Sagittal plane deformity surgery (VCR) complication


Book Section

© The Author(s) 2018. Surgery for adult spinal deformity (ASD) remains a technically challenging undertaking. Improvements in surgical techniques, instrumentation, and perioperative management have enabled correction of increasingly more complex multiplanar deformities. The surgical treatment of fixed sagittal plane deformities typically involves multilevel instrumentation and segmental release with osteotomies for the restoration of global spinopelvic alignment. Three-column osteotomies (3COs) are powerful techniques allowing for simultaneous multiplanar deformity correction from a posterior surgical approach. Serious complications may occur in these complex spinal reconstructive procedures, and postoperative instrumentation failure, especially at the osteotomy site, is among the more common of these complications (Auerbach et al. Spine (Phila Pa 1976) 37(14):1198-1210, 2012; Bianco et al. Neurosurg Focus 36(5):E18, 2014; Boachie-Adjei Instr Course Lect 55:583-589, 2006). We present a case of a 59-year-old man with degenerative kyphoscoliosis and progressive back and leg pain after multiple prior spine surgeries. The patient presented with a combination of symptoms from recurrent stenosis to progressive sagittal spinopelvic malalignment. The patient was found to have recurrent lumbar stenosis due to heterotopic bone formation and a fixed thoracolumbar kyphosis with severe sagittal malalignment. The patient underwent a T4-sacrum instrumented fusion with revision laminectomy, multilevel transforaminal lumbar interbody fusion (TLIF), supplemental iliac bolts, and a T10 vertebral column resection (VCR). The patient developed an asymptomatic rod fracture at the level of the VCR 8 months after the initial surgery requiring a reoperation. The patient experienced a second rod fracture later at the lumbosacral junction 6 months later, again requiring a reoperation for instrumentation failure and pseudarthrosis.

Full Text

Duke Authors

Cited Authors

  • Quinn, JC; Buchholz, AL; Smith, JS; Shaffrey, CI

Published Date

  • January 1, 2017

Book Title

  • Spinal Deformity: A Case-Based Approach to Managing and Avoiding Complications

Start / End Page

  • 281 - 290

International Standard Book Number 13 (ISBN-13)

  • 9783319600826

Digital Object Identifier (DOI)

  • 10.1007/978-3-319-60083-3_30

Citation Source

  • Scopus