Loose Screws

[jsewell]

Well on Jan 7th i had surgery #10 in 3 years , 6 of them spine surgeries. i am now fusing from C-4 posterior thru L-2.
Most recently in Sept 2010 I had osteotomy and fusion of T-2 thru L-2 aside from pain and developing psychosis pretty uneventful spine wise.
Fractures discovered in T-3 and T-4 so in for a quick kyphoplasty in Nov.
Then the craziest thing happened , my cervical spine fell off my thoracic spine. So back to the Or on Jan 7th. This was a cervical osteotomy and redu of fusion. From T-5 up to C-4.
First pre op apt and the xray shows the 2 uppermost screws are loose. I see my surgeon next tuesday.
Who has had experience with loose screws when you are not fused and still need them?
Is surgery needed to re do those? Is it dangerous having them in my head and possibly out altogether migrating around?
Any info would be greatly appreciated.
Thanks
judy sewell

[mmglobal]

Judy, I'm so sorry about your situation. I can only imagine the pain from such an operation. Hopefully it will be worth it in the long run. If so, you'll look back and it wont seem so bad.

I have seen revisions with loose screws. They take out the old one and put in a bigger one with better 'purchase'. The original fusion and these types of complex revision surgeries are very difficuly carpentry jobs. There is a huge difference from one carpenter to the next. Some of us will have problems that could not have been avoided by any surgeon, while others may have problems that would have been avoided by a better carpenter. It will be difficult to say which category you fall into unless there are obvious errors, cut corners, compromises, etc....

In any case, the carpentry that needs to be performed must be done on the situation that you'll present. If the stripped screw is a small screw in a large piece of bone (or wood), it's not problem to put in a bigger screw. There is plenty of structure left to support the bigger and stronger screw that has more surface area to hold onto. If there is not enough structure left, the woodworker gets to get another 'blank' and start anew. You don't have a blank to replace the violated bone.

I'd make certain that the surgeon has a great deal of complex revisions. (Hopefully, they are not because HE screws up often and must fix his mistakes!) Unless it's very clear that he could not have done a better job on the original surgery, I'd have a hard time going back to the same surgeon. You wouldn't return to an auto mechanic that had to redo much of his work.

The surgeons who have done a LOT of scoliosis work tend to be good at these surgeries. Fabien Bitan in NY, Serena Hu in SF come to mind. I'm sure that there are many other excellent surgeons around... but do you homework, and don't accepy, "Oh, I've done many." It's more like, "I was the presidend of the pediatric scoliosis society and may practice focused on scoliosis for the first two decades." (Scoliosis surgery is not the only specialty that lends itself to better experience with complex revisions, but it's a great one.)

If any redo surgery must extend the fusion, or if fusion has not occurred, perhaps it's possible incorporate an ADR into the structure to reduce the adjacent segment degeneration that may occur on top of, or below the fusion?

All the best,

Mark

PS, all the appropriate, "I'm not a doctor" qualifiers, apply here. Also... anyone could easily become psycotic after a protracted battle with such severe pain. I did, and so did I.

[Hooch]

Hi Judy,

As someone who has suffered a psychosis (long before my back probs thankfully), my heart goes out to you. If you are involved with doctors, I hope they are compassionate at least. But just like spine docs, that's not always the case hey. And just like spine docs, sometimes they leave u worse off.

If you want to talk, flick me a pm anytime.

On the spiney side of things that's a hell of a lot for anyone to endure. Are all these ops under the same surgeon? I don't really know much about the loose screws, but I assume if there's a non-union they'll want to go in to redo it regardless?

Best,
Chris.

[mmglobal]

Is having a psychosis the same as having a loose screw?

One of the things I've heard doctors say when discussion the psychological issues related to spine is,

"Crazy people get back pain, and back pain makes you crazy!"

The context is in the discussion about how many surgeons will use depression or other psych issues as an excuse not to treat a patient. Or worse, to explain the failure of thier surgery. Depression is one of the normal side-effects of chronic pain.

Antidepressants have been a very important part of my story.

All the best,

Mark

[Hooch]

lol, it's a joke, now I see

whoops, carry on

[Maria]

Hooch
Not sure that was a joke on Judy's part as she could have developed a post surgical pyschosis with all that she went and then loose screws were found and other spinal stuff.. Loose screws seem to be a problem for her now and screw loose I think was a play on words re Mark? If I'm wrong.. my bad!

Sorry Judy that you went thru any of that and hope Mark's reply re loose screws will be helpful to you. I only know of one person who had a multi-level lumbar fusion and screws became loose. He was recommended to have surgery to remove those screws and replace them and possibly do a revision on the existing fusion and he waited as long as he could. Last I had heard from him he was going to have the surgery altho haven't heard from him in over a year.

Wishing you the best and hope you'll soon get some other answers although i always value Mark's input. Sorry to hear Dr.Regan didn't work out well for you. I didn't have any further lumbar spine surgery even after I got something like 6 consults that all pretty much yielded the same recommendation which was to go ahead w/more surgery.

In any event best wishes with continued spinal endeavors~ Maria

[Maria]

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