This fracture was diagnosed after all PSO operations at 58months postop after the patient felt a pop and shoulder pain. Should Your Spinal Hardware Be Removed? - HealthCentral Tensile forces through the posterior graft cause bone resorption and reduce the chance of obtaining solid fusion.[24]. Metal plates, cages, screws and rods may be used to hold the vertebrae together so they can heal into one solid unit. to maintaining your privacy and will not share your personal information without Further, we hypothesize that our lower rate may be underestimated due to minimum follow-up of 1year in some of these patients, or due to differences in surgical technique and instrumentation trends at our institution. Absolutely! The patient underwent reoperation for replacement of the broken rods, adjustment of the occipitocervical angle, maintenance of the bone graft bed, and fusion. All rights reserved. Google Scholar. Neurosurgery 2012;71:8628. Subsequently, in 1927, Forrester described atlantoaxial and occipitocervical fusion for an unstable odontoid fracture with a fibular onlay graft, which led to satisfactory clinical results. Eur Spine J. Multicycle mechanical performance of titanium and stainless steel transpedicular spine implants. During the second operation, full bone graft fusion was achieved by unicortical iliac bone graft struts and morcellized bone chips. (A) Plain cervical radiographs taken at 31-month follow-up after the first operation showing breakage of the right rod in the region of the occipitocervical junction. Google Scholar. statement and Wolters Kluwer Health Miyazaki M, Hymanson HJ, Morishita Y, et al. VP helped draft the manuscript. Eur Spine J 2012;21:32834. Spine (Phila Pa 1976). Google Scholar. However, while mechanical complications after PSO have been well described, these complications after SPO havent specifically been of focus. 2013;22 Suppl 2:S25464. Of note, no large series to date has cited the incidence of RF and CSRF subset in a combined cohort of adult spinal deformity patients treated with either PSO and/or SPO and compared the incidence between the two procedures. 2006;31:16807. Spinal fusion may be used to treat . A spine that's unstable in other areas A fusion that's taking longer than expected to form Hardware that wasn't positioned correctly (also a rare occurrence) If you do have spine hardware inserted, reduce the risk of it breaking or becoming loose by following your surgeon's instructions. Lumbar fusion means that you take a part of the spine that's painful and bolt it together and add bone so it grows together and doesn't move (2). In this report, we present a case of revision surgery in a female patient who experienced rod breakage after occipitocervical fusion. On October 18, 2014, a posterior revision was performed. Rod breakage after occipitocervical fusion for BI and AAD. In our opinion, a nonideal angle of the OC2A and/or POCA, establishing occipitalcervical imbalance and a concentration of stress, was the most likely reason for the rod breakage in our patient. Other variables associated with increased risk but only meeting borderline statistical significance included 2 crosslinks vs. <2 crosslinks (RF and CSRF) and screw density, complete vs. incomplete (CSRF only). Spine (Phila Pa 1976). Clinically significant total rod fracture rate was 5.3% and post-PSO rate was 8.1%. Of 402 patients with radiographically apparent solid fusion, 9.5% (38) subsequently suffered a broken rod. Postoperative increase in occiput-C2 angle negatively impacts subaxial lordosis after occipito-upper cervical posterior fusion surgery. Seventy-five patients were left for analysis including 50 female and 25 male, mean age was 59 (range, 2482; SD, 12.9), Table1. Rod breakage after occipitocervical fusion (OCF) has never been described in a patient who has undergone surgery for basilar invagination (BI) and atlantoaxial dislocation (AAD). Masanori I, Masashi N, Mitsuru T, et al. Spinal fusion is a surgical procedure used to correct problems with the small bones in the spine (vertebrae). Here, we present an unusual but significant case of revision surgery to correct this complication. If Dr. Maroon has recommended a lumbar fusion, he now typically uses a facet fusion system called TruFUSE . At her first outpatient visit, plain cervical radiographs showed the following in the sagittal plane: a 9.5-mm distance from the odontoid tip to Chamberlain line and an atlas-dens interval (ADI) of 7 mm (Fig. At the 31-month follow-up after her first operation, the patient complained of severe neck pain and limitation of motion, suggesting rod breakage. If patients had both SPOs and PSO, they were included in the PSO group only. Revision surgery for non-union in adult spinal deformity. Whats the Difference Between Vertebroplasty and Kyphoplasty? Additionally, 9 patients were excluded based on a subsequent operation during first postoperative year for reasons other than rod fracture. A recent finite element analysis of a PSO model comparing mono-axial vs. poly-axial screws showed rod contour affected the location of bending moments and stress [34]. AN participated in the study design, provided statistical analysis, and helped draft the manuscript. Epub 2020 Feb 11. Spine (Phila Pa 1976). Third, cyclic loading causes repeated metal strain leading to inherent metal fatigue and failure, particularly in titanium constructs [2224, 28], while single incident instrumentation overloading is less common [28]. Domino connectors were added during the subsequent PSOs to connect to original instrumentation. Unauthorized use of these marks is strictly prohibited. Lastly, an extremely unbalanced spine requiring additional support can be a factor necessitating pelvic fixation and thus contributing to rod stress. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. All authors read and approved the final manuscript. Spine (Phila Pa 1976). These findings demonstrate a serious loss of balance and vertebral instability in the region of the occipitocervical junction and cervical sagittal plane. When Spine Hardware Breaks & What You Can Do - Inspired Spine Correspondence: De Jun Zhong, Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. The medical records and roentgenograms of 2,016 patients who were operated on from 1961 through 1974 using Harrington spinal instrumentation were reviewed to determine the incidence, clinical significance, and management of broken distraction and compression rods. Second, suitable rods were installed and the balance of the craniocervical junction was restored. Tang JA, Leasure JM, Smith JS, Buckley JM, Kondrashov D, Ames CP. For more information, please refer to our Privacy Policy. Google Scholar. