{"id":"111fd11f-655e-400f-bbbe-6eabe1dc9a56","slug":"innovative-use-of-the-hollow-mill-for-broken-pedicle-screw-extraction","title":"Innovative use of the hollow mill for broken pedicle screw extraction","authors":["Sivaraman Kumarasamy","Deepak Kumar Gupta"],"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.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/111fd11f-655e-400f-bbbe-6eabe1dc9a56/featured/hero-1781558075654.png","publishDate":"2025-12-26T00:00:00.000Z","doi":"10.25259/SNI_1030_2025","categories":["Spine","Technical Note"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2025/12/14184/SNI-16-556.pdf"}