Symptoms of Loose Screws After Spinal Fusion

In spinal fusion and other spinal procedures, hardware is essential for stability. Pedicle screws are commonly used to secure the vertebrae and encourage healing. Unfortunately, screw loosening is a prevalent complication of spinal fusion, occurring in up to 60% of patients.  

Read on to learn more about loose screws after spinal fusion and how to reduce your risk of back surgery complications. 

Table of Contents

How Are Screws Used in Spinal Fusion?

Pedicle screws are often used in spinal fusion to support and stabilize the vertebrae as they heal. Typically, the screws are positioned above and below the fused vertebrae, and a rod links the screws to prevent motion. This helps the vertebrae and bone graft fuse properly. 

These screws are called pedicle screws because they’re secured through the pedicles at the back of the vertebrae. The pedicles are cylindrical stubs of hard bone that bridge the vertebral body to the lamina. 

What Causes Loose Screws?

Poor bone quality most often causes loose screws after surgery. When the bone tissue isn’t strong and dense enough to support surgical hardware, the screws may gradually loosen and trigger symptoms of failed back surgery syndrome. 

Osteoporosis is a common cause of diminished bone quality and can contribute to loose screws after surgery. This bone disease occurs when bone mass and mineral density dwindles, leading to weaker, thinner bones.  

What Causes Screws to Loosen After Spinal Fusion?

The possible causes of screws loosening after spinal fusion include poor bone quality, poor healing, improper screw fixation, and excessive impact on the screws. 

Excessive Impact on Pedicle Screws

Excess impact on the screws after spinal fusion can result from high-impact physical activity, poor posture, and a sedentary lifestyle. Patients who frequently partake in high-impact activities (like heavy lifting) or activities that involve intensely bending or twisting the spine may experience fusion hardware failure as a result. Your surgeon will advise you on the activities to avoid after the fusion procedure. 

Poor Healing 

Poor healing or failed fusion can cause the pedicle screws and other hardware to loosen. Failed fusion occurs when the bone graft doesn’t successfully merge the vertebrae into a single bone. 

Certain factors can increase your risk of pedicle screw loosening after spinal fusion, including:

  • Diabetes: Pedicle screw loosening is more common in patients with diabetes
  • Older age: The older a patient is, the higher the risk of pedicle screw loosening. 
  • Low bone density: Patients with low bone density (whether due to fracture, osteoporosis, rheumatoid arthritis, or other medical conditions) are at an increased risk of loosening screws after spinal fusion. 

Screws can also simply loosen after spinal fusion with time. Over the years, the screws undergo normal wear and tear, which can lead to loosening or damage. Older patients may pass naturally before experiencing the effects of wear and tear on the screws, but younger patients will likely develop symptoms at some point. 

What Happens When Spinal Fusion Screws Loosen?

When spinal fusion screws loosen, they can irritate the neighboring nerves and tissue. This can cause pain, neurological symptoms, and crepitus (a grating noise or sensation). 

New or recurrent back pain after spinal fusion as a result of pedicle screw loosening can indicate failed spinal fusion (also known as failed back surgery syndrome). Many patients who develop this syndrome after undergoing spinal fusion require re-operation for pain management. 

Symptoms of failed spinal fusion include:

  • Limited spinal mobility
  • Spasms in the back
  • Insomnia
  • Numbness, tingling, or weakness in the extremities
  • Persistent back pain

Can Failed Spinal Fusion Be Fixed?

Failed spinal fusion can often be fixed with revision surgery. Before the operation, your spinal surgeon can evaluate what went wrong and consider other surgical methods to address your symptoms, including alternatives to spinal fusion.  

Patients who don’t want to undergo another surgery, or who can’t due to an underlying medical condition, can try non-surgical treatment methods. Epidural steroid injections, physical therapy, and radiofrequency ablation, among other techniques, are non-surgical options for failed spinal fusion. 

Spinal Fusion Alternatives

Spinal fusion alternatives include dynamic stabilization systems, IDET, and stem cell therapy. These advanced treatments promote healing without limiting the motion of the spine. 

Stem Cell Therapy

Stem cell therapy is rapidly gaining traction as a non-surgical treatment option for musculoskeletal conditions. With the potential to regenerate damaged tissue, stem cell therapy may offer benefits for degenerative spinal conditions. 

During stem cell therapy, stem cells derived from the patient’s blood or a donor are administered directly into the damaged area via injection. Stem cells have the unique ability to self-renew and develop into just about any specialized cell. As a result, stem cells can gradually repair injured tissue in the spine, leading to lasting pain relief in some patients. 

Given that stem cell therapy for back pain is a relatively new treatment option, research is still in its early stages. Not all patients have access to an experienced stem cell specialist in their area. However, the initial experiences with rats have produced positive results, indicating that stem cells may help heal damaged intervertebral discs. 

Intradiscal Electrothermal Coagulation (IDET)

IDET involves inserting a needle into the affected disc area. The physician then threads a catheter through the needle and applies gentle heat to the exterior of the intervertebral disc. This process helps strengthen and thicken the collagen fibers in the disc exterior, potentially offering relief from chronic back pain. 

Dynamic Stabilization Systems

Dynamic stabilization systems can replace spinal fusion after spinal decompression surgery. This type of surgical implant stabilizes the spine without permanently limiting its motion. One dynamic stabilization system is the TOPS System for the L3 to L5 vertebrae.

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The TOPS System offers immediate pain relief with the ability to move the spine in all directions. It also reduces the stress on adjacent spinal levels when compared to spinal fusion. As an alternative to lumbar spinal fusion for spinal stenosis and spondylolisthesis, the TOPS System provides motion preservation, ideal decompression, and stability. 

Spinal fusion alternatives like the TOPS System may help you avoid re-operation after back surgery. Schedule an appointment with a spine specialist in your area to learn more.