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Understanding types of back surgery - Mayo Clinic Health System Veena S, Rebecca M, Pirjo M, et al. Of the 6 LTFU patients, 4 were unable to be reached via follow-up phone calls and 2 had deceased. We suggest that it is necessary and important to give close attention to the positions of the fixed occipital bone and axis during procedures of occipitoaxial fusion. A recent study on RF in patients undergoing instrumented posterior fusion (including a subset of PSO patients) found statistically significant risk factors for RF in this population including age, body mass index (BMI), baseline sagittal imbalance, baseline pelvic incidence minus lumbar lordosis (PI-LL) mismatch, and greater sagittal imbalance correction [19]. 2012;71:8627. Atlo-axoid fracture: dislocation. 45 years post-op spinal fusion w / harrington rod. Only 3 of the 25 total subjects with postoperative sagittal imbalance developed RF during the follow-up period. Factors that may lead to breakage of the rod include multi-level fusion (greater stress on the rod), very weak spine (often broken back places large forces across the rod), deformed spine requiring surgical correction (again places large forces across the rod), bent rod (may weaken the rod but is usually necessary to align the spine), smaller diameter rod (less strong but necessary at certain areas of the spine), large patient, too active patient or someone who falls or involved in an accident (increased forces across the rod). There is a lack of information in the literature on this subject. Long, Mitchell King-wei DOa; Enders, Tyler DOa; Leven, Dante DOa; Cappellino, Anthony MDb, aDepartment of Orthopedics, Nassau University Medical Center, East Meadow, NY, bDepartment of Orthopedics, Good Samaritan Hospital, West Islip, NY, Address correspondence and reprint requests to Anthony Cappellino, MD, 2201 Hempstead Turnpike Suite 668, East Meadow, NY 11554; E-mail: [emailprotected]. Methods: Brain & Nerves - Spinal Cord Disorders: Broken titanium rods Federal government websites often end in .gov or .mil. These two variables also showed increased risk, but only held borderline significance in the CSRF subset. If you feel any significantly increased pain, or something just doesn't feel right after your spine surgery, contact your surgeon right away to address the issue. 40 Year Follow-Up After Harrington Rod Surgery - SRS Static and fatigue biomechanical properties of anterior thoracolumbar instrumentation systems. Charosky S, Moreno P, Maxy P. Instability and instrumentation failures after a PSO: a finite element analysis. What You Need to Know About This Minimally Invasive Treatment, What to Expect After a Balloon Kyphoplasty Procedure. Odds ratios (OR) were calculated to evaluate the association between risk factors and RF. official website and that any information you provide is encrypted Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, Revision surgery after rod breakage in a patient with occipitocervical fusion: A case report, Other articles in this journal by Chao Tang. This patient had two subsequent PSO operations after the original PSO operation. No CSRFs were found <12months postop with an average time to fracture of 14.8months. Rod fracture #3 was diagnosed 14months postop and occurred at T11-T12 with associated T11-12 pseudarthrosis. Rigid occipitocervical fixation: indications, outeonles, and complications in the modern era. Multiple authors have described increased complications [4, 6, 1416], pseudarthrosis [3, 4, 14, 15, 17], and instrumentation failure including rod fracture (RF) in PSO patients [4, 6, 14, 18]. Spinal fusion mimics the normal healing process of broken bones. 2023 BioMed Central Ltd unless otherwise stated. On the contrary, the VAS (2), JOA (16), and NDI (7) were better than at follow-up after the first operation. No symptoms other than an initial pop were described in this patient. Both lines were drawn perpendicular to the rods. Eur Spine J. Eur Spine J 2009;18:712. The incidence of rod fracture varies depending on impact of different confounders. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. PMID:3978906. Discomfort in the back Numbness or tingling in the back, legs, or extremities A lot of these symptoms overlap with other spine conditions and injuries so it can be hard to identify broken hardware at times. Revision surgery after rod breakage in a patient with occipitocervical These rods fractured at the apex of the rod bend with an 81 sagittal rod contour. bDepartment of Gastroenterology, Affiliated Hospital of Southwest Medical University, China. may email you for journal alerts and information, but is committed Smith JS, Shaffrey CI, Ames CP, et al. Anterior instrumentation of the thoracolumbar spine. 2010;28:E4. Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, et al. Effect of severity of rod contour on posterior rod failure in the setting of lumbar pedicle subtraction osteotomy (PSO): a biomechanical study. 2014;23(11):23409. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Factors that may lead to breakage of the rod include multi-level fusion (greater stress on the rod), very weak spine (often broken back places large forces across the rod), deformed spine requiring surgical correction (again places large forces across the rod), bent rod (may weaken the rod but is usually necessary to align the spine), smaller di. All patients meeting inclusion and exclusion criteria were included for RF and CSRF incidence analysis. I am 52 y/o female. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. [9]. L5 S1 Fusion Surgery: Success Rate & Complications - CSC Epub 2014 Oct 17. Medtronic has the only MIS+ portfolio that blends AI powered data science, robotics, navigation, spinal access, patient-specific implants and biologics to revolutionize streamlined workflows all under one roof. First, pelvic fixation may be a confounder to fusion across the lumbosacral junction of the spine, as pelvic fixation can only be present in those with fusion across the lumbosacral junction. Is a Spine Fusion Major Surgery?