A 22 year old female presented status post a posterior spinal fusion for Adolescent Idiopathic Scoliosis. Following a car accident, she experienced back pain. A pseudoarthrosis, or failure of fusion, was found on CT scan. Dr. Pashman did the revision surgery from T4-L2.

1. Case Review:
22 year old female, status post
poster spinal fusion, now with
hardware failure and
pseudoarthrosis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
22 year old female
Status post posterior spinal fusion at age 22 for what appears to
be a double thoracic curve.
The patient had a car accident but was feeling increasing pain
and feelings of instability and came to Dr. Pashman for
consultation.
The patient had a CT scan which showed a possible
pseudarthrosis.
There was increasing of the curve indicating pseudarthrosis

3. Pre-op X-rays
There is a structural proximal curve
with depression at the right shoulder.
This resulted in a compression convex
distraction concave attempt with
interval sublaminar or Wisconsin wires
through pedicle screws distally.

4. Indications for Surgery
1. Status post posterior instrumented fusion for adult idiopathic
scoliosis.
2. Double thoracic curve, now with possible pseudarthrosis,
hardware failure.
3. Adding on with significant increase in thoracic and lumbar
scoliosis.
4. Increasing pain, failed conservative therapy, status post motor
vehicle accident.
5. Some co-morbidities including chronic illness.

5. Surgical Strategy
Removal of retained hardware.
Repair of multiple level pseudarthrosis, T4-5, T5-6, T6-7, T7-8,
T9- 10, T10-11, L1-L2.
Remove granulation tissue and corrosion residue.
Reinstrumentation, segmental spinal instrumentation, T2 to L3,
using Alphatec Phygen cobalt chrome pedicle screw rod
construct.
Posterior spinal fusion, T2 to L3, using locally harvested
autogenous bone and rhBMP with allograft.
Intraoperative O-arm neuro-navigation.
Plastic closure of wound.
Multiple level spinal osteotomy for correction of residual curve
T10, T11, T12 and L1.

6. Post-Op Films
The patient is well balanced
in both the coronal and
sagittal planes. At six
months post-op she is doing
well, and has no complaints.

7. Pre-Op/Post-op Comparison
At the time of operation, a full-
thickness fracture was found in
the left rod. Also on the right-
hand side, the patient had a pull-
out of the instrumentation
through the Penultimate pedicle
screw.
The nut was lying free in the
wound. The distal right screw
was completely pulled out at L2
and so the failure was a
circumferential through the
right screw pull-out and failure
of the instrumentation through
the fracture of the left rod
underneath the cross-link.

8. Pre-Op/Post-op Comparison
The patient had multiple level
pseudarthrosis completely through the
thoracic and lumbar spine, and this
needed to be repaired completely.
There were elements of significant
black tissue that was consistent with
corrosion of the inflammatory tissue
around the pedicle screws and nuts.
The patient did not have any evidence
of infection. There was no purulence or
inflammation around the wound. The
fusion mass was wispy proximally and
distally, and the pedicles on the concave
side in the upper thoracic curve on the
right-hand side as seen through the O-
arm navigation were atretic and small.