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Late Proximal Pedicle Hook Migration Into Spinal Canal After Posterior Correction Surgery of Scoliosis Causing Neurologic Deficit: “Proximal Junctional Scoliosis”? Case Series and a Review of the Literature

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Abstract

Study Design

Case series.

Objectives

We describe 4 patients with proximal pedicle hook migration as a late complication (greater than 12 months postoperatively) of posterior correction surgery in adolescent idiopathic scoliosis. We studied failure mechanisms and propose strategies for revision surgery.

Summary of background data

>Few published cases of hook migration into the spinal canal concern mainly intra-operative or early postoperative dislodgement. Re-operation rates for adolescent idiopathic scoliosis are 2% to 10%.

Methods

We retrospectively reviewed medical records and radiographic images in 4 patients with symptomatic pedicle hook migration into the spinal canal. We studied our scoliosis revision surgery rates over the past 10 years and reviewed the literature for instrumentation failure after scoliosis surgery.

Results

Our total re-operation rate between January 2002 and April 2012 was 7.0% (56 of 800 procedures), with a mean follow-up of 61 months (range, 6—129 months). Proximal hook migration presented in 1.0% (8 of 800 procedures), including 4 into the spinal canal. These 4 patients presented with pain symptoms 19—78 months after uneventful index posterior correction surgery. In all 4 patients, radiographic imaging showed proximal pedicle hook migration into the spinal canal without proximal sagittal alignment problems. In all patients, spinal fusion was observed on computed tomographic imaging and at revision surgery. Revision surgery consisted of at least hook removal. In all 4 patients, symptoms completely resolved over time.

Conclusions

Hooks can migrate and potentially cause neurologic impairment and pain long after index surgery, despite the presence of solid spinal fusion. We believe this is partly the result of the surgical technique we used and have since abandoned, and partly the proximal spine settling and fusion mass deformation over time, which we call “proximal junctional scoliosis.” We recommend computed tomographic imaging in case of postoperative symptoms and removal of hooks in case of hook migration into the spinal canal.

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References

  1. Rittmeister M, Leyendecker K, Kurth A, et al. Cauda equina compression due to a laminar hook: a late complication of posterior instrumentation in scoliosis surgery. Eur Spine J 1999;8:417–20.

    Article  CAS  Google Scholar 

  2. Remes V, Helenius I, Schlenzka D, et al. Cotrel-Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine (Phila Pa 1976) 2004;29:2024–30.

    Article  Google Scholar 

  3. Been HD, Kalkman CJ, Traast HS, et al. Neurologic injury after insertion of laminar hooks during Cotrel-Dubousset instrumentation. Spine (Phila Pa 1976) 1994;19:1402–5.

    Article  CAS  Google Scholar 

  4. Rose PS, Lenke LG, Bridwell KH, et al. Pedicle screw instrumentation for adult idiopathic scoliosis: an improvement over hook/hybrid fixation. Spine (Phila Pa 1976) 2009;34:852–7.

    Article  Google Scholar 

  5. Arlet V, Papin P, Marchesi D, et al. Adolescent idiopathic thoracic scoliosis: apical correction with specialised pedicle hooks. Eur Spine J 1999;8:266–71.

    Article  CAS  Google Scholar 

  6. Liljengvist U, Lepsien U, Hackenberg L, et al. Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J 2002;11:336–43.

    Article  Google Scholar 

  7. Kuklo TR, Potter BK, Lenke LG, et al. Surgical revision rates of hooks versus hybrid versus screws versus combined anteroposterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2007;32:2258–64.

    Article  Google Scholar 

  8. Grisafi FN, Emery SE. Migration of laminar hook causing thoracic myelopathy eight years post scoliosis surgery: a case report. Spine (Phila Pa 1976) 2010;35:228–39.

    Article  Google Scholar 

  9. Universal Spine System: technique guide. West Chester, PA: Synthes Spine; 2006.

  10. Langeloo DD, Lelivelt A, Journee L, et al. Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine (Phila Pa 1976) 2003;28:1043–50.

