Nonunion at the lumbosacral junction is a classic complication of long construct and deformity corrections. Iliac fixations have been extensively studied in the literature and have demonstrated superior biomechanical proprieties and lower complication rates. S2 alar iliac screws address the drawbacks of classical iliac screws but demonstrate similar biomechanical advantage. The main aim of this paper was to describe the S1 alar iliac (S1AI) screw fixation technique while evaluating our early results. S1AI screw fixation technique has the advantage of being able to achieve pelvic fixation without dissection to the S2 pedicle entry and is therefore a viable option for salvage of a failed S1 promontory screw.
Congenital Abnormalities ; Lumbosacral Region ; Pseudarthrosis

Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging problems in pediatric orthopaedics. The treatment goals are osteosynthesis, stabilization of the ankle mortise by fibular stabilization, and lower limb-length equalization. Each of these goals is difficult to accomplish but regardless of the surgical options, the basic biological considerations are the same: pseudarthrosis resection, biological bone bridging of the defect by stable fixation, and the correction of any angular deformity. The Ilizarov method is certainly valuable for the treatment of CPT because it can address not only pseudarthrosis but also all complex deformities associated with this condition. Leg-length discrepancy can be managed by proximal tibial lengthening using distraction osteogenesis combined with or without contralateral epiphysiodesis. However, treatment of CPT is fraught with complications due to the complex nature of the disease, and failure is common. Residual challenges, such as refracture, growth disturbance, and poor foot and ankle function with stiffness, are frequent and perplexing. Refracture is the most common and serious complication after primary healing and might result in the re-establishment of pseudarthrosis. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed. This review describes a multi-targeted approach for tackling these challenges, which utilizes the Ilizarov technique in atrophic-type CPT.
Humans ; *Ilizarov Technique/adverse effects ; Pseudarthrosis/*congenital/*surgery ; Tibia/*surgery

OBJECTIVE: Iliac screw fixation has been used to prevent premature loosening of sacral fixation and to provide more rigid fixation of the sacropelvic unit. We describe our technique for iliac screw placement and review our experience with this technique. METHODS: Thirteen consecutive patients who underwent spinopelvic fixation using iliac screws were enrolled. The indications for spinopelvic fixation included long segment fusions for spinal deformity and post-operative flat-back syndrome, symptomatic pseudoarthrosis of previous lumbosacral fusions, high-grade lumbosacral spondylolisthesis, lumbosacral tumors, and sacral fractures. Radiographic outcomes were assessed using plain radiographs, and computed tomographic scans. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and questionnaire about buttock pain. RESULTS: The median follow-up period was 33 months (range, 13-54 months). Radiographic fusion across the lumbosacral junction was obtained in all 13 patients. The average pre- and post-operative ODI scores were 40.0 and 17.5, respectively. The questionnaire for buttock pain revealed the following: 9 patients (69%) perceived improvement; 3 patients (23%) reported no change; and 1 patient (7.6%) had aggravation of pain. Two patients complained of prominence of the iliac hardware. The complications included one violation of the greater sciatic notch and one deep wound infection. CONCLUSION: Iliac screw fixation is a safe and valuable technique that provides added structural support to S1 screws in long-segment spinal fusions. Iliac screw fixation is an extensive surgical procedure with potential complications, but high success rates can be achieved when it is performed systematically and in appropriately selected patients.
Buttocks ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Pseudarthrosis ; Surveys and Questionnaires ; Spinal Fusion ; Spondylolisthesis ; Wound Infection

BACKGROUND:Lumbar spine fractures treated conservatively or operatively may result in severe kyphotic deformity. Reliable operation plan should be made to prevent the development of delayed kyphosis in unstable lumbar spine fracture. STUDY DESIGN: Between September 1995 and March 1997, twelve cases with highly unstable lumbar spine fractures (7 according to'Load-sharing classification score') or fracture-dislocations were operated with combined retroperitoneal and posterior approach. The patients underwent anterior corpectomy, interbody fusion and short segment fixation with posterior transpedicular screws(1 level above and 1 level below). All patients were operated on the same day except one case. The patients were followed-up at least 12 months and mean follow-up period was 17.2 months after operation. The kyphotic angle was measured by Salter's method preoperative, immediate postoperative and at 12 months. RESULTS: There were 9 cases of burst fractures and 3 cases of fracture-dislocations. The mean kyphotic angle was 24degrees preoperatively, -5degrees postoperatively and -2degrees at 12 months follow-up. This means the patients regained normal lumbar lordosis after the operation and maintained on long term follow-up. There was no case of pseudoarthrosis or delayed kyphosis development during follow-up period. CONCLUSIONS: Highly unstable lumbar spine fracture with high load-sharing classification score could be treated to achieve normal lumbar lordosis immediate postoperatively and prevent kyphotic deformity on long-term follow-up evaluation with combined approach.
Animals ; Classification ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Pseudarthrosis ; Spine*

