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European Spine Journal

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01-10-2014 | Original Article

Revision surgery after PSO failure with rod breakage: a comparison of different techniques

Authors: A. Luca, A. Lovi, F. Galbusera, M. Brayda-Bruno

Published in: European Spine Journal | Special Issue 6/2014

Abstract

Study design

Author experience and literature review.

Objectives

To compare different revision techniques in the treatment of implant failure after pedicle subtraction osteotomy (PSO).

Summary of background data

The complication rate of pedicle subtraction osteotomy is substantially higher than other corrective procedures available for the treatment of spinal sagittal imbalance: in particular, hardware failures and mechanical complications affect this technique and their biomechanical explanation is still purely speculative.

Methods

The author’s experience and the literature regarding the revision techniques for PSO failures are discussed.

Results

In this paper, eight consecutive revision cases due to rod breakage after PSO surgery are reported. In our experience, the main goals are to restore the spinal balance, through a posterior approach (correction and hardware revision and implementation) and to get a solid anterior fusion (both through a traditional anterior approach or minimally invasive transpsoas approach).

Conclusion

The efficacy of PSO should be balanced with the high risk of the procedure reported in the literature. Management of revision surgery after PSO may require the addition of anterior column support to maintain correction and reduce complications.

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Kim Y et al (2007) Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance. A minimum 5-year follow-up study. Spine 32(20):2189–2197PubMedCrossRef

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Smith J et al (2011) Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity. Spine 36(12):958–964PubMedCrossRef

Smith JS, Shaffrey CI, Ames CP et al (2012) Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery 71:862–868PubMedCrossRef

10.

Cho KS et al (2012) Major complications in revision adult deformity surgery. Risk factors and clinical outcomes with 2- to 7-year follow-up. Spine 37(6):489–500PubMedCrossRef

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Berjano P et al (2013) Failures and revisions in surgery for sagittal imbalance: analysis of factors influencing failure. Eur Spine J 22(Suppl 6):S853–S858PubMedCrossRef

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Charosky S, Moreno P, Maxy P (2014) Instability and instrumentation failures after a PSO: a finite element analysis. Eur Spine J (in press)

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Enercan M et al (2013) Osteotomies/spinal column resection in adult deformity. Eur Spine J 22(Suppl 2):S254–S264PubMedCrossRef

Title: Revision surgery after PSO failure with rod breakage: a comparison of different techniques
Authors: A. Luca
A. Lovi
F. Galbusera
M. Brayda-Bruno
Publication date: 01-10-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 6/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3555-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Revision surgery after PSO failure with rod breakage: a comparison of different techniques

Abstract

Study design

Objectives

Summary of background data

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Objectives

Summary of background data

Methods

Results

Conclusion

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