26. Risk Factors and Outcomes for Catastrophic Failures at the Top of Long Pedicle Screw Constructs (FPSC): A Matched Cohort Analysis Performed at a Single Center

O'Leary, Patrick; Good, Christopher R.; Lenke, Lawrence G.; Buchowski, Jacob M.; Kim, Yong-Jung; Karlow, Jennifer A.

doi:10.1016/j.spinee.2008.06.030

Cited by 38 publications

(51 citation statements)

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“…O'Leary et al [4] investigated the risk factors and outcomes for PJF of adult patients who had undergone spinal fusion from the thoracic spine to the sacrum. They reported that the incidence of PJF after surgery was 4.9 % (13 of 264) over an 8-year period at a single institution.…”

Section: Discussionmentioning

confidence: 99%

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Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Odate¹,

Shikata²,

Fujibayashi

et al. 2012

Eur Spine J

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Purpose We describe cases presenting with progressive thoracic myelopathy after lumbopelvic fusion attributed to proximal junctional vertebral compression fracture (PJF) followed by spinal calcium pyrophosphate dehydrate (CPPD) crystal deposition. Methods The study included six patients, ranging from 62 to 75 years. All patients had been treated previously with lumbopelvic fusion. The mean period from the detection of PJF to the onset of myelopathy was 4.8 months. Notably, five patients demonstrated upper-instrumented vertebra (UIV) collapse. Results After revision surgery involving decompressive laminectomy and extension of the spinal fusion, all patients experienced significant improvement. Photomicrographs of the resected ligamentum flavum showed CPPD crystals and multinucleated giant cells. Conclusions The combination of mechanical stress plus PJF and CPPD crystal deposition followed by a foreign body reaction to the deposited crystals caused myelopathy. Patients with radiographic evidence of PJF, especially UIV collapse, after lumbopelvic fusion should be followed carefully for the emergence of myelopathy.

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Section: Discussionmentioning

confidence: 99%

“…Any abnormal process that develops in the mobile segment next to a spinal fusion is known as an adjacent segment disease (ASD) [1][2][3]. Proximal junctional vertebral compression fracture (PJF) is one type of ASD that can sometimes result in severe neurological deficits [4,5].…”

Section: Introductionmentioning

confidence: 99%

Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Odate¹,

Shikata²,

Fujibayashi

et al. 2012

Eur Spine J

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“…The potentially modifiable risk factors include greater curvature correction [30,33,[45][46][47][48][49], combined anterior-posterior spinal fusion [19,33,42,44,50,51], fusion to the sacro-pelvis [30, 34, 40-42, 44, 52], and residual sagittal imbalance [53]. Nonmodifiable factors with clear correlation to PJK development include the following: older age (>55 years) [19,22,33,45] and severe pre-operative sagittal imbalance [30,42,44,46,49,52,[54][55][56]. Other less well-established but likely risk factors include low bone density [44], presence of a comorbidity [33], and high body mass index [22,33].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Nonmodifiable factors with clear correlation to PJK development include the following: older age (>55 years) [19,22,33,45] and severe pre-operative sagittal imbalance [30,42,44,46,49,52,[54][55][56]. Other less well-established but likely risk factors include low bone density [44], presence of a comorbidity [33], and high body mass index [22,33].…”

Section: Risk Factorsmentioning

confidence: 99%

Proximal junctional kyphosis and failure—diagnosis, prevention, and treatment

Nguyễn

Kong

Hart

2016

Curr Rev Musculoskelet Med

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Technical advancements have enabled the spinal deformity surgeon to correct severe spinal mal-alignment. However, proximal adjacent segment pathology (ASP) remains a significant issue. Examples include proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Agreement on the definition, classification, and pathophysiology of PJK and PJF remains incomplete, and an understanding of the risk factors, means of prevention, and treatment of this problem remains to be elucidated. In general, PJK is a relatively asymptomatic radiographic diagnosis managed with patient reassurance and monitoring. On the other hand, PJF is characterized by mechanical instability, pain, and more severe kyphosis, with potential for neurologic compromise. Patients who develop PJF more often require revision surgery than those with PJK. This chapter will review the current understanding of PJK and PJF.

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“…4,9,10,13 Another common complication is failure to properly lordose the spine, as well as symptomatic rod fracture in the middle of the fusion constructs that is generally located at the apex of the lordotic curve in the rods. 1 The occurrence of these complications is multifactorial and includes patient selection and construct design; however, we hypothesize that an important factor may be the intraoperative loads placed on the implants during these powerful correction maneuvers and the residual load states that may be left on the implants after the procedure.…”

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confidence: 99%

Biomechanical demands on posterior fusion instrumentation during lordosis restoration procedures

Kuo

Martin

Telles³

et al. 2016

SPI

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OBJECTIVE The goal of this study was to investigate the forces placed on posterior fusion instrumentation by 3 commonly used intraoperative techniques to restore lumbar lordosis: 1) cantilever bending; 2) in situ bending; and 3) compression and/or distraction of screws along posterior fusion rods. METHODS Five cadaveric torsos were instrumented with pedicle screws at the L1–5 levels. Specimens underwent each of the 3 lordosis restoration procedures. The pedicle screw pullout force was monitored in real time via strain gauges that were mounted unilaterally at each level. The degree of correction was noted through fluoroscopic imaging. The peak loads experienced on the screws during surgery, total demand on instrumentation, and resting loads after corrective maneuvers were measured. RESULTS A mean overall lordotic correction of 10.9 ± 4.7° was achieved. No statistically significant difference in lordotic correction was observed between restoration procedures. In situ bending imparted the largest loads intraoperatively with an average of 1060 ± 599.9 N, followed by compression/distraction (971 ± 534.1 N) and cantilever bending (705 ± 413.0 N). In situ bending produced the largest total demand and postoperative loads at L-1 (1879 ± 1064.1 and 487 ± 118.8 N, respectively), which were statistically higher than cantilever bending and compression/distraction (786 ± 272.1 and 138 ± 99.2 N, respectively). CONCLUSIONS In situ bending resulted in the highest mechanical demand on posterior lumbar instrumentation, as well as the largest postoperative loads at L-1. These results suggest that the forces generated with in situ bending indicate a greater chance of intraoperative instrumentation failure and postoperative proximal pedicle screw pullout when compared with cantilever bending and/or compression/distraction options. The results are aimed at optimizing correction and fusion strategies in lordosis restoration cases.

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26. Risk Factors and Outcomes for Catastrophic Failures at the Top of Long Pedicle Screw Constructs (FPSC): A Matched Cohort Analysis Performed at a Single Center

Cited by 38 publications

References 0 publications

Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Proximal junctional kyphosis and failure—diagnosis, prevention, and treatment

Biomechanical demands on posterior fusion instrumentation during lordosis restoration procedures

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