Pedro Fernandes University Hospital Santa Maria

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Pedro Fernandes University Hospital Santa Maria Failure of lumbopelvic fixation Clinical Case Pedro Fernandes University Hospital Santa Maria

Failure of lumbo sacral fixation Pseudarthrosis Kostuick e Hall 1983 – 40% Boachie et al 1991 – 41% (83% comp) Devlin et al 1991 - 33% ( 41% comp) Sagital deformity Instrumentation failure Long fusion to the sacrum in adult spine deformity presents a challenging surgical dilemma. Fusion to the sacrum in the management of adult, nonparalytic deformity is indicated in cases involving a fixed lumbosacral curve, lumbosacral pain, degenerative disease, spinal stenosis below a prior fusion, or those involving pseudarthrosis. However, these long fusions often are associated with high rates of complications such as pseudarthrosis, sagittal deformity, and instrumentation failure.5,14,20

Galveston technique

S1 – Iliaque screws

Adult deformity surgery!

Adult deformity surgery!

Clínical Case 75 years old lady Severe lumbar pain with neurogenic claudication Marked flex-forward posture Slow gait with support Unhable to walk on her eels with weak dorsiflexors III/V Sensation intact / Hyporreflexia No vascular compromise

Clinical Case

Caso Clínico

Clinical case Aprill 2012

I&D at day 8 post-op Wound deiscence with drainage I&D performed with debridement, Bone graft removed and wound closed over two drains Vancomicine and Meropenem started Gram – isolated Meropenem kept for 6 weeks IV suitched to cefuroxime up to 3 months

Clinical Case 08/14 02/14

Clinical case

Chon W. et al J Neurosurg Spine 2013 Failures of Lumbopelvic fixation 23/67pts Major failures - 8 (11,9%) Rod breakage S1<<L4, Iliaque crew failure, proeminent iliaque screw req. removal Minor Failures – 15 (23%) Rod breakage Il screw <S1 and failure iliac screw not req removal

Discussion Role of anterior surgery in this case What to do to with infected bone graft Proximal level selected

Discussion What to do Extension to T2 with rod replacement bilaterally and allograft, if possible anterior support in L4L5 Do we need any PSO?