ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2020
Revision strategies for failed adult spinal deformity surgery.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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5 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Systematic review and meta-analysis for the impact of rod materials and sizes in the surgical treatment of adult spine deformity.Spine deformity · 2022Pooled it
- Surgical technique: proximal extension of instrumentation using sublaminar bands for salvage of postoperative proximal junctional failure in pediatric patients.Spine deformity · 2024Article
- Revision Surgery for Proximal Junctional Kyphosis and the Role for Addressing Residual Deformity.International journal of spine surgery · 2023Article
- Revision Surgery Due to Proximal Junctional Failure and Rod Fracture in Adult Deformity Surgery at a Single Institution in Japan.Spine surgery and related research · 2022Article
- Correction of a severe coronal malalignment in adult spinal deformity using the "kickstand rod" technique as primary surgery.Journal of orthopaedicsArticle
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4 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
purposeThe 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.
methodsWe 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).
resultsSeventy-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%.
conclusionRevision 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. These slides can be retrieved under Electronic Supplementary Material.
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