Review ArticleComplications

Distal Junctional Failure Secondary to Nontraumatic Fracture of Lower Instrumented Vertebra: Our Experience and Review of Literature

Akash Hosthota, Ramachandran Govindasamy and Satish Rudrappa
International Journal of Spine Surgery October 2021, 15 (5) 1031-1038; DOI: https://doi.org/10.14444/8131

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Figure 1: (A-E) Of Case 1 (A) Pre-operative sagittal MRI of whole spine showing multi-level canal stenosis; (B) Sagittal CT showing ossified ligamentum flavum and posterior longitudinal ligament; (C, D) Coronal CT image of whole spine (E) Axial CT at D6-D7 with maximum stenosis.

  • Figure 2
    Figure 2

    (A, B) Immediate post-operative X ray of case 1 after decompression and posterior instrumentation. (A) Antero posterior view, (B) Supine lateral view.

  • Figure 3
    Figure 3

    (A-C) MRI and X ray investigation after onset of neurological deterioration in case 1. (A) Sagittal MRI showing adequate decompression, (B) Supine AP X ray and (C) Supine lateral X ray of thoraco- lumbar spine.

  • Figure 4
    Figure 4

    (A-C) Retrospective analysis of the chance fracture. (A) Hairline fracture at posterior inferior corner of L1 vertebra, (B, C) Dynamic instability and failure at the LIV in sitting and supine position, (D) Intra operative image intensifier fracture displacement at L1 corner, secondary to prone position.

  • Figure 5
    Figure 5

    (A, B) Post-operative radiograph of extension of posterior instrumented fusion till pelvis, (A) AP view, (B) lateral view

  • Figure 6
    Figure 6

    Intra operative image (arrow) showing the discontinuity in the posterior elements, which was mobile with manipulation. (Case 1)

  • Figure 7
    Figure 7

    Pre-operative sagittal MRI of Case 2, showing canal stenosis at multi-level with cord changes maximum at D6-D7. (A) Coronal, (B, C) Sagittal view; (D) Axial view.

  • Figure 8
    Figure 8

    (A-B) Immediate supine post-operative radiograph of case 2 (A) AP view, (B) lateral view.

  • Figure 9
    Figure 9

    (A-D) MRI and X ray investigation after onset of neurological deterioration in case 2. (A) MRI showing adequate decompression, (B) AP view of thoraco- lumbar spine, (C) supine lateral view of spine showing change in the direction of LIV screw, so this was followed by, (D) sitting lateral view showing failure at LIV with kyphosis D12-L1.

  • Figure 10
    Figure 10

    (A, B) demonstration of spine alignment (A) In supine position, anterior pelvic tilt with lumbar lordosis and fixed thoracic spine. (B) In sitting position, neutral pelvis with decrease in lumbar lordosis and no change in thoracic kyphosis due to instrumentation leading to stress at the LIV, resulting in failure.

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Distal Junctional Failure Secondary to Nontraumatic Fracture of Lower Instrumented Vertebra: Our Experience and Review of Literature
Akash Hosthota, Ramachandran Govindasamy, Satish Rudrappa
International Journal of Spine Surgery Oct 2021, 15 (5) 1031-1038; DOI: 10.14444/8131
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