Removal of poly-axial pedicular screw with fractured screw driver slot

Abstract

The use of pedicular screws for spinal surgery has revolutionised the field. The use of poly-axial pedicle screws has eased the difficulties of assembling the rod and screw construct by providing a degree of freedom to the coupling component. This is also associated with increased difficulty in removal of implants, due to the mobile nature of the poly-axial tulip component. We describe a case of a 48 year old patient who had undergone discectomy and posterolateral instrumented fusion of the lumbar spine for L4L5 prolapse of intervertebral disc 3 years ago. She presented with L5 radiculopathy due to malpositioned pedicular screw in the L4 vertebra and was taken for exploration and implant removal. Intra-operatively the L4 pedicular screw was found to have a fractured screwdriver slot. It was removed by dismantling the poly-axial tulip to expose the threaded shaft, which was subsequently removed with the help of a plier.