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KMID : 1040920170020010044
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Journal of Minimally Invasive Spine Surgery and Technique
2017 Volume.2 No. 1 p.44 ~ p.46
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A Novel Technique to Instrument Proximal and Distal Adjacent Segment Pathology
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Kulkarni Arvind Gopalrao
Dutta Shumayou
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Abstract
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Objective: Revision surgeries for clinical adjacent segment pathology (ASP) are fraught with challenges. While various aspects of ASP is extensively covered in literature, there is a dearth of information related to the challenges encountered during these revision surgeries and salvage options. In this technical report, the authors describe a novel surgical technique for the management of Clinical ASP.
Methods: A 55 year old, obese diabetic woman, operated 5 years back for a L3-5 decompression and an instrumented postero-lateral fusion (PLF), developed symptomatic vertical instability at L5-S1 as well as lumbar canal stenosis at L2-3. Decompression and extension of the fusion both proximally and distally was planned. Several challenges were identified both technical and patient related and a novel technique developed to stabilise her. L5-S1 trans-foraminal lumbar inter-body fusion (TLIF) and L2-3 decompression and postero-lateral fusion (PLF) was fixed by bypassing the old fixation with proximal and distal screws and connecting rods.
Results: Patient was subsequently mobilised out of bed the next day and continues to do well 1 year post operatively as evidenced by an improved VAS and ODI score.
Conclusion: This technical report describes the current challenges encountered during revision surgery for ASD as well as the steps of a simple, easily implementable and hassle free solution to this unique problem.
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KEYWORD
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Spinal stenosis, Spinal instrumentation, Pedicle screws, Revision spine surgery, Spinal fusion.
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