title: Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.
abstract: OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.
authors.affiliation: Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, Massachusetts.|Washington University in St. Louis, Brown School, St. Louis, Missouri.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, Massachusetts.|Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California; and.
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008141:Lordosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D065289:Pedicle Screws / Q000009:adverse effects; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
keywords: EBL = estimated blood loss; PSO = pedicle subtraction osteotomy; multiple-hook fixation; revision surgery; spinal deformity