Figure - uploaded by Yoon-Chung Kim
Content may be subject to copyright.
Postoperative plain radiographs showing extended instrumented fusion with decompressive laminecotmy and discectomy.
Source publication
We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a...
Context in source publication
Context 1
... posterior approach was used to remove the mass. After a total laminectomy (using a high-speed burr) of T9-T10, the sequestrated disc was detected posterolateral to the dural sac, and was excised without damaging the spinal cord. Instrumented fusion was then performed from T8 to T10 (Fig. 3). Immediately after surgery, improvement was noted in the left lower extremity hyposthesia, with partial muscle contractions in both lower extremities by day 4. The MRI study performed at day 7 postoperative failed to reveal any residual sequestrated disc, and the motor grades of both extremities were restored close to the ...Similar publications
Introduction. There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (A...
Citations
... Among them is adjacent disc degeneration, which may be due to increased stress adjacent to fusion. However, to the best of our knowledge, only three cases of thoracic disc herniation after posterior fusion have been reported [2][3][4]. Here, we present a case of sudden lumbar huge disc herniation with acute paraplegia after posterior short fusion without any adjacent segment degeneration just before the herniation occurred. ...
... Proximal adjacent segment degeneration or disc degeneration after instrumented spinal fusion has been widely reported [6][7][8]. However, to our knowledge, there have been only three reports of disc hernia after spinal fusion [2][3][4]. All the cases occurred in the thoracic level after long spinal fusion. ...
... In the other two cases [3,4], junctional failure occurred in the thoracic disc level itself, without any failure of the upper instrumented vertebra and the supra-adjacent vertebra. According to Badra et al. [3], stress concentration at the proximal adjacent disc space between two stiff vertebrae led to acute disc failure. ...
A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3-5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an "intact" disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted.
... Adult thoracolumbar fusion and instrumentation is a relatively common surgical procedure that is used for treatment of different spine pathologies including degenerative scoliosis , flat-back deformities and revision cases where extension of instrumentation to the upper thoracic segments is often needed to achieve an acceptable sagittal balance and to decrease the risk of construct failure. Several adjacent segment problems, mainly at the proximal level, have been reported after such procedures123456 . These problems include proximal adjacent disc degeneration, failure of the instrumentation at the upper-instrumented vertebra (UIV) and fracture of the UIV or the first mobile vertebra above it, leading to sagittal thoracic decompensation. ...
... Proximal junctional severe disc degeneration causing spinal stenosis has also been reported as a complication [3]. However, to our knowledge, only one case of thoracic disc herniation of the adjacent segments following long instrumented thoracolumbar fusion with rapidly progressing myelopathy has been described [4]. We report on a case of acute upper thoracic disc herniation (T4-T5) with rapidly progressing paraplegia after T5 to S1 spinal fusion and in- Mohammad Ibrahim Badra et al. 56 Asian Spine J 2013;1:55-59 strumentation with bone cement augmentation at the adjacent segments. ...
... Adjacent segment disease following long instrumented thoracolumbar fusion has been widely reported in medical literature123. Stress concentration on the proximal junctional area after such procedures may lead to several junctional problems such as proximal adjacent disc degeneration, stress fracture of the upper instrumented vertebra or the first mobile vertebra above it with a loss of sagittal balance456. In a retrospective study that included 35 patients with long lumbar-instrumented fusion, Kim et al. [9] reported a 43% prevalence of proximal adjacent segmental problems. ...
Proximal junctional disease is a well-recognized postoperative phenomenon in adults who are undergoing long thoracolumbar fusion and instrumentation, and is attributed to increased a junctional stress concentration. In general, the onset of symptoms in these patients is insidious and the disease progresses slowly. We report on a contrary case of rapidly progressing paraplegia secondary to acute disc herniation at the proximal adjacent segment after long posterior thoracolumbar fusion with cement augmentation at the upper instrumented vertebra and the supra-adjacent vertebra. The patient was treated with a discectomy through the costo-transverse approach combined with extension of the posterior instrumentation. The patient's neurological status improved markedly. Stress concentration at the proximal junction disc space may have caused accelerated disc degeneration which in turn lead to this complication.
OBJECTIVE
Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine.
METHODS
Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors’ experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined.
RESULTS
Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months.
CONCLUSIONS
This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.
