This is a case of a 55 year old female presenting with severe pain along her cervical and thoracic spine. She also had difficulty holding her head erect. Prior to the above scans, she most recently had a posterior C7 – T9 vertebral fusion 6 months ago. She returned multiple times for poor wound healing requiring multiple I&Ds, debridements, and wound vac placements. She also required an additional closure with a plastic surgeon. Her surgical history was complicated with over 10 previous surgeries over the course of a decade. 

This case demonstrates multiple failures with orthopedic hardware.

These are domino connector devices used in revision and extension procedures which eliminate the need for hardware removal when doing an extended fusion or revision. When hardware fails, it can result in pseudoarthroses, non-union, and significant pain.

Pedicle screw loosening can be visualized by both X-ray and CT as lucency around the screw threads. Both modalities show low sensitivity but high specificity. One study showed that X-rays demonstrated 54.2% sensitivity and 83.5% specificity while CT demonstrated 64.8% sensitivity and 96.7% specificity ¹.

Misplaced pedicle screws have an increased risk of non-union and morbidity. Back pain, spinal stenosis, radiculopathy, and neurogenic claudication are common post-surgical complaints. Spine surgery has a high burden of medical liability and malpractice litigation with misplaced pedicle screws being a common cause for claims ².

This patient was taken for revision surgery after the above findings were reported. Intra-operatively, multiple non-unions were found. Revision was successful and the patient was pain-free at 1 month follow-up.

Case authors: Le J, Senti M, Huser M