Innovative use of the hollow mill for broken pedicle screw extraction
Year: 2025
Type: article
Abstract: Background: Removal of fractured pedicle screws is technically demanding. Despite significant advances in transpedicular screw instrumentation and surgical techniques, screw breakage continues to account for 25% of complications and affecting 0.8-24.6% of patients. Here, we developed an innovative technique that employs the hollow mill set for broken pedicle screw retrieval. Methods: We describe our innovative technique for broken pedicle screw retrieval utilizing a hollow mill set. We also provide a comparison of its safety/efficacy with established extraction methodologies. Results: Our technique begins with tulip head removal followed by careful curettage of newly formed bone; this exposes the fracture surface without compromising pedicle structural integrity. Next, the hollow mill sleeve is advanced clockwise until achieving >50% engagement with the retained screw fragment. Subsequently, with counterclockwise rotation of the handle-mechanism, the broken screw fragment can be extracted within a protective sleeve. This approach requires minimal bone exposure and avoids aggressive pedicle bone removal, thereby preserving anatomical integrity essential for larger-diameter screw placement (i.e., without extending to additional fusion levels). Further, the hollow mill is part of standard orthopedic instrumentation readily available in most surgical suites. Conclusion: The hollow mill set for retrieving broken pedicle screw is readily available, cost-effective, technically simple, and effective for addressing fractured screws of varying diameters.
Source: Surgical Neurology International
Authors: Sivaraman Kumarasamy, Deepak Kumar Gupta
Institution: All India Institute of Medical Sciences
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7117302778