Spine Lecture: nonunion of PSO pedicle subtraction osteotomy

1. PSO non-union
Upper Chesapeake Medical Center Spine Conference
March 2nd, 2018

2. 3/29/16
66 year old woman
cc:LBP
HPI: pain onset June
2017 15 months postop
PMH: L2S1 PSF Dr.
McDonald 1962 age 12
for high grade
spondylolisthesis
T9S1 PSF L3 PSO for
flat back and back pain
3/14/16 difficult recovery,
2 months in rehab
B TSA, L THA x2,
anxiety, R TKA
Exam: 4’11” 175 lb

3. 2013

4. 2013

7. MRI 2/24/17

8. Spinal canal open at all levels

9. no evidence of fusion
Vacuum sign at L2L3 disc space

10. Vacuum sign

11. T9

12. In-out-in

14. T9

16. L2

19. L4
No bone present posteriorly

26. Is this lateral screw symptomatic because the
chief complaint was R LBP

28. Widening of SI joints bilaterally

30. After osteotomy Before osteotomy

31. Paul Harrington,
M.D.
1911-1980
Kansas
National javelin
champ
WW2 service
Harrington Rod 1953
for polio
Baylor Texas
1M cases 1960-1990

38. Neurosurgical Focus
May 1 2014 | Volume 36 | Issue 5 | ppg E18 doi: 10.3171/2014.2.FOCUS1422
Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective
review of 423 patients.
Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I, Mundis G Jr, Shaffrey CI, Kebaish K, Hostin R, Hart R,
Gupta MC, Burton D, Ames C, Boachie-Adjei O, Protopsaltis TS, Lafage V, International Spine Study Group
• 423 patients 8 centers
• IOC: 7%
• POC: 39%
• Overall complications 42%
• Cord deficit 2.6%
• MBL 4 liters 24%
• Average EBL: 3 liters

43. Optimally PSO should include the disc space

44. After removing the R SI screw

47. Postop day 2

58. 64 year old woman
Cc: LBP L>R hip pain
(July 2011)
PSF noninstrumented
L4S1 L PICBG 1993
s/p ALIF 2006 L3L4
PMH: B TKA HTN 2008
Exam: 5’7” 164lb hips
have 20 flexion
contracture

71. IVF: 5.6 L 2 Units Alb
2 units PRBC CS 375cc
U/O: 650 EBL: 1.7 L
operative time: 9 hours

78. August 2017 6 years

80. 65 year old man
Bent forward deformity
Severe LBP
Severe L5S1 radiculopathy

92. Review intraoperative xray

93. REVIEW
1. CT 4-1-11
2. L5S1 ALIF 4-6-11

102. Collapsed while at
Bingo in OC taken
to ER on 1-13-12
(8months postop);
lumbar MRI normal;
Thoracic MRI
performed 1-15-12
Transferred for
emergent
decompression 1-15-
12 T8 incomplete
with sensation only

109. 67 man cc: LBP L>R LE pain
S/P L3L4L5 laminectomy
2000 with good result
presents seven years later

119. ONE YEAR
LATER……

120. ONE YEAR LATER Left SCIATICA S1L sciatica

122. 12/18/08

133. Review postoperative
CT