scholarly journals Remaining spine deformity after revision surgery for pelvic reconstruction and spinopelvic fixation: illustrative case

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Takayuki Ito ◽  
Shunsuke Fujibayashi ◽  
Bungo Otsuki ◽  
Shimei Tanida ◽  
Takeshi Okamoto ◽  
...  
Keyword(s):  
Back Pain ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Pelvic Ring ◽  
Spine Deformity ◽  
Illustrative Case ◽  
Coronal Alignment ◽  
Reference Axis ◽  
Spinopelvic Fixation ◽  
Vascularized Fibula

BACKGROUND Pelvic deformity after resection of malignant pelvic tumors causes scoliosis. Although the central sacral vertical line (CSVL) is often used to evaluate the coronal alignment and determine the treatment strategy for scoliosis, it is not clear whether the CSVL is a suitable coronal reference axis in cases with pelvic deformity. This report proposes a new coronal reference axis for use in cases with pelvic deformity and discusses the pathologies of spinal deformity remaining after revision surgery. OBSERVATIONS A 14-year-old boy who had undergone internal hemipelvectomy and pelvic ring reconstruction 2 years prior was referred to our hospital with severe back pain. His physical and radiographic examinations revealed severe scoliosis with pelvic deformity. The authors planned a surgical strategy based on the CSVL and performed pelvic ring reconstruction using free vascularized fibula graft and spinopelvic fixation from L5 to the pelvis. After the procedure, although the patient’s back pain was relieved, his scoliosis persisted. At the latest follow-up, his spinal deformity correction was acceptable with corset bracing. Therefore, the authors did not perform additional surgeries. LESSONS The CSVL may not be appropriate for evaluating coronal alignment in cases with pelvic deformity. Accurate preoperative planning is required to correct spinal deformities with pelvic deformity.

Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Neurosurgery ◽  
2020 ◽  
Author(s):  
Se-Jun Park ◽  
Jin-Sung Park ◽  
Yunjin Nam ◽  
Tae-Hoon Yum ◽  
Youn-Taek Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Scan ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Study Cohort ◽  
Related Factors ◽  
Fixation Failure ◽  
Failure Group ◽  
Pelvic Fixation ◽  
Spinopelvic Fixation

Abstract BACKGROUND Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors. OBJECTIVE To classify the types of SPFF and investigate its risk factors, including the fusion status at L5-S1 on CT scan. METHODS The study cohort consisted of ninety-eight ASD patients who underwent more than 4-level fusions to the sacrum with interbody fusion at L5-S1. Patients with SPFF were divided into the two groups: above-S1 and below-S1 failure groups. The patient, surgical, and radiographic variables in each group were compared to those of the no-failure group. The L5-S1 fusion status was assessed using 2-yr computed tomography (CT) scan. Univariate and multivariate analyses were performed to determine the risk factors for each failure group. RESULTS The mean age was 68.5 yr. Follow-up duration was 55.7 mo. The SPFF developed in 46 (46.9%) patients at 32.7 mo postoperatively. There were 15 patients in the above-S1 failure group and 31 patients in the below-S1 failure group. Multivariate analysis revealed that nonunion at L5-S1 was a single risk factor for above-S1 failure. In contrast, the risk factors for below-S1 failure included a greater number of fused segments and postoperative less thoracic kyphosis. CONCLUSION SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.

scholarly journals Coronal T1 Pelvic Tilt, a Novel Predictive Index for Global Coronal Alignment in Adult Spinal Deformity

Spine ◽  
2020 ◽  
Vol 45 (19) ◽  
pp. 1335-1340
Author(s):  
Jiandang Zhang ◽  
Zheng Wang ◽  
Pengfei Chi ◽  
Cheng Chi
Keyword(s):  
Spinal Deformity ◽  
Pelvic Tilt ◽  
Adult Spinal Deformity ◽  
Coronal Alignment ◽  
Predictive Index

Identification of Decision Criteria for Revision Surgery Among Patients With Proximal Junctional Failure After Surgical Treatment of Spinal Deformity

Spine ◽  
2013 ◽  
Vol 38 (19) ◽  
pp. E1223-E1227 ◽  
Author(s):  
Robert Hart ◽  
Ian McCarthy ◽  
Michael OʼBrien ◽  
Shay Bess ◽  
Brett Line ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Decision Criteria ◽  
Proximal Junctional Failure

scholarly journals A Novel Placement Technique of S2 Screw (from S2 to Promontorium) and Double Screwing from S2