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the radiographic and clinical results of two-level discectomies and fusion with plating and a singlelevel corpectomy with plating. SUMMARY OF LITERATURE REVIEW: Previous studies of multisegment fusion have shown decreased fusion rates correlating with the number of increasing levels, and the use of anterior plate in multilevel fusions may be warranted because of the increased pseudoarthrosis rates. MATERIALS AND METHODS: A total 30 consecutive patients operated at our institutions between Oct. 1995 and Mar. 2000 were entered into this study. Twenty patients with cervical spondylosis had performed two-level discectomies with tricortical bone grafts and plating, and ten patients with cervical myelopathy had a single-level corpectomy with plating. Follow up averaged 2.4 years, radiographic and clinical follow up evaluation was performed. We assessed the radiologic value by postoperative and follow-up sagittal radiograms at monthly intervals until fusion was judged to be solid, and the clinical evaluation by Odom's criteria. RESULTS: Comparing the radiographic data between the two groups of patients, the values were not different. Of the thirty patients, no non-unions occurred in all patients. The average amount of graft collapse for patients with single-level corpectomy with plating or a two-level discectomy with plating was less than 1 mm for both groups. And, the average amount of kyphotic deformity was less than 1 degrees for both groups. The clinical results of the operations graded by Odom's criteria are no statistical significance between the two groups. (p < 0.9, chi test) CONCLUSION: There is no significant statistical differences for two-level discectomies with plating and a single-level corpectomy with plating in fusion rate and clinical results, and each methods can be used a viable alternative procedure by anatomical structure that were primarily causing the neural impingement with more reliable fusion rates.
Congenital Abnormalities ; Diskectomy* ; Follow-Up Studies ; Humans ; Pseudarthrosis ; Retrospective Studies ; Spinal Cord Diseases ; Spondylosis ; Transplants

The indications for surgical treatment of spondylolisthesis are as follows:pain unrelieved by conservative treatment. Persistent neurologic signs. Progression of the slip or slip greater than 50 per cent. Postural deformity or walking difficulty due to tight hamstring muscles. The goal of operation for spondylolisthesis is to relieve radiculopathy and low back pain, and to prevent further progression of the slip through decompression of neural elements and fusion for pseudoarthrosis. The authors performed the posterior lumbar interbody fusion using Threaded Fusion Cage(TFC) on 23 patients with spondylolisthesis. All patients have been followed for 3 to 12 months. We then studied the clinical and radiological outcomes of these patients and verified the relationship between clinical outcomes and radiological findings. Summaries of the results are as followings. 1) Successful bone fusion was achieved in 20 out of 23 cases(87%). 2) Neurological signs were improved in 20 out of 23 cases(87%). 3) The majority of cases which demonstrated radiologic bone fusion also showed clinical improvement. Posterior lumbar interbody fusion using TFC was useful in the treatment of mild degree spondylolisthesis.
Congenital Abnormalities ; Decompression ; Humans ; Low Back Pain ; Muscles ; Neurologic Manifestations ; Pseudarthrosis ; Radiculopathy ; Spondylolisthesis* ; Walking

PURPOSE: To evaluate the results of a posterior procedure with segmental pedicle screw fixation in severe adolescent idiopathic scoliosis > or =70 degrees. MATERIALS AND METHODS: Twenty-three adolescent idiopathic patients with a curve magnitude > or =70 degrees subject to segmental pedicle screw fixation were analyzed retrospectively with a minimum follow-up of 2 years (2-7.8 years). There were 19 females and 4 males with a mean age of 14.9 years. All patients, except for 4 patients with King type I, were subjected to thoracic curve fusion. Twenty patients showed a thoracic curve > or =70 degrees (70-96), and 4 patients had a lumbar curve > or =70 degrees (70-77), preoperatively. The preoperative and postoperative standing roentgenograms were used to check the radiological parameters. RESULTS: The mean preoperative thoracic curve was corrected from 79.5+/-9.1 degrees to 25.3+/-5.8 degrees at the most recent follow-up, showing a correction of 67.9+/-7.8% and loss of correction of 2.5+/-1.9%. The mean preoperative lumbar curve was corrected from 72.3+/-3.3 degrees to 30.0+/-10.1 degrees at the most recent follow-up (58.4+/-14.8% curve correction, 2.4+/-2.5% loss of curve correction). The mean preoperative lowest instrumented vertebral tilting was corrected from 30.0+/-7.4 degrees to 10.5+/-5.6 degrees, showing a correction of 64.8+/-20.9%. The preoperative thoracic kyphosis improved from 28.3+/-11.2 degrees (0-50 degrees) to 35.0+/-9.1 degrees (22-53 degrees) postoperatively. There was neither pseudoarthrosis nor complications related to the pedicle screws at the most recent follow-up. CONCLUSION: Segmental pedicle screw fixation without an anterior release procedure in severe adolescent idiopathic scoliosis produced a satisfactory deformity correction with no significant loss of the curve correction. This procedure obviates the need for the anterior release and reduces the complications associated with anterior surgery.
Adolescent* ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Male ; Pseudarthrosis ; Retrospective Studies ; Scoliosis*

