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- 저자 : Venkat Boddapati (검색결과 2 건)
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Venkat Boddapati,Joseph M. Lombardi,Lawrence G. Lenke 대한척추신경외과학회 2020 Neurospine Vol.17 No.4
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.
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Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion
Wenbo Lin,Alex Ha,Venkat Boddapati,Wen Yuan,K. Daniel Riew 대한척추신경외과학회 2018 Neurospine Vol.15 No.3
Radiographic confirmation of fusion after anterior cervical discectomy and fusion (ACDF) surgery is a critical aspect of determining surgical success. However, there is a lack of established diagnostic radiographic parameters for pseudoarthrosis. The purpose of this study is to summarize the findings of previous studies, review the advantages and disadvantages of frequently employed diagnostic criteria, and present our recommended protocol of fusion assessment. This study identified randomized controlled trials, case-control studies, and prospective and retrospective cohort studies reporting on spinal fusion and how successful fusion after ACDF. Among the 39 articles reviewed, bridging bone across the operated levels on static radiographs was the most commonly used criteria to confirm fusion (31 of 39, 79%). Dynamic flexion-extension radiographs were used to assess for interspinous movement (ISM) (22 of 39, 56.4%) and change in Cobb angle (12 of 39, 30.8%). Computed tomography (CT) based findings (21 of 39, 53.8%) were employed in ambiguous cases with improved sensitivity and specificity. Reconstructed CT scans were used to assess for intragraft bridging bone and extragraft bridging bone (ExGBB). ExGBB were proved to have the highest diagnostic sensitivity and specificity for pseudoarthrosis detection when compared to all other radiographic criteria. The ISM <1 mm on dynamic flexion-extension radiographs had high diagnostic sensitivity and specificity as well. After our reviewing, we recommend using dynamic lateral flexion-extension cervical spine radiographs at 150% magnificationin which the interspinous motion <1 mm and superjacent interspinous motion ≥4 mm confirms fusion. In ambiguous cases, we recommend using reconstructed CT scans to evaluate for ExGBB.
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