2021 ◽  
Author(s):  
Sedat Dalbayrak ◽  
Ahmet Öğrenci ◽  
Ezgi Akar ◽  
Orkun Koban ◽  
Mesut Yılmaz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Revision Surgery ◽  
Chronic Low Back Pain ◽  
Screw Placement ◽  
Low Back ◽  
Screw Loosening ◽  
Dynamic Instrumentation ◽  
Placement Technique

AbstractSince pseudoarthrosis or screw loosening is frequently seen in lumbosacral stabilizations ending in S1, S2 screws are used more frequently to support S1 screws. This study aims to describe a new screw placement technique and location from S2. Revision surgery was applied to the patient who had previously undergone surgery with the rigid instrumentation system and encountered pseudoarthrosis during the follow-up period. Instrumentation was performed from S2 to the promontorium. The patient’s chronic low back pain arising due to pseudoarthrosis was reduced and a strong lumbosacral dynamic instrumentation was performed to the patient. Dual screw placement from S2 and/or screw placement in the S2-promontorium direction is a new alternative to provide a powerful instrumentation.

scholarly journals Acute thoracic disc heralded by change in spinal cord stimulation pattern: illustrative case

2021 ◽  
Vol 2 (20) ◽  
Author(s):  
Faraz Behzadi ◽  
Edvin Telemi ◽  
Tarek R. Mansour ◽  
Thomas M. Zervos ◽  
Muwaffak M. Abdulhak ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Chronic Back Pain ◽  
Cord Compression ◽  
Illustrative Case ◽  
Disc Protrusion ◽  
Stimulation Parameters ◽  
Spine Pathology ◽  
Thoracic Disc

BACKGROUND Spinal cord stimulation (SCS) uses unique electric stimulation parameters to selectively treat specific regions of chronic or refractory back pain. Changing these parameters can lead to spreading paresthesia and/or pain beyond the desired region. OBSERVATIONS A patient with a history of stable, successful SCS treatment presented with acute development of paresthesias that were relieved by reduction of stimulation parameters. The patient required paradoxically lower SCS settings for control of chronic back pain. This presentation prompted further investigation, which revealed a new disc protrusion and cord compression at the level of the paddle lead. LESSONS In patients with SCS, a new onset of back pain accompanied by acute paresthesia that is reversible by reducing the SCS amplitude warrants investigation for new spine pathology.

The adult patient with spine deformity and low back pain

1989 ◽  
pp. 118-124
Author(s):  
Gunnar B. J. Andersson ◽  
Thomas W. McNeill
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Adult Patient ◽  
Spine Deformity ◽  
Low Back

Novel radiographic parameters for the assessment of total body sagittal alignment in adult spinal deformity patients

2019 ◽  
Vol 31 (3) ◽  
pp. 372-379 ◽  
Author(s):  
Yong-Chan Kim ◽  
Ji Hao Cui ◽  
Ki-Tack Kim ◽  
Gyu-Taek Park ◽  
Keun-Ho Lee ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Distance Measures ◽  
Spine Deformity ◽  
Radiographic Parameters ◽  
Patient Reported ◽  
Total Body

OBJECTIVEIn this study, the authors’ goal was to develop and validate novel radiographic parameters that better describe total body sagittal alignment (TBSA).METHODSOne hundred sixty-six consecutive operative spinal deformity patients were evaluated using full-body stereoradiographic imaging. Seven TBSA parameters were measured and then correlated to 6 commonly used spinopelvic measurements. TBSA measures consisted of 4 distance measures relating the cranial center of mass (CCOM) to the sacrum, hips, knees, and ankles, and 3 angular measures relating the CCOM to the hips, knees, and ankles. Furthermore, each TBSA parameter was correlated to patient-reported outcome (PRO) scores using the Oswestry Disability Index (ODI) and Scoliosis Research Society–22 (SRS-22) instruments. Thirty patients were randomly selected for inter- and intraobserver reliability testing of the TBSA parameters using intraclass correlation coefficients (ICCs).RESULTSAll TBSA radiographic parameters demonstrated strong linear correlation with the currently accepted primary measure of sagittal balance, the C7 sagittal vertical axis (r = 0.55–0.96, p < 0.001). Moreover, 5 of 7 TBSA measures correlated strongly with ODI and SRS-22 total scores (r = 0.42–0.51, p < 0.001). Inter- and intraobserver reliability for all TBSA measures was good to excellent (interrater ICC = 0.70–0.98, intrarater ICC = 0.77–1.0).CONCLUSIONSIn spine deformity patients, novel TBSA radiographic parameters correlated well with PROs and with currently utilized spinal sagittal measurements. Inter- and intrarater reliability was high for these novel parameters. This is the first study to propose a reliable method for measuring head-to-toe global spinal alignment.

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