Boddapati Venkat, Lombardi Joseph M, Lenke Lawrence G
The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
Neurospine. 2020 Dec;17(4):941-946. doi: 10.14245/ns.2040208.104. Epub 2020 Dec 31.
Pseudarthrosis in the setting of 3-column osteotomies such as vertebral column resection (VCR) is not well described, and pseudarthrosis at the VCR site itself has never been reported. This study reports pseudarthrosis with 4-rod implant failure at a multilevel VCR site. The authors report a case of pseudarthrosis in a patient treated previously for severe segmental thoracolumbar kyphosis resulting in significant pain and myelopathic signs in the setting of radiation therapy for metastatic myeloma. This patient initially underwent 2-level VCR (T11, T12) and fusion from T4-sacrum. This was complicated by pseudarthrosis and associated with same-level 4-rod fracture, resulting in prominent, painful implants, and worsening kyphosis. This patient underwent revision VCR during which time significant motion was found only at the site of the prior VCR with a loose anterior cage. A new expandable VCR cage was placed and the spine was reinstrumented, resulting in significant improvement in coronal and sagittal alignment. Pseudarthrosis at a VCR site has not been previously described. Technical considerations presented in the revision procedure include a 6-rod spanning construct, meticulous endplate repreparation, and the generous use of osteo-inductive and -conductive augments to promote solid fusion.
在诸如脊柱切除术（VCR）等三柱截骨术的情况下，假关节形成的情况尚未得到充分描述，且VCR部位本身的假关节形成从未有过报道。本研究报告了在多级VCR部位出现伴有四棒植入物失败的假关节形成情况。作者报告了一例曾接受治疗的严重节段性胸腰椎后凸患者发生假关节形成的病例，该患者在转移性骨髓瘤放疗过程中出现了严重疼痛和脊髓病体征。该患者最初接受了两节段VCR（T11、T12）以及从T4至骶骨的融合术。术后出现了假关节形成并伴有同水平的四棒骨折，导致植入物突出、疼痛，后凸畸形加重。该患者接受了翻修VCR手术，在此期间仅在前次VCR部位发现明显活动，前路椎间融合器松动。放置了一个新的可扩张VCR椎间融合器，并重新固定脊柱，冠状面和矢状面排列得到显著改善。此前尚未有关于VCR部位假关节形成的描述。翻修手术中提出的技术要点包括使用六棒跨越结构、细致地重新准备终板，以及大量使用骨诱导和骨传导增强材料以促进牢固融合。
