Complications in Long Fusions to the Sacrum for Adult Scoliosis

Weistroffer, Joseph K.; Perra, Joseph H.; Lonstein, John E.; Schwender, James D.; Garvey, Timothy A.; Transfeldt, Ensor E.; Ogilvie, James W.; Denis, Francis; Winter, Robert B.; Wroblewski, Jill M.

doi:10.1097/brs.0b013e3181753c53

Cited by 143 publications

(58 citation statements)

References 15 publications

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“…A review of the literature regarding adult spinal deformity surgery, including studies with sample sizes of at least 40 patients, reveals an overall complication rate lingering around one-third of Treatment was with anterior release and fusion L1-S1 with corpectomies of L3 and L4 and second-stage posterior reconstruction of lordosis and spino-pelvic alignment and posterior fusion T12-S2 using iliac crest bone. Screws in S2 were used to augment the lumbopelvic fixation in the patient with osteoporotic bone cases with revision and subsequent surgeries indicated in one-quarter of patients treated [9,10,13,34,40,44]. Risk factors for failure were elucidated in a report on 144 patients by Kim et al [27]: Besides a thoracolumbar kyphosis and osteoarthritis of the hip, positive postoperative sagittal balance of 5 cm or more, age [55 years, and Explanation of failure in a the patient experienced recurrent sagittal imbalance due to an incomplete correction of the spino-pelvic alignment.…”

Section: Discussionmentioning

confidence: 99%

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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Only a few reports exist concerning biomechanical challenges spine surgeons face when treating Parkinson's disease (PD) patients with spinal deformity. We recognized patients suffering from spinal deformity aggravated by the burden of PD to stress the principles of sagittal balance in surgical treatment. Treatment of sagittal imbalance in PD is difficult due to brittle bone and (the neuromuscular disorder) with postural dysfunction. We performed a retrospective review of 23 PD patients treated surgically for spinal disorders. Mean ASA score was 2.3 (2-3). Outcome analysis included review of medical records focusing on failure characteristics, complications, and radiographic analysis of balance parameters to characterize special risk factors or precautions to be considered in PD patients. The sample included 15 female and 8 male PD patients with mean age of 66.3 years (57-76) at index surgery and 67.9 years (59-76) at follow-up. 10 patients (43.5%) presented with the sequels of failed previous surgery. 18 patients (78.3%) underwent multilevel fusion (C3 level) with 16 patients (69.6%) having fusion to S1, S2 or the Ilium. At a mean follow-up of 14.5 months (1-59) we noted medical complications in 7 patients (30.4%) and surgical complications in 12 patients (52.2%). C7-sagittal center vertical line was 12.2 cm (8-57) preoperatively, 6.9 cm postoperatively, and 7.6 cm at follow-up. Detailed analysis of radiographs, sagittal spinal, and spino-pelvic balance, stressed a positive C7 off-set of 10 cm on average in 25% of patients at follow-up requiring revision surgery in 4 of them. Statistical analysis revealed that patients with a postoperative or follow-up sagittal imbalance (C7-SVL [10 cm) had a significantly increased rate of revision done or scheduled (p = 0.03). Patients with revision surgery as index procedure also were found more likely to suffer postoperative or final sagittal imbalance (C7-SPL, 10 cm; p = 0.008). At all, 33% of patients had any early or late revision performed. Nevertheless, 78% of patients were satisfied or very satisfied with their clinical outcome, while 22% were either not satisfied or uncertain regarding their outcome. The surgical history of PD patients treated for spinal disorders and the reasons necessitating redo surgery for recalcitrant global sagittal imbalance in our sample stressed the mainstays of spinal surgery in Parkinson's: If spinal surgery is indicated, the reconstruction of spinopelvic balance with focus on lumbar lordosis and global sagittal alignment is required.

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Section: Discussionmentioning

confidence: 99%

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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“…Based on anatomical and biomechanical studies that demonstrate the existence of an extensive anatomical area of the posteroanterior iliac spine that permits solid anchoring of iliac screws 17,19,20 and of the biomechanical improvements in the use of more than one iliac screw, 19,20 it has been proposed that the use of more than one iliac screw bilaterally improves stability and the ability to correct spinal deformities. 19,21,22 In a previous study that presents incidence of implant failures similar to ours, 14 the incidence of failures of implants using one or two bilateral iliac screws for long fusions in patients with scoliosis of neurological etiology was evaluated, determining that the use of two bilateral iliac screws significantly reduced the number of instrumentation failures.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] Iliac screws are easier to place, but lysis 13,14 and implant failures in the spinopelvic connection 15,16 are not uncommon. Classically, the literature presents a high percentage of non-fusion following long spinopelvic fusions 17 and these percentages have not been significantly reduced by the use of iliac screws, so that nowadays it continues to be a surgical technique that involves a high number of reinterventions, both in primary and revision fusions. 18 There have been few studies analyzing the long term results of long spinopelvic assemblies using pedicle and iliac screws.…”

