title: Revision surgery after PSO failure with rod breakage: a comparison of different techniques.
abstract: METHODS
  Author experience and literature review.
  
  
  OBJECTIVE
  To compare different revision techniques in the treatment of implant failure after pedicle subtraction osteotomy (PSO). The complication rate of pedicle subtraction osteotomy is substantially higher than other corrective procedures available for the treatment of spinal sagittal imbalance: in particular, hardware failures and mechanical complications affect this technique and their biomechanical explanation is still purely speculative.
  
  
  METHODS
  The author's experience and the literature regarding the revision techniques for PSO failures are discussed.
  
  
  RESULTS
  In this paper, eight consecutive revision cases due to rod breakage after PSO surgery are reported. In our experience, the main goals are to restore the spinal balance, through a posterior approach (correction and hardware revision and implementation) and to get a solid anterior fusion (both through a traditional anterior approach or minimally invasive transpsoas approach).
  
  
  CONCLUSIONS
  The efficacy of PSO should be balanced with the high risk of the procedure reported in the literature. Management of revision surgery after PSO may require the addition of anterior column support to maintain correction and reduce complications.
authors.affiliation: 3rd Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy, aluca.md@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Luca
authors.forename: A
authors.initials: A
authors.lastname: Lovi
authors.forename: F
authors.initials: F
authors.lastname: Galbusera
authors.forename: M
authors.initials: M
authors.lastname: Brayda-Bruno
mesh_terms: D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D006801:Humans; D008875:Middle Aged; D009989:Orthotic Devices; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome