Hitchon_Lumb

8/7/2019 Hitchon_Lumb

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Can we fuse thedegenerated segment, and

not the entire curve?? Professor of Neurosurgery andBioengineering Director of Spine Fellowship University of Iowa Hospitalsand Clinics

Patrick W. Hitchon, MD


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Can we fuse thedegenerated segment,

and not the entirecurve??


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11/17/09Pain in the left leg

Patient CD


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11/17/09


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Treatment

Short Long instrumentation


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4/29/1050-year-old female presentswith low back pain radiating tothe right hip and right upper leg.She had fusion atL2-L3 level in December 2009.


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4/29/10


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3/24/10epidural fluid around the hardwarestable in size.


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1/13/10


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1/13/10


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1/13/10L2 screw on the right side hasmedial pedicle violation.EMG showingright L2 nerve root damage


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5/26/10


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5/26/10


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50 patients with lumbar DD and scoliosisunderwent decomp and fusion with PS

Short fusion (28) within deformity not includingend vertebra,

Long fusion (22) extended above upper end

vertebra Follow-up 4.3+/- 1.9 years (Range 2-8.9 yrs)


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Cobb angle from the end platesOf the most angulated vertebrae


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Sagittal balance from center of C7 intersecting horizontal through L5-S1.Balanced if passes through the post 1/3 of the disc space,positve bal if in front, negative balance if behind. .


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Coronal balance by a vertical line from center of C7 body through pelvis.Positive balance if line is to left, negative balance if to right


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AP

Lat T12-S1


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ADD 4/7 when fusion stopped at L1 ADD 1/12 when fusion extended to T10


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Decompression alone in the presence ofscoliosis not recommended as it leads tomore deformity

Short fusion for small deformity withoutsagittal or coronal imbalance

Long fusion for sign deformity, in additionto coronal and sagittal imbalance


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Even with long fusion, correction oflordosis and sagittal imbalance wasinsufficient

Do not stop fusion within deformity Traverse th-lu junction to T10-11 No diff in Oswestry


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He is a 59-year-old male with pain

between his shoulder blades for the past year

Previously undergone C5-6 and C6-7 ACDF

in 1998. He then developed low back pain in 2000.

He underwent numerous procedures and

ultimately an anterior discectomy and fusion

from L2 to the sacrum

5/18/09

Patient DS


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124 casesRetrospective study5 levels or moreF/U min 1.2 yrs64 pts > 65 yrs


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Total 9 (14%) 15 (23%) 19(30%) 17 (27%)


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Age is a positive risk factor for major postoperative complicationsin extensive thoracolumbar spinal fusions.Complication rates in the elderly are high.Good clinical judgment, and careful patient selection are neededbefore performing extensive reconstruction in older persons .

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