ArticleJournal of spine surgery (Hong Kong)2024
Hardware failure following multilevel posterior percutaneous fixation using the minimally invasive antepsoas (MIS-ATP) approach in adult spine deformity.
Article in Journal of spine surgery (Hong Kong), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
Background: Adult spinal deformities (ASDs) requiring long fusions to the lumbosacral junction are notorious for L5-S1 pseudarthrosis and hardware-related complications. The minimally invasive surgery antepsoas (MIS-ATP) technique allows for substantial anterior column reconstruction thereby reducing the risk of posterior hardware-related complications. This study investigates the incidence of posterior hardware-related complications following long-segment fusion (seven or more vertebrae) using MIS-ATP and posterior percutaneous fixation (PPF). Methods: This is a retrospective review of patients who underwent long spinal fusion (MIS-ATP + PPF) to the sacrum and pelvis for the management of ASD between 2008 and 2019. Postoperative clinical complications and radiographic parameters were collected and analyzed. The following postoperative variables were collected: surgical site infections, neuro-vascular injuries, implant fracture, implant displacement, hardware prominence and related pain, pseudarthrosis, junctional disease (proximal and distal), and need for surgical revision. Results: A total of 143 patients were included in this study. The most common indications for fusion included: degenerative scoliosis (76.9%) and degenerative spondylolisthesis (17.5%). The average number of fused vertebrae per individual was 8.7. The most common levels fused were: T12-S1 anterior/T10-S1 posterior (53.1%). Forty-four patients (30.8%) experienced a total of 48 complications: pseudarthrosis (2.1%), deep infections (4.2%), painful iliac hardware (5.6%), pedicle screw complications (6.3%), and proximal junctional disease (PJD) (9.8%). Of these, 30 patients (21%) required revision surgery, mostly due to PJD (8 patients; 5.6%). Conclusions: Long spinal fusions to the sacrum and pelvis are technically challenging and notorious for hardware failure (HF) and revision surgeries. The use of MIS-ATP fusion coupled with PPF could provide a safe and effective strategy against posterior HF. Furthermore, additional benefits of the MIS-ATP technique are inherent to its relatively safe approach-related profile.
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