Abstract
Study design
To report the use of a posterior based ‘fusion mass screw’ (FMS) as a primary or salvage fixation point in a revision spinal deformity following a previous posterior spinal fusion (PSF). Our experience of this technique in a case report and the clinical and radiological results are reported.
Objectives
To describe the technique and uses of the FMS as a primary/salvage fixation point in osteotomies in previously arthrodesed spinal deformity surgery.
Summary of background data
Obtaining fixation points to correct and stabilize a spinal deformity with coronal and sagittal imbalance in a previously arthrodesed spine during revision surgery can be challenging. Several alternate pedicle fixation techniques and laminar screw techniques have been described in the literature. However, there is no description of these techniques in the presence of a spinal fusion with distorted anatomy. A pedicle screw placed coronally across a thick posterior fusion mass can provide an alternate method of fixation in these cases with complex anatomy.
Methods
Two cases of complex spinal deformity and corrective spinal osteotomies using fusion mass screws (FMSs) placed coronally across the posterior fusion mass are described. The first case is an 8-year-old patient with Marfan’s syndrome who developed a crank shaft phenomenon and severe thoracolumbar kyphoscoliosis following a previous PSF. The second case is a 53-year-old patient with coronal imbalance following PSF as a child using Harrington instrumentation who developed distal degeneration with stenosis in her remaining mobile segments. Both patients underwent vertebral column resection and osteotomy closure plus stabilisation using FMS. The clinical and radiological results and technique for insertion of the FMS are described.
Conclusion
In this report, we present a novel method of using posterior FMSs to achieve fixation and correction in cases of revision deformity surgery with difficult anatomy. While we feel pedicle screws are the gold standard in deformity correction, knowledge of alternatives such as the FMS can allow surgeons to achieve stable constructs when faced with challenging situations.
References
Sponseller PD, Ahn NU, Ahn UM et al (2000) Osseous anatomy of the lumbosacral spine in Marfan syndrome. Spine 25:2797–2802
Floman Y, Penny JN, Micheli LJ et al (1982) Osteotomy of the fusion mass in scoliosis. J Bone Jt Surg Am Vol 64:1307–1316
Gill JB, Levin A, Burd T et al (2008) Corrective osteotomies in spine surgery. J Bone Jt Surg Am Vol 90:2509–2520
Suk SI, Chung ER, Kim JH et al (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30:1682–1687
Lewis SJ, Canavese F, Keetbaas S (2009) Intralaminar screw insertion of thoracic spine in children with severe spinal deformities: two case reports. Spine 34:E251–E254
Bridwell KH, Lewis SJ, Rinella A et al (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Jt Surg Am Vol 86A(Suppl 1):44–50
Suk SI, Kim JH, Kim WJ et al (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382
Lim MR, Girardi FP, Yoon SC et al (2005) Accuracy of computerized frameless stereotactic image-guided pedicle screw placement into previously fused lumbar spines. Spine 30:1793–1798
Lagrone MO, Bradford DS, Moe JH et al (1988) Treatment of symptomatic flatback after spinal fusion. J Bone Jt Surg Am Vol 70:569–580
Rampersaud YR, Lee KS (2007) Fluoroscopic computer-assisted pedicle screw placement through a mature fusion mass: an assessment of 24 consecutive cases with independent analysis of computed tomography and clinical data. Spine 32:217–222
Kim YW, Lenke LG, Kim YJ et al (2008) Free-hand pedicle screw placement during revision spinal surgery: analysis of 552 screws. Spine 33:1141–1148
Belmont PJ Jr, Klemme WR, Dhawan A et al (2001) In vivo accuracy of thoracic pedicle screws. Spine 26:2340–2346
Dvorak M, MacDonald S, Gurr KR et al (1993) An anatomic, radiographic, and biomechanical assessment of extrapedicular screw fixation in the thoracic spine. Spine 18:1689–1694
Magerl FP (1984) Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 189:125–141
Dick W, Kluger P, Magerl F et al (1985) A new device for internal fixation of thoracolumbar and lumbar spine fractures: the ‘fixateur interne’. Paraplegia 23:225–232
Grob D, Humke T (1998) Translaminar screw fixation in the lumbar spine: technique, indications, results. Eur Spine J 7:178–186
Humke T, Grob D, Dvorak J et al (1998) Translaminar screw fixation of the lumbar and lumbosacral spine. A 5-year follow-up. Spine 23:1180–1184
Reich SM, Kuflik P, Neuwirth M (1993) Translaminar facet screw fixation in lumbar spine fusion. Spine 18:444–449
Kim KT, Lee SH, Lee YH et al (2006) Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine 31:1351–1357 discussion 8
Aepli M, Mannion AF, Grob D (2009) Translaminar screw fixation of the lumbar spine: long-term outcome. Spine 34:1492–1498
Wang MY (2007) Cervical crossing laminar screws: early clinical results and complications. Neurosurgery 61:311–315 discussion 5-6
Kretzer RM, Sciubba DM, Bagley CA et al (2006) Translaminar screw fixation in the upper thoracic spine. J Neurosurg Spine 5:527–533
Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 17:158–162
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lewis, S.J., Arun, R., Bodrogi, A. et al. The use of fusion mass screws in revision spinal deformity surgery. Eur Spine J 23 (Suppl 2), 181–186 (2014). https://doi.org/10.1007/s00586-013-2843-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2843-0