Adult revision surgery of prior hook-and-rod wire instrumentation for idiopathic scoliosis

Rebecca M Burke,Thomas J Buell,Dominic M Maggio,Ulas Yener,Christopher I Shaffrey,Justin S Smith,Chun-Po Yen

doi:10.3171/2020.1.focusvid.19742

Rebecca M Burke, Thomas J Buell + Show 5 more

Open Access

https://doi.org/10.3171/2020.1.focusvid.19742

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Abstract

Adolescent idiopathic scoliosis patients treated with spinal fusion may develop adjacent segment disease and curve progression into adulthood. Revision operations can be challenging, especially for adult patients treated with outdated instrumentation such as sublaminar hooks and/or wires. The authors demonstrate revision lumbar spine surgery in a 38-year-old female with scoliosis progression from junctional degeneration below a prior T5–L3 posterior instrumented arthrodesis with a hook-and-rod wire system. They also demonstrate safe application of an ultrasonic bone scalpel for completion of a Smith-Petersen osteotomy. The patient provided written, informed consent for all material presented in this case demonstration.The video can be found here: https://youtu.be/3PmaFtNcqKc.

Highlights

We demonstrate a case of revision surgery of an adult patient that had been surgically treated as an adolescent for idiopathic scoliosis
The surgical plan involved cutting the distal portions of the previous rods at L1–2; placement of pedicle screw instrumentation starting from L3 through S1 and extending down to the ilium; L3–4, L4–5, and L5– S1 Smith-Petersen osteotomies; L3–4, L4–5, and L5–S1 discectomies and transforaminal lumbar interbody fusion with titanium interbody spacers with dimensions as below; placement of rods spanning from side-to-side connectors at L2–3 extending to the bilateral iliac bolts; and placement of a third accessory rod
We demonstrate utilization of the ultrasonic bone scalpel to complete the initial cut through the bilateral pars and lamina

Summary

Introduction

KEYWORDS adjacent-level disease; adult spinal deformity; idiopathic scoliosis; revision spine surgery; ultrasonic bone scalpel; video We demonstrate a case of revision surgery of an adult patient that had been surgically treated as an adolescent for idiopathic scoliosis. Scoliosis films demonstrate prior instrumentation from T5–L3 with a hook-and-rod wire system. Her CT myelogram demonstrated multilevel degenerative disease most significant at the adjacent distal levels including L3–4 and L4–5 with associated vacuum disc.

Results

Conclusion