Section: Objetivo: Conocer Los Factores Que Influyen En Los Fracasos mentioning

confidence: 99%

Resultado a largo plazo de las fusiones largas espinopelvicas en escoliosis: importancia de la edad, la capacidad de marcha y el tipo de fijación ilíaca

et al. 2013

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Objective: To determine the factors that influence lumbosacral instrumentation failures following spinopelvic fusions. Methods: A retrospective study of patients diagnosed with scoliosis who underwent spinopelvic fusion via posterior, from T2 or T3 proximally to iliac crest, using pedicle and iliac screws. Instrumentation failures were analyzed, and the association of this complication with different parameters was studied. Results: We present 44 patients, with an average age of 24 years, with different etiologies. The mean value of the largest preoperative major curve was 74.2°, and in the final review, it was 67%. The anterior-posterior imbalance, pelvic tilt, thoracic kyphosis, lumbar lordosis and lateral imbalance were significantly improved in the final review. There were instrumentation failures in 41% cases, all at the lumbosacral level. A significant association was found between increased instrumentation failures in patients over 17 years and in patients with independent walking ability. In 24 patients, a bilateral single iliac screw was used and in 20 patients, two or more screws were used. Both groups had a similar incidence of failures. In the group with two or more screws, only rod breakages occurred, without detachment or screw lysis. There was lower instrumentation failure incidence in the patients who underwent L3-S1 interbody fusion or a third rod attached with sublaminar compression hooks. Conclusions: This series had 41% instrumentation failures, all located at lumbosacral level. There were significant more instrumentation failures in patients with independent walking ability and those aged over 17 years. There was lower instrumentation failure incidence in the patients who underwent L3-S1 interbody fusion or a third rod attached with sublaminar compression hooks.

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“…1,16,24 To protect distal fixation, particularly S-1 screws, the addition of iliac screws and anterior interbody support at L5-S1 is recommended to offset load on distal fixation. 3,8,34 While interbody fusion at L5-S1 caudal to long fusion constructs has traditionally been achieved using an ALIF, PLIF, or TLIF, the axial interbody approach has recently been demonstrated to provide anterior support distal to long posterior fusions at short-term follow-up (Fig. 4).…”

Section: Axialif Caudal To Long Fusion Constructsmentioning

confidence: 99%

“…3,8,34 Interbody fusion at L5-S1 may be achieved anteriorly (anterior lumbar interbody fusion [ALIF]), posteriorly (posterior lumbar interbody fusion [PLIF]), or via the neural foramen (transforaminal lumbar interbody fusion [TLIF]). These techniques have specific advantages and pitfalls, making none of them the ideal approach for lumbosacral fusion.…”

confidence: 99%

The axial transsacral approach to interbody fusion at L5–S1

Issack

Kotwal²,

Boachie-Adjei³

2014

FOC

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Lumbosacral interbody fusion may be indicated to treat degenerative disc disease at L5–S1, instability or spondylolisthesis at that level, and severe neural foraminal stenosis resulting from loss of disc space height. In addition, L5–S1 interbody fusion may provide anterior support to a long posterior fusion construct and help offset the stresses experienced by the distal-most screws. There are 3 well-established techniques for L5–S1 interbody fusion: anterior lumbar interbody fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion. Each of these has advantages and pitfalls. A more recently described axial transsacral technique, utilizing the presacral corridor, may represent a minimally invasive approach to obtaining lumbosacral interbody arthrodesis. Biomechanical studies demonstrate that the stiffness of the axial rod is comparable to existing fixation devices, suggesting that, biomechanically, it may be a good implant for obtaining lumbosacral interbody fusion. Clinical studies have demonstrated good early results with the use of the axial transsacral approach in obtaining lumbosacral interbody fusion for degenerative disc disease, spondylolisthesis, and below long posterior fusion constructs. The technique is exacting and complications can be major, including rectal perforation and fistula, loss of correction, and pseudarthrosis.

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Complications in Long Fusions to the Sacrum for Adult Scoliosis

Cited by 143 publications

References 15 publications

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Resultado a largo plazo de las fusiones largas espinopelvicas en escoliosis: importancia de la edad, la capacidad de marcha y el tipo de fijación ilíaca

The axial transsacral approach to interbody fusion at L5–S1

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