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

[jsewell]

Hi Everyone and thanks for your replies.
Mark, thanks for the humor too. The psychosis was pretty bad but now that 4months have gone by just a memory already. It did involve the end of the world which made it pretty darn scary. My husband had to hire someone to stay with me at nite as i heard i got up like 50 times. That amazes me as i could not get up alone before and after the psychosis.

My spine surgeon has studied in Germany and UK and that is where he had practiced the cervical osteotomy. When my neck actually fell off the thoracic spine i had a piece of hardware sticking out of my thoracic spine. Creepy reminder every day.
I think he would have to sink the new screws in C3 which he was trying to avoid. I need to look up the range of motion for C-3 to see what else i would miss.

One question to Mark as i value your non medical opinion very much, as much as a medical one. Do you think as no fusion has taken place with surgery only a few weeks ago that surgery has to happen. In other words it would be bad medical practice to leave the loose screws in there?
thanks again
judy

[Maria]

The person I mentioned who has the lumbar fusion surgery had non union and screws were loose. Fusion didn't take. He was recommended to have the revision surgery because of loose screws and non non union. His original surgery was 2 years prior to finding out that he had non union and loose screws. He actually didn't feel badly re the non union but the loose screws were impinging on something (nerve I think) and creating increased pain/limitations.

I'm sorry if I didn't get the story straight initially. The question you posed to Mark sparked my memory re this particular person's situation.

[Hooch]

Ah, so you did have one. Pretty awesome fun hey. Sounds like you are doing ok considering all of that.

If you are a few weeks out from the op and the screws are loose, I would expect that they need to be rectified, as they will not be securing the joint and any motion introduced significantly reduces your chances of successful fusion in the long term.

Best.

[jsewell]

That is how my thinking has gone Hooch. Yes i was diagnosed with steroid induced psychosis. My spine surgeon thinks it was more pain medication induced. I definately had too many doctors involved and they could have caused the psychosis themselves.
I sure did not know which way was up and here still all kinds of stories about what i did and said.
One which seemed funny and i vagely remember is one night when the nurses would not let me get up to go to the bathroom , they kept shoving that uncomfortable cold bedpan under my butt. I kept lecturing them on the reasons they should let me up and move around . so no response from them so i stood up and peed on the bed and said now you have to let me get up so you can change this bed. Oh they must have cried when they saw me back a month later and then 2 months later in the same place.
I really did think the world was ending and i couldn't find my youngest child and then i thought the building roof was collapsing with all the weight of the ice frozen on it . My girlfriend said the nite she came i kept telling her to get all the babies to safety. Crazy places my braiin went.
I don't evern remember my first week home at all.

[Hooch]

That sucks, I'm glad it's gone, terrifying bloody thing. Just the last thing you need after everything else hey. Hope u are getting on ok.

[jsewell]

Thanks Hooch except for the unknown about another surgery to fix the screws, i'm not doing too bad. The sept osteotomy and kyphosis correction of my thoracic spine and some lumbar hurt much more than this surgery. now that i am walking around my lower back pain has returned and with it some bad right hip pain. I have a right hip replacement with a recalled part . I am hoping the pain is related to the lower back though.
Past my bedtime
judy

[mmglobal]

Psychotic reactions to surgery? My surgery at the AlphaKlinik was Sept 2002. In Oct. 2003, I went back to the AK and had been invited into the OR to observe surgery. I kept hearing some tittering among the staff and I seem to be the subject, so I asked, "what's funny?"

"They call you the alligator!"

"Why?"

Apparently, I had a psychotic reaction to the anesthesia and awoke in the recovery room, sitting up and swinging. I slugged an OR nurse putting her on the floor. The had kind of a TV episode moment as everyone was scrambling to hold me down and sedate me. They halted surgery for over an hour while everyone's adrenaline subsided.

I had some comparatively minor, but still quite unpleasant for the staff; episodes in the next few days in the hospital. For the next couple of weeks, I had horrible dreams. I could not believe I had those thoughts in my head. Waking up was kind of a 1/2 dream, 1/2 waking fog kind of torture. "Please, let me wake up from this dream."

So we have something in common. Let's get a camera crew and get together to do some anesthesia... could generate some great reality TV!

You are not alone.

The Alligator

[mmglobal]

By the way, I'm typing this message from Dr. Zeegers' house in Maastricht, Netherlands. Through the years, I was able to spend a great deal of time in the OR and laugh about it with the staff. We are still great friends. I'm sorry that the party had to be cancelled, becuase many of them would have been there.

[jsewell]

Mark i can't imagine what they called me was anything nice. I was totally gone for days in the hospital . Spent 12 days , most for the phychosis. I have seen nurses notes from a different surgery stating i thought i was in a submarine. This last time they asked me every day (several times) where i was and what the date was. Ususally it is written on a board, but sneaky nurse assistant did not do that. I was back in 1930's and asked my doc if that was close enough to get me out.
I first thought there were wild animals in my room. A mountain lion under my walker . There was a guy with a gun but he would not shoot until i told him the proper word. Then a snake came out of the end table. I guess just writing about it is reminding me that this happened in a previous surgery as well. The mind is a very powerful thing. Wish i could use it to stop pain.

Alligator you must have missed my question a page back. About the screws. In your opinion, do they definately have to come out? Just want to have all i need to talk to my surgeon next week.
judy

[mmglobal]

My layperson's opinion is worth little. Check your PM's

Mark

[jsewell]

Bad me i forgot to follow up here. I saw my doc and he took an xray, my screws have not moved at all so he is leaving them there for now. They are small screws with not much purchase. I am already fused from C4-7 anteriorly and the posterior fusion starts at C8 T1 so it is pretty far away he put it in as extra insurance and does not think it matters too much.

WE looked at the xray of my lower thoracic fracture and discussed that for awhile. so next week i am having injections to see if he can help with the pain there and see if my hip pain is referred from my spine . Sure hope so. And life goes on.
I think i typed this somewhere else, but maybe on face book. I don't want to be repeating my self here.

[Maria]

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