Table 4 Early adjacent segment failure (ASF) complications requiring surgical treatment are listed below. (Sex: F = female, M = male)
From: Perioperative complications after surgical treatment in degenerative adult de novo scoliosis
Case | Sex, Age (years) | Previous operations | Fusion length | ASF | Cause and further treatment |
|---|---|---|---|---|---|
1 | M, 62 | Yes | 2 | Yes | Patient had persitant back pain postoperatively and paresthesia in the lower extremity. MRI showed an adjacent vertebral fracture leading to an elongation of the initial fusion of up to 4 segments and second explorative operation due to persistant paresthesia. No specific cause was identifed for this. Sensation returned to normal in the further course. |
2 | F, 67 | No | 6 | Yes | Early adjacent failure was caused by an osteoporotic cut out of the upper uncemented pedicle screws. This led to an elongation of the fusion by two segements with cement-augmentation. |
3 | F, 74 | No | 5 | Yes | After the inital dorsoventral fusion, an osteoporotic adjacent segment failure in the upper instrumented vertebra caused the need of a fusion extension of one more segment with pedicle screw cement augmention. Thereafter, the patient developed a wound dehiscence. This led to a further operation for wound debridement and closure. |
4 | M, 65 | No | 6 | Yes | This adjacent segment failure included a pedicle fracture causing a transient paresis of the hip flexion requiring immediate screw removal and nerve exploration. There was no nerve root damage. The fusion was elongated by 2 levels. The muscle regained full function in the follow-ups. |
5 | F, 72 | No | 4 | Yes | This patient had a screw misplacement as idenfied by the CT-scan. The screw was causing irritation of the nerve root and had a cut out through upper vertebral plate. This complex cause of adjacent segment failure and spinal nerve compression lead to an early revision and elongation by one segment. |
6 | M, 85 | No | 5 | Yes | This patient showed during the primary operation a poor bone quality (osteoporosis) with the need to use cement augmentation of the upper instrumented vertebra. During the early mobilisation process, the patient suffered an adjacent vertebral fracture with progression needing a revision with elongation of 2 more segments with careful cement augmentation. |
7 | F, 67 | No | 6 | Yes | Due to osteoporotic bone, the upper pedicle screws were cement augmented. However, the poor bone quality caused an osteoporotic fracture with nerve irritation needing a revision surgery with elongation of the fusion by 2 segments. Unfortunately thereafter, a wound healing defect caused a further superfical wound revision. |
8 | F, 83 | No | 3 | Yes | Due to a collapse of the upper vertebral plate during the mobilisation process, a surgical revision with elongation of 1 segment with cement augmentation was necessary. |