Management of Catastrophic Proximal Junctional Failure Following Spinal Deformity Correction in an Adult with Osteogenesis Imperfecta: Case Report and Technical Note

2019 ◽  
Vol 131 ◽  
pp. 154-158
Author(s):  
Akshay Gadiya ◽  
Giuseppe Lambros Morassi ◽  
Olakunle Badmus ◽  
Ann Marriot ◽  
Masood Shafafy
Keyword(s):  
Case Report ◽  
Osteogenesis Imperfecta ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Technical Note ◽  
Proximal Junctional Failure

Sublaminar banding as an adjunct to pedicle screw-rod constructs: a review and technical note on novel hybrid constructs in spinal deformity surgery

2019 ◽  
Vol 30 (6) ◽  
pp. 807-813
Author(s):  
Vibhu K. Viswanathan ◽  
Amy J. Minnema ◽  
Stephanus Viljoen ◽  
H. Francis Farhadi
Keyword(s):  
Pedicle Screw ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Relevant Literature ◽  
Case Series ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Technical Note ◽  
Mineral Density ◽  
Bone Contact

Sublaminar implants that encircle cortical bone are well-established adjuncts to pedicle screw-rod constructs in pediatric deformity surgery. Sublaminar bands (SLBs) in particular carry the advantage of relatively greater bone contact surface area as compared to wires and pullout loads that are independent of bone mineral density, in contrast to pedicle screws. Whereas the relevant technical considerations have been reported for pediatric deformity correction, an understanding of the relative procedural specifics of these techniques is missing for adult spinal deformity (ASD), despite several case series that have used distinct posterior tethering techniques for proximal junctional kyphosis prevention. In this paper, the authors summarize the relevant literature and describe a novel technique wherein bilateral tensioned SLBs are introduced at the nonfused proximal junctional level of long-segment ASD constructs.

scholarly journals Mesenteric ischemia following the correction of adult spinal deformity: case report

2017 ◽  
Vol 26 (4) ◽  
pp. 426-429 ◽  
Author(s):  
Krishn Khanna ◽  
Sigurd H. Berven
Keyword(s):  
Case Report ◽  
Reconstructive Surgery ◽  
Spinal Deformity ◽  
Mesenteric Ischemia ◽  
Adult Spinal Deformity ◽  
Vascular Complications ◽  
Deformity Correction ◽  
Symptomatic Disease ◽  
Venous Injury ◽  
Vascular Insufficiency

Vascular complications are an important adverse event that can be associated with spinal reconstructive surgery. Direct injury of vessels, or indirect traction or compression of vessels, can cause both arterial and venous injury. Indirect compression of the mesenteric vessels is a well-recognized complication of bracing and surgical care of children with spinal deformity (superior mesenteric artery syndrome), but the complication is not common or well recognized in the adult population with spinal deformity. The purpose of this case report is to detail the case of postoperative mesenteric ischemia in a 63-year-old man in whom a posterior approach was used to perform spinal deformity correction. Preoperatively, the patient had had significant lumbar hypolordosis. The reconstructive surgery with the use of posterior-based osteotomies resulted in a shortening of the posterior column of the spine but a relative lengthening of structures anterior to the spine. The significant lordosis achieved by the surgery led to an acute worsening of the mesenteric stenosis suffered by the patient. He required a vascular surgery intervention to restore perfusion to the bowel. Recognition of severe vasculopathy is important in anticipating potential postoperative vascular insufficiency. This case report will inform surgeons and clinicians to have a higher index of suspicion for the exacerbation of vascular insufficiency, including mesenteric pathology, in patients undergoing surgery that involves significant realignment of the spine. Preoperative recognition of vascular insufficiency and treatment of symptomatic disease may limit the occurrence of postoperative vascular complications in spinal reconstructive surgery.

Spinal dural arteriovenous fistula formation after scoliosis surgery: case report

2020 ◽  
Vol 32 (1) ◽  
pp. 144-149
Author(s):  
Clay M. Elswick ◽  
Siri Sahib S. Khalsa ◽  
Yamaan S. Saadeh ◽  
Aditya S. Pandey ◽  
Mark E. Oppenlander
Keyword(s):  
Case Report ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Fistula Formation ◽  
Scoliosis Surgery ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
First Case ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas are diagnostically challenging lesions, and they are not well described in patients with a history of a spinal deformity correction. The authors present the challenging case of a 74-year-old woman who had previously undergone correction of a spinal deformity with subsequent revision. Several years after the last deformity operation, she developed a progressive myelopathy with urinary incontinence over a 6-month period. After evaluation at the authors’ institution, an angiogram was obtained, demonstrating a fistula at the T12–L1 region. Surgical ligation of the fistula was performed with subsequent improvement of the neurological symptoms. This case is thought to represent the first fistula documented in an area of the spine that had previously been operated on, and to the authors’ knowledge, it is the first case report to be associated with spinal deformity surgery. A brief historical overview and review of the pathophysiology of spinal dural arteriovenous fistulas is also included.

‘Double trouble': Duchenne muscular dystrophy and osteogenesis imperfecta in one patient - a case report

2015 ◽  
Author(s):  
Milan Bayer ◽  
Renata Taslerova ◽  
Lenka Mrazova ◽  
Lenka Fajkusova ◽  
Hana Oslejskova
Keyword(s):  
Case Report ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Osteogenesis Imperfecta

Osteogenesis imperfecta type V due to a rare mutation c.119C> T in the IFITM5: A case report

2020 ◽  
Author(s):  
Tatiana Grebennikova ◽  
Alina Gavrilova ◽  
Anatoly Tiulpakov ◽  
Natalia Tarbaeva ◽  
Galina Melnichenko ◽  
...  
Keyword(s):  
Case Report ◽  
Osteogenesis Imperfecta ◽  
Osteogenesis Imperfecta Type ◽  
Rare Mutation ◽  
Type V

Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

2019 ◽  
Vol 30 (6) ◽  
pp. 822-832
Author(s):  
Cecilia L. Dalle Ore ◽  
Christopher P. Ames ◽  
Vedat Deviren ◽  
Darryl Lau
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Deformity ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Vena Cava ◽  
Deformity Correction ◽  
Perioperative Outcomes ◽  
Medical Complications ◽  
Filter Placement ◽  
Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

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