Simple technique for removing broken pedicular screw with plain and serviceable screwdriver

Broken lumbar pedicle screw – a short report

Spinal fixation is one of the common surgical procedure performed by spine surgeons. Among the various spinal fixation technique, pedicle screw fixation is of paramount importance especially when instability is in dorsolumbar and sacral region of spine. Like any surgical procedure, pedicle screw fixation is not devoid of complications. Broken pedicle screws are one of the rare complication of this procedure with a great challenge to deal with such situation. We are reporting one of the rare complication of pedicle screw fixation with literature review and our philosophy to deal such complication.

Simple New Screw Insertion Technique without Extraction for Broken Pedicle Screws

OBJECTIVE

Spinal transpedicular screw fixation is widely performed. Broken pedicle screw rates range from 3%-7.1%. Several techniques have been described for extraction of broken pedicle screws. However, most of these techniques require special instruments. We describe a simple, modified technique for management of broken pedicle screws without extraction. No special instruments or drilling in an adjacent pedicle are required.

METHODS

We used a high-speed air drill with a round burr. With C-arm fluoroscopy guidance, the distal fragment of a broken pedicle screw was palpated using free-hand technique through the screw entry hole. A high-speed air drill with a round burr (not a diamond burr) was inserted through the hole. Drilling began slowly and continued until enough space was obtained for new screw insertion. Using this space, we performed new pedicle screw fixation medially alongside the distal fragment of the broken pedicle screw. We performed the insertion with a previously used entry hole and pathway in the pedicle. The same size pedicle screw was used.

RESULTS

Three patients were treated with this modified technique. New screw insertion was successful in all cases after partial drilling of the distal broken pedicle screw fragment. There were no complications, such as screw loosening, dural tears, or root injury.

CONCLUSION

We describe a simple, modified technique for management of broken pedicle screws without extraction. This technique is recommended in patients who require insertion of a new screw.

An innovative universal screw removal instrument

Objective

To present the clinical benefits of an instrument designed to facilitate removal of polyaxial screws during revision surgery.

Methods

All polyaxial screws can be removed without additional materials or a large amount of debridement using our newly designed instrument. Forty-two screws were removed from five patients without any complications using this instrument.

Results

We removed the cap screws and rods from the 42 polyaxial screws in five patients and made them monoaxial using the new screw removal apparatus. The screws and rods were removed quickly in a minimally invasive way with no complications. No damage to the pedicle or surrounding soft tissue occurred during screw removal. No neurogenic changes developed during revision surgery after changing the screws.

Conclusion

This newly designed screw removal instrument was used safely and effectively to remove all polyaxial and monoaxial pedicle screws.

Proposed alternative revision strategy for broken S1 pedicle screw: radiological study, review of the literature, and case reports

BACKGROUND CONTEXT

There have been many reports outlining differing methods for managing a broken S1 screw. To the authors' best knowledge, the technique used in the present study has not been described previously. It involves insertion of a second pedicle screw without removing the broken screw shaft.

STUDY DESIGN

Radiological study, literature review, and two case reports of the surgical technique.

PURPOSE

To report a proposed new surgical technique for management of broken S1 pedicle screws.

METHODS

Computed tomography (CT) scans of 50 patients with a total of 100 S1 pedicles were analyzed. There were 25 male and 25 female patients with an average age of 51 years ranging from 36 to 68 years. The cephalad-caudal length, medial-lateral width, and cross-sectional area of the S1 pedicle were measured and compared with the diameter of a pedicle screw to illustrate the possibility of inserting a second screw in S1 pedicle without removal of the broken screw shaft. Two case reports of the proposed technique are presented.

RESULTS

The left and right S1 pedicle cross-sectional area in female measured 456.00 ± 4.00 and 457.00 ± 3.00 mm(2), respectively. The left and right S1 pedicle cross-section area in male measured 638.00 ± 2.00 and 639.00 ± 1.00 mm(2), respectively. There were statistically significant differences when comparing male and female S1 pedicle length, width, and cross-sectional area (p<.05). At 2-year follow-up, the two case reports of the proposed technique showed resolution of low back pain and radicular pain. Plain radiograph and CT scan showed posterolateral fusion mass and hardware in good position with no evidence of screw loosening.

CONCLUSIONS

The S1 pedicle dimensions measured on CT scan reviewed in the present study showed that it may be anatomically feasible to place a second screw through the S1 pedicle without the removal of the broken screw shaft. This treatment method will reduce the complications associated with other described revision strategies for broken S1 screws.