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

2. Failure of lumbo sacral fixation
Pseudarthrosis
Kostuick e Hall 1983 – 40%
Boachie et al 1991 – 41% (83% comp)
Devlin et al % ( 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

3. Galveston technique

4. S1 – Iliaque screws

5. Adult deformity surgery!

6. Adult deformity surgery!

7. 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

8. Clinical Case

9. Caso Clínico

10. Clinical case
Aprill 2012

11. 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

12. Clinical Case
08/14 02/14

13. Clinical case

14. 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

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

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