In this video from the Open Operating Theatre, Marco Brayda -Bruno, MD , from IRCCS Istituto Ortopedico Galeazzi in Milan, discussed how to perform revision surgery for implant failure in a 38-year-old woman after pedicle subtraction osteotomy.
The surgery was performed in two steps. The first step was posterior correction and implant revision. The patient was placed in prone position. Scar tissue around the broken rods was removed to expose the implant. The broken rods were reconnected with two new rods to achieve maximal stability. Sagittal correction was achieved with compression of the implant construct which was then stabilized. Bone graft was placed along the fusion and the wound was closed.
The second step was anterior fusion with two-level extreme lateral interbody fusion adjacent to the L3 pedicle subtraction osteotomy (PSO). The patient was placed in lateral position under neurologic monitoring control. Surgeons then performed a lateral transpsoas approach. Progressive tubes were used, and the psoas was split under fluoroscopic control. The discs above and under L3 PSO were dissected and the cages inserted. The wound was closed.
This video is intended as a teaching tool to help surgeons prepare for surgery or they can use it as a refresher on the surgical technique and indications for this surgery.