surgery, enduring severe arthritis of the spine.

That is ALWAYS the result of fusion.

I live with constant pain, dependant on Co-codamol. Better to be drug-dependant than to end up needing more surgery to try to correct the damage cause first time around......

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on 08/03/2011 5:12pm
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on 08/03/2011 5:12pm
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on 08/03/2011 5:11pm

LTK20PINK

this is ray,
i just came from the surgens office.
he told me i need the sugery do to my L5 being so bad.
he explained it all to me and showed me the hardware he would use.
and that he will bound my L5 to my pelves.
useing my own bone peaces that he will get from opening the disc space to pull the disc out.
and he will open the nerve hole leading to my legs so there is no more pressure on them.
all of the hardware is titanium metal.
do to if they need to do any MRI in the future.
what was the metal peaces made of that they put in your back.
titanium from what i know is to be one of the hardest metals known.
please let me know....................
i asked about removeal of the hardware after i heal.
and he siad it could do more hard then good.
he siad 95% of people leave it in.
and some do remove them.
but do to infections and ect.
i just might leave it in.
but please let me know what yours are made of.
thank you ray.
p.s. scared and at the same hopeful this will help me.

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on 08/09/2011 9:22pm

Hello!!!
I had posterior lumbar inner-body fusion surgery- L4-S1 on Nov.30,2010. Everything was ok until the end of March. I started to feel and hear a creak and feel ALOT of pain.I called my surgeon and went to the E.R. for x rays and the E.R. doc saw what looked like a broken screw. He immobilzed me and sent me to my surgeon,they did a myelogram and said all is fine. So yesterday I went August 8 2011 for xrays and checkup on my fusion and my surgeon said he wants revise the surgery due to both screws in my sacrum being possibly broken. When we looked at x-rays from Feb, April and yesterday and you can clearly see the breaks and difference between Feb and April x rays. Yesterdays are the same as April both look broken. What would any of you do if in April they were broken and they are just now "suspecting broken screws" and want to do surgey AGAIN?

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on 08/10/2011 4:09am

Hi painallover72

This is my problem. Only 1 screw so far has totally snapped after three months of it being fractured. My surgeon is going to re operate and take out the non broken screws and replace with new ones. Then six months later going to re examine then see if i need the cage inserting via anterior. I, like you, also in a lot of pain feel that even though I am taking medication (which doesnt take all pain away) I have to do this operation as I cannot live the rest of my life in this amount of pain. I am hopeful that the new operation will be more of a success. My only worry is that if the screws fracture, then break again - I will have to go through the op a third time and then definately have the cage in??

Let me know what you decide and how you are.

Kind Regards

LTK20pink

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on 08/10/2011 7:19am

Thanks for responding!
The problem I have is I already have cages in each level and this still happened. My surgeon used bone marrow from my pelvis along with the bone he ground off to use in the"cement" he made for fusion gap and I wore the brace and bone stimulator. I am really curious as to why he didnt say this in April and do it then!?? Any how I had my C5-C7 fusion surgey in my neck in July of 09 and I was fused and released in 7 months,but I know the lumbar area is harder to fuse. If I do this I will probably lose my job and home so I dont know which way to go. My pain doc says to definately get a second opinion since my surgeon says yes they are broke then says 2 minutes later he isnt positive but wants to do surgery. Like all of us I cant deal with this much longer but dont want to lose everything just to "see" if they are broken.
THANKS and GOOD LUCK to ALL!!!

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on 08/10/2011 11:45am

I have a broken screw also, but it does not cause me any problems. My main problem is Arachnoiditis. This started after my second surgery. The more surgerys you have the more scar tissue you will get. I suggest you get a second opion from a Dr. specializing in pain mangement and has an MD in physiologist. You can call a Rehab. Hospital to seek the information you will need to find this type of Dr. The work in that type of hospital also in pain clinics and sports medicine. Avoid anaestheiologist pain clinic. Also look up this disease on this web site. See if that might be your main problem. I now take Kadian 60 mg. two times a day and also cymbalta 60mg two times a day. Alos I take antidepressent meds. and sleeping medicine. This is also a part of the pain treatments for any one who has pain over 6 months.

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on 08/11/2011 2:15am

Yes I agree, maybe a 2nd opinion is called for. Its a little worrying that you have the cages in aswell and the screw still have broken? This does nothing for confidence. I am sorry that it is affecting you so badly and I wish you well in your decision. It is really comforting there are other people out there with similar problems and I dont feel so alone in discussing this (I know my family and friends are probably sick of hearing mine! But its been 5 years now with constant pain (except after my operation of about 8 months) I am back to see my doctor this morning regarding trying different medication. I am also not sleeping now - which doesnt help!!)

BEST WISHES TO YOU ALL and if you need to write and put your thoughts on paper then do so, as i think it is helping me.

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on 11/02/2012 9:25am

I have FBSS and getting ready to have an Xray to make sure all my nuts and bolts are the way they should be! I've been experiencing horrible pain, (this pain new to me), for about a week and feel the same as you....it's like I'm being broken in half. The only way I can describe it is it's like that stitch we've all felt in our sides at one time or another while running etc., except that it's to the immediate right of my spine and radiates to my hip and is constant. Only multiply that 'stitch' feeling about 100 times. Just attempting to bend down to pick up or even carry my 5lb Chihuahua is a huge problem. (I know, so don't do it!) I had a triple fusion back in 2009 and as I stated, this type of pain is brand new to me. I do know that the pins can just pop up and break sometimes with failed back surgery syndrome and I'm hoping this isn't what happened, but need to find out why my pain has changed this way and why so suddenly.

All of us that have had back surgery, failed or not, have to be careful from now on not to overdue. I'll be on pain medication the rest of my life unfortunately and constantly have to remind myself there are things I just can't and/or shouldn't do anymore. My biggest problem right now and the reason I'm in such a great deal of pain normally is the amount of fibrosis I have in my L5 and S1 nerve roots. I'm keeping my eyes on the progression of laser surgery because I feel this may be the way to remove fibrosis and keep it from coming back in the future and will keep discussing this with my surgeon. But until then I manage with pain medication and will start water therapy once I can hopefully find out what this new pain is all about.

Good luck to you ltk and to all of us who've had or are going to have back surgery!

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