PURPOSE: To determine the efficacy of minimally invasive plate osteosynthesis (MIPO) for distraction callus after a lengthening procedure with an external fixator. MATERIALS AND METHODS: Distraction osteogenesis were performed using an external fixator for growth arrest (7 cases), congenital pseudoarthrosis of tibia (2 cases), and congenital leg length discrepancy (2 cases). MIPO was performed using a locking compression plate over the distraction callus. The mean age of the index procedure was 11 years, and mean amount of distraction was 5.4 cm. Eight were treated earlier to remove the external fixator after achieving of the target length, and 3 were treated as a salvage operation of fractures after removal. RESULTS: In all patients, the distraction callus healed with its length or correction into the original alignment maintained. The mean external fixation index was 34.3 days/cm and the mean healing index was 52.6 days/cm. In 8 patients with the early removal of the external fixator, the mean external fixation index was 26.9 days/cm. No patient developed a deep infection or implant failure. All patients recovered their preoperative joint motion and were satisfied with their function. CONCLUSION: MIPO can prevent or correct a deformity after distraction osteogenesis, and allow patients to return to their daily life earlier.
Bony Callus ; Congenital Abnormalities* ; External Fixators ; Humans ; Joints ; Leg ; Osteogenesis, Distraction* ; Pseudarthrosis ; Tibia

Demand for surgical management of adult spine deformity has increased due to a recent increase in the elder population, development of surgical techniques, and increased desire for a better quality of life. More surgeries led to more and various complications. Complications of surgery for adult spine deformity have been reported from 37% to 53% depending on the types of disease, cause, and patient. This rate is higher than complications from general spine surgeries. Complications of surgery for adult spine deformity include; infection, excessive bleeding, nerve injury, pseudarthrosis, adjacent segment disease, and iliac screw complication. Factors influencing these complications include; old age, diabetes, steroid use, and osteoporosis. Proximal junctional kyphosis (PJK) is an abnormal kyphosis at the proximal level of the instrument after spine deformity surgery. Risk factors for PJK include; injury of paravertebral muscles and posterior ligament complex, over- and under-correction of coronal sagittal imbalance, age older than 55 years, and osteoporosis. There is a high risk of unexpected complications during surgery for adult spine deformity. Patients with degenerative spine sagittal imbalance are more prevalent in Korea than in Western countries. They tend to be old, have underlying diseases and osteoporosis, making them susceptible to complications related to instrumentation. Postoperative satisfaction tends to be low thus surgeons need to take care when selecting surgical methods and fusion level.
Adult* ; Congenital Abnormalities* ; Hemorrhage ; Humans ; Korea ; Kyphosis ; Ligaments ; Muscles ; Osteoporosis ; Pseudarthrosis ; Quality of Life ; Risk Factors* ; Spine*

PURPOSE: To report the clinical findings and results of the surgical treatment of the spinal pseudarthrosis in ankylosing spondylitis patients. MATERIALS AND METHODS: We reviewed 24 destructive vertebral lesions in 15 patient with ankylosing spondylitis who underwent pseudarthrosis repair and/or correction of kyphotic deformity. We assessed the clinical, laboratory, pathological and radiological findings. We performed anterior interbody fusion with or without Smith-Petersen osteotomy (SPO) at the level of pseudarthrosis. Pedicle subtraction osteotomy (PSO) was performed additively at lumbar spine in severe kyphotic patients. Clinical outcomes and complications were assessed. RESULTS: Traumatic history and inflammatory reaction were not universal findings. Histopathological specimens showed fibrous degeneration with sclerotic bony spicules and mild chronic inflammation. We performed AIF with SPO in 12 kyphotic patient with additional PSO in 6 patients. Posterior interbody fusion was performed in non-kyphotic patients. Radiolographic results demonstrated solid union of pseudarthrosis at average 4.2 months after operation and sagittal imbalance was improved from 24 cm to 4.2 cm at follow up. The subjective satisfactions of the patients at the last follow up were excellent or good in all of the cases. CONCLUSION: The principal etiology of pseudarthrosis in ankylosing spondylitis thought to be a mechanical weakness of unfused segment. Most of patients have had good clinical results by surgical stabilization of destructed anterior column with or without correction of deformity in combination with SPO and PSO.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Inflammation ; Osteotomy ; Pseudarthrosis* ; Spine ; Spondylitis, Ankylosing*