Skip to main content
SpringerLink
Log in

Lumbar Scoliosis (Degenerative) MIS Surgery (PSO/TLIF) Complication

  • Chapter
  • First Online:
Spinal Deformity

  • 964 Accesses

Abstract

Pedicle subtraction osteotomy (PSO) is a highly effective procedure in the context of adult spinal deformity (ASD) surgery to achieve lordosis at the index segment. Traditional open PSO procedure can be associated with high perioperative morbidity and complication rates, which may be substantially reduced with the development of minimally invasive techniques. However, in long-term follow-up, pseudarthrosis still affects 9–24% of the patients after a PSO procedure.

This chapter describes a case with the typical presentation of pseudarthrosis in terms of the clinical symptoms, presentation time, and radiographic progression. The patient underwent revision surgery with replacement of the broken instrumentation and extension of the original fusion segments cranially and caudally. Proper realignment of the sagittal curvature was achieved, and the patient had an uneventful recovery after the revision surgery.

Pseudarthrosis is a major concern after an extensive procedure such as PSO and long fusion in ASD surgery. Due to the insidious presentation, patient should be monitored closely with caution, especially those who fail to achieve expected clinical outcomes. All efforts should be made to tailor the surgical plan on an individual basis with long-term follow-up to avoid such complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;194:142–52.

    Google Scholar 

  2. Wang MY, Berven SH. Lumbar pedicle subtraction osteotomy. Neurosurgery. 2007;60(2 Suppl 1):ONS140–6; discussion ONS6.

    Google Scholar 

  3. Wang MY. Miniopen pedicle subtraction osteotomy: surgical technique and initial results. Neurosurg Clin N Am. 2014;25(2):347–51.

    Article  PubMed  Google Scholar 

  4. Dickson DD, Lenke LG, Bridwell KH, Koester LA. Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity. Spine (Phila Pa 1976). 2014;39(15):1190–5.

    Article  Google Scholar 

  5. Klineberg E, Gupta M, McCarthy I, Hostin R. Detection of pseudarthrosis in adult spinal deformity: the use of health-related quality-of-life outcomes to predict pseudarthrosis. Clin Spine Surg. 2016;29(8):318–22. doi: 10.1097/BSD.0000000000000062

  6. Berjano P, Bassani R, Casero G, Sinigaglia A, Cecchinato R, Lamartina C. Failures and revisions in surgery for sagittal imbalance: analysis of factors influencing failure. Eur Spine J. 2013;22(Suppl 6):S853–8.

    Article  PubMed  Google Scholar 

  7. Kim YJ, Bridwell KH, Lenke LG, Rinella AS, Edwards C 2nd. Pseudarthrosis in primary fusions for adult idiopathic scoliosis: incidence, risk factors, and outcome analysis. Spine (Phila Pa 1976). 2005;30(4):468–74.

    Article  Google Scholar 

  8. Kim YJ, Bridwell KH, Lenke LG, Cho KJ, Edwards CC 2nd, Rinella AS. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg Am. 2006;88(4):721–8.

    PubMed  Google Scholar 

  9. Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976). 2006;31(20):2329–36.

    Article  Google Scholar 

  10. Kelly MP, Lenke LG, Bridwell KH, Agarwal R, Godzik J, Koester L. Fate of the adult revision spinal deformity patient: a single institution experience. Spine (Phila Pa 1976). 2013;38(19):E1196–200.

    Article  Google Scholar 

  11. Cho SK, Bridwell KH, Lenke LG, Yi JS, Pahys JM, Zebala LP, et al. Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up. Spine (Phila Pa 1976). 2012;37(6):489–500.

    Article  Google Scholar 

  12. Mummaneni PV, Dhall SS, Ondra SL, Mummaneni VP, Berven S. Pedicle subtraction osteotomy. Neurosurgery. 2008;63(3 Suppl):171–6.

