title: Salvage of lumbar pseudarthrosis with customized large-diameter pedicle screws: report of two cases.
abstract: METHODS
  A report of two cases using custom-manufactured pedicle screws for revision spinal arthrodesis for pseudarthrosis in the setting of widely dilated pedicle screw tracts.
  
  
  OBJECTIVE
  To present surgical outcomes of a previously unreported treatment for pseudarthrosis with widely dilated pedicle screw tracts.
  
  
  BACKGROUND
  Techniques for revision of lumbar pseudarthrosis with severe screw loosening and widely dilated pedicle screw tracts represent a challenging clinical scenario. If stable fixation cannot be achieved, fixation may fail or adjacent normal levels may need to be included in the construct.
  
  
  METHODS
  Two patients presenting with painful pseudarthrosis after lumbar spinal fusion and instrumentation loosening with widely dilated pedicle screw tracts were treated with revision anterior and posterior spinal fusion using custom-manufactured large-diameter pedicle screws.
  
  
  RESULTS
  In both cases, the custom-manufactured pedicle screws achieved excellent purchase in the dilated pedicle screw tract. Both patients went on to solid fusion at 1 year after surgery.
  
  
  CONCLUSIONS
  This is a previously unreported technique for revision spinal fusion in the setting of loose instrumentation with widely dilated pedicle screw tracts.
authors.affiliation: Hospital for Special Surgery, Weill Cornell Medical Center, Department of Orthopaedic Surgery, Spine & Scoliosis Service, NY, NY 10021, USA.
authors.forename: Russel C
authors.initials: RC
authors.lastname: Huang
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Meredith
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Patrick
authors.initials: P
authors.lastname: Tropiano
mesh_terms: D000368:Aged; D001863:Bone Screws; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D011474:Prosthesis Design; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D016879:Salvage Therapy; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome