A Novel Technique to Instrument Proximal and Distal Adjacent Segment Pathology

Abstract

Objective Revision surgeries for clinical adjacent segment pathology (ASP) are fraught with challenges. While various aspects of ASP is extensively covered in literature, there is a dearth of information related to the challenges encountered during these revision surgeries and salvage options. In this technical report, the authors describe a novel surgical technique for the management of Clinical ASP. Methods A 55 year old, obese diabetic woman, operated 5 years back for a L3-5 decompression and an instrumented postero-lateral fusion (PLF), developed symptomatic vertical instability at L5-S1 as well as lumbar canal stenosis at L2-3. Decompression and extension of the fusion both proximally and distally was planned. Several challenges were identified both technical and patient related and a novel technique developed to stabilise her. L5-S1 trans-foraminal lumbar inter-body fusion (TLIF) and L2-3 decompression and postero-lateral fusion (PLF) was fixed by bypassing the old fixation with proximal and distal screws and connecting rods. Results Patient was subsequently mobilised out of bed the next day and continues to do well 1 year post operatively as evidenced by an improved VAS and ODI score. Conclusion This technical report describes the current challenges encountered during revision surgery for ASD as well as the steps of a simple, easily implementable and hassle free solution to this unique problem.

Keywords

• spinal stenosis
• spinal instrumentation
• pedicle screws
• revision spine surgery
• spinal fusion