Use of the "Two-Three Click" Protocol in Screw Stabilization of a Patient With Loosened Nuts and Dislocation of Rods - A Case Report.
| Autor: | Penchev P; Medicine, Medical University of Plovdiv, Plovdiv, BGR., Petrov PP; Anatomy, Histology, and Embryology, Medical University of Plovdiv, Plovdiv, BGR., Ivanov K; Medicine, Medical University of Plovdiv, Plovdiv, BGR., Ilyov I; Medicine, Medical University of Plovdiv, Plovdiv, BGR., Hyusein RR; Medicine, Medical University of Sofia, Sofia, BGR., Velchev V; Medicine, Medical University of Plovdiv, Plovdiv, BGR., Iliev B; Neurosurgery, University Hospital Saint Marina, Varna, BGR.; Neurosurgery, Medical University of Varna, Varna, BGR. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Jun 28; Vol. 16 (6), pp. e63373. Date of Electronic Publication: 2024 Jun 28 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.63373 |
| Abstrakt: | Vertebral fixation, utilizing titanium screws, is a highly prevalent technique employed to address spinal instability. Screw stabilization malfunction due to pedicle screw nuts loosening is rare. Under tightening the internal nut in the pedicle screw head may increase the likelihood of rod movement within the system resulting in severe pain when moving. Our goal is to raise the attention of surgeons when tightening the screws nuts of the screw stabilization because the consequences for the patient can be subsequent additional operations and complications. This report describes a clinical case of a 40-year-old man who underwent three surgeries at different clinics several years ago for disc herniation at the L4-L5 level and screw stabilization at the same level. The patient presents to the neurosurgery clinic of Saint Marina University Hospital with a clinical manifestation of low back pain escalating with movement, with a pain intensity rating of six on the Visual Analogue Scale (VAS). From the CT scan, it was revealed a malfunction in the screw stabilization with loosening of the screw nuts and dislodgement of the rods. Screw stabilization was restored using intraoperative X-ray guidance and following the "two-three click" protocol. The patient was mobilized on the first day after surgery and discharged on the fifth day with neurological improvement (VAS=1). The patient was followed up for a period of six months, and no further complications were observed. Surgeons must use caution while tightening the screw nuts, as not doing so may result in additional surgeries and complications for the patient in the future. The "two-three click" protocol for screw stabilization is an effective method for minimizing the issues associated with inner loosening and rod migration. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. University Hospital Saint Marina issued approval 266/20.04.2024. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Penchev et al.) |
| Databáze: | MEDLINE |
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