Pedicle shifting or migration as one of the causes of curve progression after posterior fusion

An interesting case report and review of literature

Sudeep Jain, Hitesh N. Modi, Seung-Woo Suh, Jae Hyuk Yang, Jae-Young Hong

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The aim of this retrospective study was to explain a previously undescribed mechanism of 'pedicle migration or shift' with longitudinal growth of the spine owing to biological remodeling of plastic posterior fusion mass as well as pedicles which may explain at least a few cases of deformity recurrence after posterior fusion in scoliosis surgery. Progressive loss of deformity correction after scoliosis surgery in growing children has been variously described. The various mechanisms described have been 'crankshaft effect', pseudoarthrosis, implant failure (loosening/breakage), biological plasticity, choosing wrong levels, excessive apical translation causing decompensation by unfused segments, progressive etiology, inadequate anchorage provided by some older instrumentation systems, etc. Though there have been claims that segmental pedicle instrumentation might prevent crankshaft phenomenon by providing a more rigid fixation, numerous studies have shown progressive loss of correction even after segmental pedicle instrumentation. A 10.6-year-old girl was fused posteriorly before her prepubertal growth spurt using segmental screw rod instrumentation. The index case in our study showed progressive loss of operative correction during subsequent follow-up at 2 years. This probably occurred because of longitudinal growth of the spine and posterior fusion mass because of its biological plasticity during the period of rapid growth spurt. In conclusion, despite the recent trend towards the use of segmental pedicle instrumented correction and fusion and claims that by providing rigid, tri-column fixation, it enhances fusion and controls growth of the vertebral body anteriorly; caution must be taken in children with high remaining growth and high growth velocity. J Pediatr Orthop B 18:369-374

Original languageEnglish
Pages (from-to)369-374
Number of pages6
JournalJournal of Pediatric Orthopaedics Part B
Volume18
Issue number6
DOIs
Publication statusPublished - 2009 Nov 1

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Growth
Scoliosis
Spine
Pseudarthrosis
Plastics
Retrospective Studies
Recurrence

Keywords

  • Biological plasticity
  • Growing spine
  • Pedicle migration
  • Posterior fusion
  • Scoliosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

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title = "Pedicle shifting or migration as one of the causes of curve progression after posterior fusion: An interesting case report and review of literature",
abstract = "The aim of this retrospective study was to explain a previously undescribed mechanism of 'pedicle migration or shift' with longitudinal growth of the spine owing to biological remodeling of plastic posterior fusion mass as well as pedicles which may explain at least a few cases of deformity recurrence after posterior fusion in scoliosis surgery. Progressive loss of deformity correction after scoliosis surgery in growing children has been variously described. The various mechanisms described have been 'crankshaft effect', pseudoarthrosis, implant failure (loosening/breakage), biological plasticity, choosing wrong levels, excessive apical translation causing decompensation by unfused segments, progressive etiology, inadequate anchorage provided by some older instrumentation systems, etc. Though there have been claims that segmental pedicle instrumentation might prevent crankshaft phenomenon by providing a more rigid fixation, numerous studies have shown progressive loss of correction even after segmental pedicle instrumentation. A 10.6-year-old girl was fused posteriorly before her prepubertal growth spurt using segmental screw rod instrumentation. The index case in our study showed progressive loss of operative correction during subsequent follow-up at 2 years. This probably occurred because of longitudinal growth of the spine and posterior fusion mass because of its biological plasticity during the period of rapid growth spurt. In conclusion, despite the recent trend towards the use of segmental pedicle instrumented correction and fusion and claims that by providing rigid, tri-column fixation, it enhances fusion and controls growth of the vertebral body anteriorly; caution must be taken in children with high remaining growth and high growth velocity. J Pediatr Orthop B 18:369-374",
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AU - Yang, Jae Hyuk

AU - Hong, Jae-Young

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N2 - The aim of this retrospective study was to explain a previously undescribed mechanism of 'pedicle migration or shift' with longitudinal growth of the spine owing to biological remodeling of plastic posterior fusion mass as well as pedicles which may explain at least a few cases of deformity recurrence after posterior fusion in scoliosis surgery. Progressive loss of deformity correction after scoliosis surgery in growing children has been variously described. The various mechanisms described have been 'crankshaft effect', pseudoarthrosis, implant failure (loosening/breakage), biological plasticity, choosing wrong levels, excessive apical translation causing decompensation by unfused segments, progressive etiology, inadequate anchorage provided by some older instrumentation systems, etc. Though there have been claims that segmental pedicle instrumentation might prevent crankshaft phenomenon by providing a more rigid fixation, numerous studies have shown progressive loss of correction even after segmental pedicle instrumentation. A 10.6-year-old girl was fused posteriorly before her prepubertal growth spurt using segmental screw rod instrumentation. The index case in our study showed progressive loss of operative correction during subsequent follow-up at 2 years. This probably occurred because of longitudinal growth of the spine and posterior fusion mass because of its biological plasticity during the period of rapid growth spurt. In conclusion, despite the recent trend towards the use of segmental pedicle instrumented correction and fusion and claims that by providing rigid, tri-column fixation, it enhances fusion and controls growth of the vertebral body anteriorly; caution must be taken in children with high remaining growth and high growth velocity. J Pediatr Orthop B 18:369-374

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