Ali KOÇ, Alperen UYSAL, Ümit Özgür GÜLER, Mustafa KAYA, Fevzi SAĞLAM, Bekir Murat ÇINAR
Journal of Turkish Spinal Surgery - 2026;37(3):130-133
Pedicle screw removal during revision spinal surgery may become technically difficult because of stripped screw heads, incompatible drivers, or unavailable manufacturer-specific instrumentation. Existing extraction methods often depend on implant design and may increase operative time, costs, and risk of complications. To describe the Z-rod technique, a geometry-independent pedicle screw removal method, and to evaluate its clinical feasibility, safety, and effectiveness. A retrospective, single-center study was conducted involving patients who underwent revision spinal surgery between 2020 and 2025. Patients in whom conventional screwdrivers failed to remove pedicle screws and who subsequently underwent removal using the Z-rod technique were included. The technique involves bending a standard spinal rod into a Z shape, rigidly fixing it to the tulip head with the existing set screw, and applying controlled rotational torque through a long lever arm. Demographic data, surgical indications, technical success, and complications were evaluated. A total of 83 pedicle screws in 24 patients (mean age: 42.1+/-16.7 years) were successfully removed using the Z-rod technique after failure of standard driver systems. Adequate mechanical stability and controlled torque transmission were achieved in all cases. No implant fractures, neurological deficits, vascular injuries, or additional bone and soft tissue injuries were observed. The technique was successfully applied across different implant manufacturers and screw-head geometries without requiring dedicated extraction systems. The Z-rod technique is a simple, universal, and cost-effective method for pedicle screw removal that eliminates dependence on screw-head geometry and manufacturer-specific instrumentation. It may represent a practical alternative in revision spinal surgery when conventional removal methods fail.
