Revitalizing Revision Surgery: A Novel Technique for Broken Screw Extraction and Replacement in Lumbar Spine Fixation

Abstract

Transpedicular instrumentation is a cornerstone of spine surgery because of the vertebral pedicle's superior anatomical and biomechanical properties, which enable short-segment, three-dimensional stabilization. However, implant failure occurs in 3 to 7% of cases, with about 25% attributed to screw breakage. Removing broken fragments without compromising pedicle integrity remains technically challenging, and many existing techniques require bone removal that weakens subsequent fixation. Reported complications include fragment retrieval failure, nerve root injury, and dural tears.

We aim to evaluate the safety and efficacy of a novel technique for extracting broken lumbar pedicle screws while preserving pedicle integrity and enabling successful reinstrumentation, and to assess associated clinical and radiological outcomes.

We conducted a retrospective series of 20 patients with radiologically confirmed broken lumbar pedicle screws at Menoufia University Hospitals after informed consent and Institutional Review Board approval. Patients were followed up after 6 months of the revision to assess clinical and radiological outcomes.

Data were tabulated and analyzed using Microsoft Excel 2019 and SPSS, version 25.

All patients underwent revision of previous lumbar fixation using the novel extraction technique. The mean age of the patients was 49.4 ± 8.7 years. Mean visual analog scale improved from 7.05 ± 1.36 preoperatively to 2.4 ± 0.68 postoperatively. Successful extraction of broken pedicle screws and reinstrumentation was achieved in all cases, with no intraoperative complications. At 6-month follow-up, all patients demonstrated clinical improvement and stable radiological fusion, without implant failure.

Management of broken pedicle screws is challenging, especially when pedicle preservation is required. Our technique enables safe extraction of deeply seated fragments while preserving pedicle integrity and original trajectory, facilitating a larger screw reinsertion.