    Article  PubMed  Google Scholar 

  13. Cho KJ, Kim KT, Kim WJ, Lee SH, Jung JH, Kim YT, et al. Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance. Spine (Phila Pa 1976). 2013;38(24):E1561–6.

    Article  Google Scholar 

  14. Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA Jr, Kim YJ, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007;32(20):2245–52.

    Article  Google Scholar 

  15. Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976). 2007;32(20):2189–97.

    Article  Google Scholar 

  16. Raizman NM, O'Brien JR, Poehling-Monaghan KL, Yu WD. Pseudarthrosis of the spine. J Am Acad Orthop Surg. 2009;17(8):494–503.

    Article  PubMed  Google Scholar 

  17. Lapp MA, Bridwell KH, Lenke LG, Daniel Riew K, Linville DA, Eck KR, et al. Long-term complications in adult spinal deformity patients having combined surgery a comparison of primary to revision patients. Spine (Phila Pa 1976). 2001;26(8):973–83.

    Article  CAS  Google Scholar 

  18. Saer EH 3rd, Winter RB, Lonstein JE. Long scoliosis fusion to the sacrum in adults with nonparalytic scoliosis. An improved method. Spine (Phila Pa 1976). 1990;15(7):650–3.

    Article  Google Scholar 

  19. Weistroffer JK, Perra JH, Lonstein JE, Schwender JD, Garvey TA, Transfeldt EE, et al. Complications in long fusions to the sacrum for adult scoliosis: minimum five-year analysis of fifty patients. Spine (Phila Pa 1976). 2008;33(13):1478–83.

    Article  Google Scholar 

  20. Yadla S, Maltenfort MG, Ratliff JK, Harrop JS. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus. 2010;28(3):E3.

    Article  PubMed  Google Scholar 

  21. Mulconrey DS, Bridwell KH, Flynn J, Cronen GA, Rose PS. Bone morphogenetic protein (RhBMP-2) as a substitute for iliac crest bone graft in multilevel adult spinal deformity surgery: minimum two-year evaluation of fusion. Spine (Phila Pa 1976). 2008;33(20):2153–9.

    Article  Google Scholar 

  22. Pichelmann MA, Lenke LG, Bridwell KH, Good CR, O'Leary PT, Sides BA. Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine (Phila Pa 1976). 2010;35(2):219–26.

    Article  Google Scholar 

  23. Luca A, Lovi A, Galbusera F, Brayda-Bruno M. Revision surgery after PSO failure with rod breakage: a comparison of different techniques. Eur Spine J. 2014;23(Suppl 6):610–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuroregeneration Center, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Peng-Yuan Chang

  2. Departments of Neurosurgery & Rehabilitation Medicine, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 Northwest 14th Terrace, Miami, FL, 33136, USA

    Peng-Yuan Chang & Michael Y. Wang

Authors
  1. Peng-Yuan Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Y. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Y. Wang .

Editor information

Editors and Affiliations

  1. Joan O’Reilly Endowed Professor in Spinal Surgery, Vice Chairman, Department of Neurosurgery, University of California, San Francisco, California, USA

    Praveen V. Mummaneni

  2. Professor, Director of Spinal Surgery, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

    Paul Park

  3. University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Charles H. Crawford III

  4. Chief, Division of Spine Surgery, Associate Professor of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Adam S. Kanter

  5. Department of Orthopedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Steven D. Glassman

Rights and permissions

Reprints and permissions

Copyright information

© 2018 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chang, PY., Wang, M.Y. (2018). Lumbar Scoliosis (Degenerative) MIS Surgery (PSO/TLIF) Complication. In: Mummaneni, P., Park, P., Crawford III, C., Kanter, A., Glassman, S. (eds) Spinal Deformity . Springer, Cham. https://doi.org/10.1007/978-3-319-60083-3_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60083-3_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60082-6

  • Online ISBN: 978-3-319-60083-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation