• Fei Chen, Yijun Kang, Haisheng Li, Guohua Lv, Chang Lu, Jing Li, Bing Wang, Weihua Chen, Yihui Liao, and Zhehao Dai.
• *Department of Spine Surgery, the 2nd Xiangya Hospital of Central South University, Changsha 410011, China †Department of Orthopaedics E, Aarhus University Hospital, Aarhus,Denmark ‡Department of orthopedics, Xiangxiang city second people's hospital, Changsha 411400,China.
• J Spinal Disord Tech. 2015 May 12.

Study DesignRetrospective study.Summary Of Background DataShort-segment pedicle instrumentation (SSPI) is widely used to treat thoracolumbar junction fracture. Implant failure is the most common complication of SSPI and often necessitates revision surgery. The stand-alone anterior technique for failed SSPI provides excellent decompression and anterior column reconstruction but it is incapable of restoring normal stability. High rate of complications is solely attributable to the anterior approach. Thus, the reconstruction of the anterior column with posterior compression instrumentation is the strategy of choice. In this study, we use a modified pedicle subtraction osteotomy (PSO) technique through a single posterior approach as the salvage method for the failed SSPI.MethodsThirteen patients with failed SSPI after thoracolumbar fracture were included and followed up at regular intervals. Revision indications include intractable pain, deteriorating neurological deficits and progressive deformity. The modified pedicle subtraction osteotomy (PSO) was performed. After osteotomy, anterior cortex thinned and the anterior longitudinal ligament was also preserved to maintain stability during correction. Autograft inserted into osteotomy gap to increase stability and fusion rate. The correction has been achieved with closure. We evaluated the patients' clinical symptoms, Segmental kyphosis correction, Bony fusion time, and complications.ResultsSegmental kyphosis correction was from preoperative average 20.9°(range 9.5° to 38.5°) to 3.0° (range 1° to 5.5°) immediately after operation and 6.1° (range 3° to 8° at the last follow-up. Bony fusion was confirmed on radiographs in all patients at average 9.9 months (range 7.5-12 mo) after revision surgery. There was no implant failure in any of the 13 patients. Average preoperative VAS was 6.5 (range 5-9) and reduced to 3.7 (range 2-5) at the last follow-up. There was also a significant decrease in mean preoperative ODI from 55.2 (range38-76) to 32.8 (16-56). No patients suffered any neurological deterioration related to revision surgery. Complication was encountered in 6 patients (46.1%), including 4 with CSF leak and 2 with superficial wound infection. All these complications were managed conservatively and none of them underwent re-operation.ConclusionsWe conclude that modified PSO possesses the advantages of excellent kyphosis correction safe and reliable salvage alternative for revision of SSPI failure.

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