Advertisement

Revision strategies for failed adult spinal deformity surgery

  • Carlotta MartiniEmail author
  • Francesco Langella
  • Luca Mazzucchelli
  • Claudio Lamartina
Original Article

Abstract

Purpose

The aim of this study is to analyse the results of revision surgery for failed adult spinal deformity patients and to describe the surgical strategy selection process, based on the identification of the main clinical diagnosis responsible for failure.

Methods

We retrospectively reviewed the clinical and radiological data of 77 consecutive patients treated in a 3-year time (2016–2019) for surgical revision of long fusion (more than five levels fused) for adult spinal deformity in a high-volume spine centre, divided into four groups based on the diagnosis: rod breakage (RB) group, proximal junctional failure (PJF) group, distal junctional failure (DJF) group and loss of correction (LOC) group with symptomatic sagittal or coronal malalignment (including iatrogenic flatback).

Results

Seventy-seven patients met our inclusion criteria, with a female prevalence (66 F vs. 11 M). The mean age at revision surgery was 63. Fused levels before surgery were averagely 12, and revision added averagely two levels to the preexisting fusion area. Clinical status was apparently improved in ODI scores and VAS scores, while it was slightly worsened in SF36 scores. Different diagnosis groups have been addressed with different surgical strategies, according to the different surgical goals: interbody cages and multi-rod construct to improve stiffness and favour bony fusion, “kickstand” rod and “tie” rod to correct coronal and sagittal malalignment, specific rod contouring and proximal hooks in “claw” configuration to reduce mechanical stress at the proximal junctional area. Intraoperative complications occurred in 18% of patients and perioperative complications in 39%.

Conclusion

Revision surgery in long fusions for adult spinal deformity is a challenging field. Surgical strategy should always be planned carefully. A successful treatment is a direct consequence of a correct preoperative diagnosis, and surgery should address the primary cause of failure. All the above-mentioned surgical techniques and clinical skills should be part of surgeon’s expertise when managing these patients.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Revision surgery Spinal deformity Junctional kyphosis Distal kyphosis Non-union Complications 

Notes

Compliance with ethical standards

Conflict of interest

C Martini, F. Langella, L. Mazzucchelli and C. Lamartina declare that they have no conflict of interest.

Supplementary material

586_2019_6283_MOESM1_ESM.pptx (421 kb)
Supplementary material 1 (PPTX 422 kb)

References

  1. 1.
    Carreon LY et al (2019) Cost-effectiveness of operative versus nonoperative treatment of adult symptomatic lumbar scoliosis an intent-to-treat analysis at 5 year follow-up. Spine (Phila Pa 1976)Google Scholar
  2. 2.
    Cerpa M, Lenke LG, Fehlings MG (2019) Evolution and advancement of adult spinal deformity research and clinical care: an overview of the Scoli-RISK-1 study. Glob Spine J 9(1 Suppl):8s–14sCrossRefGoogle Scholar
  3. 3.
    Faraj SSA et al (2018) Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis. J Neurosurg Spine 28(6):573–580CrossRefGoogle Scholar
  4. 4.
    Yuksel S et al (2019) Minimum clinically important difference of the health-related quality of life scales in adult spinal deformity calculated by latent class analysis: Is it appropriate to use the same values for surgical and nonsurgical patients? Spine J 19(1):71–78CrossRefGoogle Scholar
  5. 5.
    Pitter FT et al (2019) Revision risk after primary adult spinal deformity surgery: a nationwide study with two-year follow-up. Spine Deform 7(4):619–626.e2CrossRefGoogle Scholar
  6. 6.
    Yagi M et al (2019) Risk, recovery, and clinical impact of neurological complications in adult spinal deformity surgery. Spine (Phila Pa 1976) 44:1364–1370CrossRefGoogle Scholar
  7. 7.
    Mobbs RJ et al (2016) Anterior lumbar interbody fusion as a salvage technique for pseudarthrosis following posterior lumbar fusion surgery. Glob Spine J 6(1):14–20CrossRefGoogle Scholar
  8. 8.
    Chan AK, Mummaneni PV, Shaffrey CI (2018) Approach selection: multiple anterior lumbar interbody fusion to recreate lumbar lordosis versus pedicle subtraction osteotomy: When, Why, How? Neurosurg Clin N Am 29(3):341–354CrossRefGoogle Scholar
  9. 9.
    Merrill RK et al (2017) Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity. Glob Spine J 7(6):514–520CrossRefGoogle Scholar
  10. 10.
    Kim YC et al (2014) Results of revision surgery after pedicle subtraction osteotomy for fixed sagittal imbalance with pseudarthrosis at the prior osteotomy site or elsewhere: minimum 5 years post-revision. Spine (Phila Pa 1976) 39(21):1817–1828CrossRefGoogle Scholar
  11. 11.
    Bederman SS, Le VH, Pahlavan S (2016) An approach to lumbar revision spine surgery in adults. J Am Acad Orthop Surg 24(7):433–442CrossRefGoogle Scholar
  12. 12.
    Melhem E et al (2016) EOS((R)) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 10(1):1–14CrossRefGoogle Scholar
  13. 13.
    Berjano P et al (2015) Corner osteotomy: a modified pedicle subtraction osteotomy for increased sagittal correction in the lumbar spine. Eur Spine J 24(Suppl 1):58–65CrossRefGoogle Scholar
  14. 14.
    Berjano P et al (2019) Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study. Eur Spine J 28(9):2198–2207CrossRefGoogle Scholar
  15. 15.
    Hyun SJ et al (2014) Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976) 39(22):1899–1904CrossRefGoogle Scholar
  16. 16.
    Alobaid A et al (2005) Pull-out strength of the suprapedicle claw construct: a biomechanical study. Eur Spine J 14(8):759–764CrossRefGoogle Scholar
  17. 17.
    Salvi G et al (2016) Biomechanical analysis of Ponte and pedicle subtraction osteotomies for the surgical correction of kyphotic deformities. Eur Spine J 25(8):2452–2460CrossRefGoogle Scholar
  18. 18.
    Dickson DD et al (2014) Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity. Spine (Phila Pa 1976) 39(15):1190–1195CrossRefGoogle Scholar
  19. 19.
    Hori Y, Hoshino M (2019) ISSLS PRIZE IN CLINICAL SCIENCE 2019: clinical importance of trunk muscle mass for low back pain, spinal balance, and quality of life-a multicenter cross-sectional study. Eur Spine J 28(5):914–921CrossRefGoogle Scholar
  20. 20.
    Makhni MC et al (2018) The “Kickstand Rod” technique for correction of coronal imbalance in patients with adult spinal deformity: theory and technical considerations. J Spine Surg 4(4):798–802CrossRefGoogle Scholar
  21. 21.
    Garin C, Boutrand S (2016) Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis. Int Orthop 40(9):1875–1882CrossRefGoogle Scholar
  22. 22.
    Sielatycki JA et al (2018) Autologous chondrocyte grafting promotes bone formation in the posterolateral spine. JOR Spine 1(1):e1001CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.GSpine4, I.R.C.C.S. Istituto Ortopedico GaleazziMilanItaly
  2. 2.Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly

Personalised recommendations