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J Minim Invasive Spine Surg Tech > Accepted Articles
A novel technique to instrument proximal and distal clinical adjacent segment pathology.
Arvind Gopalrao Kulkarni1, Shumayou Dutta2
1Mumbai Spine Scoliosis & Disc Replacement Centre, Mumbai, India
2Bombay Hospital and Medical Research Center, Mumbai, India
Correspondence :  Arvind Gopalrao Kulkarni ,Tel: +91-9892875490, Fax: +91-22-22080871, Email: drarvindspines@gmail.com
Received: October 25, 2016  Revised: October 25, 2016   Accepted: March 9, 2017
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.
Method
- 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 by-passing 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 surgery; implant removal
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A Novel Technique to Instrument Proximal and Distal Adjacent Segment Pathology  2017 June;2(1)
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