Pseudarthrosis in Long Adult Spinal Deformity Instrumentation and Fusion to the Sacrum: Prevalence and Risk Factor Analysis of 144 Cases

Kim, Yongjung J.; Bridwell, Keith H.; Lenke, Lawrence G.; Rhim, Seung Chul; Cheh, Gene

doi:10.1097/01.brs.0000238968.82799.d9

Cited by 375 publications

(261 citation statements)

References 12 publications

Supporting

Mentioning

241

Contrasting

Unclassified

Order By: Relevance

“…The hardware employed, if correctly positioned, provides an immediate primary stability; however, it is not able to bear alone the physiological load to which the spine is subjected and if bone fusion is not achieved the hardware fails. The success of the spine fusion depends on many factors, some related to the patient (age, smoking, previous spine surgery, thoracolumbar kyphosis, coexistence of hip osteoarthritis) [17], other related to the surgical treatment, among them the choice of bone graft or bone graft substitutes having adequate osteogenic, osteoinductive and osteoconductive properties. Autograft, in particular iliac crest bone graft, is considered the gold standard for bone fusion.…”

Section: Discussionmentioning

confidence: 99%

Mesenchymal stem cells derived from vertebrae (vMSCs) show best biological properties

et al. 2013

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Mesenchymal stem cells derived from vertebrae (vMSCs) show best biological properties

et al. 2013

View full text Add to dashboard Cite

“…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. In the first revision surgery lumbar lordosis was corrected from kyphosis (left) to slight lumbar lordosis (middle).…”

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

View full text Add to dashboard Cite

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.

show abstract

“…However, fixation failures have frequently been reported [10,12]. Many studies have demonstrated a correlation between bone mineral density (BMD) and the strength of pedicle screw fixation [5, 7-9, 11, 17, 20, 22].…”

Section: Introductionmentioning

confidence: 99%

Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body

Chang

et al. 2011

Eur Spine J

View full text Add to dashboard Cite

Many studies have proven that the polymethylmethacrylate (PMMA) augmentation of the pedicle screw can significantly increase stiffness and strength of spinal fixation. Some major complications have also been reported. However, there are no reports discussing cement distribution and its morphology in the osteoporotic vertebral body, which is critical in the analysis of the biomechanical strength of the pedicle screw and the risk of cement leakage after pedicle screw augmentation. In this study, we used computed tomography (CT) to evaluate the cement distribution in the osteoporotic vertebral body after PMMA augmentation of a pedicle screw and to analyze the factors leading to cement leakage. Two groups of patients were studied. Group A consisted 25 osteoporotic patients (mean age of 73 years) with spinal instrumentation who had a total of 145 pedicle screws and cement augmentation with biopsy needles. Group B consisted of 23 osteoporotic patients (mean age of 74.6 years) with spinal instrumentation who had a total of 125 cannulated pedicle screws with cement augmentation. All patients had CT evaluation of the cement distribution in the vertebral body after the surgery. The cement distribution in the vertebrae was divided into four zones in the axial CT view: anterior onethird, middle third, and posterior third of vertebral body, and the pedicle. The morphology of the cement distribution around the pedicle screw was defined as scattered type or concentrate type. The leakage pattern was divided to anterior-lateral, posterior-lateral, and canal leakage. The correlations among bone mineral density (BMD), the cement leakage rate, and cement distribution morphology were also analyzed. The results showed that most augmented pedicle screws had cement extension into three of the four zones of the vertebral body (66.3%), followed by two zones (20%), all four zones (11.5%), and only one zone (2.2%). Overall, 123 screws (84.8%) in Group A and 108 screws (86.4%) in Group B had cement concentrate type distribution. The cement leakage rate in Group A is 18.3% and 13.6% in Group B. Patients with a BMD \0.6 g/cm 2 had significantly higher rates of cement leakage and tended toward a scattered cement distribution. There was only one patient who had a symptomatic leakage (sciatica) in Group B. We concluded that the cement distribution after pedicle screw augmentation with biopsy needle or cannulated screw technique was mostly localized in three zones of the vertebral body, and patients with lower BMD had a higher risk of cement leakage and scattered cement distribution.

show abstract

Pseudarthrosis in Long Adult Spinal Deformity Instrumentation and Fusion to the Sacrum: Prevalence and Risk Factor Analysis of 144 Cases

Cited by 375 publications

References 12 publications

Mesenchymal stem cells derived from vertebrae (vMSCs) show best biological properties

Mesenchymal stem cells derived from vertebrae (vMSCs) show best biological properties

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

Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body

Contact Info

Product

Resources

About