Why Plates and Screws?

Why Plates and Screws?

Why Plates and Screws?

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So,  your surgeon says you need spine surgery.  And,  it is a surgery that will require hardware,  including plates and screws.  Go to the other blog pages about why the surgery.  Let’s talk about Why Plates and Screws?

For the most part,  plates and screws are used to hold your vertebra still,  or in a certain position.  But that is not the end of the story.  Usually (but not always),  plates and screws are used to help the spine mend together into an optimal position.  The surgeon will then let the natural healing process occur,  and the vertebra will heal or mend together,  ideally in that position.

That healing process of mending two or more bones together is called a fusion.  In simple terms,  you are making two or more bones into one bone.  The fusion process is a surgeon’s effort into tricking your body into thinking the bones are broken,  and therefore must be mended together.

An explanation of the bodies ability to mend broken bones is necessary to understand the fusion process.  When a bone breaks,  the natural bony structures are damaged or disrupted.  Small blood vessels course through the bone,  and are therefore disrupted.  It causes chemicals and various hormones to be released into the tissues.  This causes an irritation,  or an inflammation.  There is increased blood flow to the area of irritation,  and the building blocks to repair damaged tissue also arrives via this increased blood flow.  The body has the ability to send “trash collectors” to get rid of the debris, and damaged tissue.  The body also sends “repairmen”  that re-establish the scaffolding to the broken bone channels and blood vessels.  Then,  additional “repairmen” deliver bony substances called osteoid and lay it down on the scaffold.  Over time, the bony substance remodels,  hardens and thickens to the old strength.

In the case of the fusion,  the surgeon will create an environment similar to a broken bone.  The bones to be fused are roughed up,  to allow some bleeding.  Often times,  extra cells that act as the “repairmen” are harvested from the hips to act as bone graft.  And,  because the bones are held into a certain position by the plates and screws,  it will result in the bone healing in the optimal position for that section of the spine.

The science to bone healing is still evolving,  but still,  we have not been able to completely achieve fusion in certain situations  ( smokers,  diabetics,  renal failure,  osteoporosis,  are associated with poor fusion rates).

In terms of plates and screws,  these are still mechanical,  metal devices,  and over time  they will fail.  The best situation is when the bone has successfully mended and fused,  and the plates and screws are no longer necessary.  When the metal breaks (and many times they will),  ideally it has served its function,  and will no longer be needed.

In rare instances,  the plates and screws may begin to back out,  causing problems and will need to be removed.

In even rarer instances,  patients may have an unknown metal allergy and it will cause a reaction that will cause increased inflammation.  If there are any concerns for metal allergies  ( you cannot wear jewelry, rings,  etc),  there are metal allergy tests that may need to be done if you are anticipating us of plates and screws.

Modern plates and screw constructs in the spine are made of titanium,  as it has less image scattering properties if an MRI is necessary in the future.  And,  at least in the Spine,  you can still have an MRI,  without the metal moving secondary to the magnetic  field  ( not so for implants in the eyes,  ears,  brain, and blood vessels).

Plates and screws sound scary,  but in the proper situation,  can be very helpful in maintaining the desired position of the bone after surgery.

 

 

Citations

  • Voronov LI, Vastardis G, Zelenakova J, Carandang G, Havey RM, Waldorff EI, Zindrick MR, Patwardhan AG. Biomechanical characteristics of an integrated lumbar interbody fusion device. Int J Spine Surg. 2014;8 PubMed PMID: 25694931

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    1. Not necessarily. If the fusion is solid and there are no symptoms, it should be fine. If the bones did not fuse, it may have to be redone. Ask your surgeon if it’s necessary.

  1. If/When the plates and screws break,due to the success in mending the bone, are they surgically removed?
    Also what kind of physical activity is apt to cause breakage if any?
    I am looking forward to bike riding again and spin class as well as strength training just to get back into shape and keep my body physically healthy. Is this something I can look forward to without ruining the results of my surgery?

    1. Hi Deb, Often if the plates and screws break, the bones are not fused under them. An x-ray will tell you for sure. Generally hardware is not removed unless it is causing a problem. Once bones are fused, you should be able to do what you want but definitely check with your surgeon first. We recommend avoiding “pounding activities” such as running.

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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