Broken Surgical Screw in the Spine

What Do You Do?

Question: I have rods and screws in my lower back from a spine surgery three years ago. We just found out that one of the screws is broken. Should I be alarmed about this? The fusion has successfully healed, and I'm not having any pain, but do I need to get the rods and screws removed?
— Seattle, WA
orthopedic surgery implant plate and screwsAnswer: You can better understand what's going on in your back if you think of a construction project—specifically a road paving project.

Have you ever seen a road crew just getting ready to pour the concrete? There are a lot of steel bars and wires on the roadbed already, creating a mold for the concrete. The steel bars and wires are carefully placed to strengthen the road once the concrete sets. All those steel parts are held in place by the concrete. The bars and wires won't be taken out, and if part of a bar breaks, it won't really cause any damage.

The rods and screws in your low back are kind of like the "hardware" in a road. As your spinal fusion heals, the rods and screws are there to stabilize your spine. Once you have full fusion—meaning the vertebrae have healed and are stabilizing the spine—the rods and screws are enmeshed in the "concrete" of your bones, muscles, tendons, and ligaments.

Therefore, a broken screw won't move very much in your spine, so if it's not causing you issues now (you don't have any pain, so it sounds like it isn't), the screw isn't likely to be a problem later on.

If, however, the broken screw was pressing on a nerve or obstructing the spinal canal, surgery to remove the instrumentation would be considered. In that case, just the broken screw—the part that's pressing on your nerve or obstructing the spinal canal—would be taken out; the other rods and screws would be left in because they're not causing problems.