    Google Scholar 

  11. Campos M, Dolan L, Weinstein S. Unanticipated revision surgery in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2012;37:1048–53.

    Article  Google Scholar 

  12. Dobbs MB, Lenke LG, Kim YJ, et al. Selective posterior thoracic fusions for adolescent idiopathic scoliosis: comparison of hooks versus pedicle screws. Spine (Phila Pa 1976) 2006;31:2400–4.

    Article  Google Scholar 

  13. Wu X, Yang S, Xu W, et al. Comparative intermediate and long-term results of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. J. Spinal Disord Tech 2010;23:467–73.

    Article  CAS  Google Scholar 

  14. Kim YJ, Lenke LG, Cho SK, et al. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004;29:2040–8.

    Article  Google Scholar 

  15. Bjerkreim I, Steen H, Brox JI. Idiopathic scoliosis treated with Cotrel-Dubousset instrumentation: evaluation 10 years after surgery. Spine (Phila Pa 1976) 2007;32:2103–10.

    Article  Google Scholar 

  16. Karatoprak O, Unay K, Tezer M, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. Int Orthop 2008;32:523–9.

    Article  Google Scholar 

  17. Boos N, Dolan LA, Weinstein SL. Long-term clinical and radiographic results of Cotrel-Dubousset instrumentation of right thoracic adolescent idiopathic scoliosis. Iowa Orthop J 2007;27:40–6.

    PubMed  Google Scholar 

  18. Danielsson AJ, Nachemson AL. Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II. Spine (Phila Pa 1976) 2003;28:E373–83.

    Article  Google Scholar 

  19. Helenius I, Remes V, Yrjonen T, et al. Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis: long-term functional and radiographic outcomes. J Bone Joint Surg Am 2003;85:2303–9.

    Article  Google Scholar 

  20. Connolly PJ, Von Schroeder HP, Johnson GE, et al. Adolescent idiopathic scoliosis: long-term effect of instrumentation extending to the lumbar spine. J Bone Joint Surg Am 1995;77:1210–6.

    Article  CAS  Google Scholar 

  21. Laar van W, Meester RJ, Smit TH, et al. A biomechanical analysis of the self-retaining pedicle hook device in posterior spinal fixation. Eur Spine J 2007;16:1209–14.

    Article  Google Scholar 

  22. Kim JY, Bridwell KH, Lawrence GL, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine (Phila Pa 1976) 2005;30:2045–50.

    Article  Google Scholar 

  23. Helgeson MD, Shah SA, Newton PO, et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976) 2010;35:177–81.

    Article  Google Scholar 

  24. Arlet V, Shilt J, Ouellet J. The suprapedicle claw construct in anterior scoliosis surgery. Eur Spine J 2005;14:789–94.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Sint Maartenskliniek, Hengstdal 3, PO Box 9011, 6500, GM Nijmegen, The Netherlands

    I. M. P. Vereijken MD & M. de Kleuver MD, PhD

  2. Department of Orthopedic Surgery, VU University Medical Center, de Boelelaan 1117, PO Box 7057, 1081, HV Amsterdam, The Netherlands

    M. de Kleuver MD, PhD

Authors
  1. I. M. P. Vereijken MD
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  2. M. de Kleuver MD, PhD
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Corresponding author

Correspondence to M. de Kleuver MD, PhD.

Additional information

Author disclosures: IMPV (none); MD (consultancy for DePuy Spine; payment for lectures from DePuy Spine).

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Vereijken, I.M.P., de Kleuver, M. Late Proximal Pedicle Hook Migration Into Spinal Canal After Posterior Correction Surgery of Scoliosis Causing Neurologic Deficit: “Proximal Junctional Scoliosis”? Case Series and a Review of the Literature. Spine Deform 1, 229–236 (2013). https://doi.org/10.1016/j.jspd.2013.04.001

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  • DOI: https://doi.org/10.1016/j.jspd.2013.04.001

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