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Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis

INTRODUCTION: In patients with lumbosacral agenesis (SA), Renshaw type III or IV, lumbosacral instability is the primary cause of major clinical complications. Although they are usually treated with spinopelvic fusion, nonunion at the spinopelvic junction is a major complication due to the congenita...

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Autores principales: Kanbara, Shunsuke, Nohara, Ayato, Ohara, Tetsuya, Saito, Toshiki, Tauchi, Ryoji, Imagama, Shiro, Kawakami, Noriaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society for Spine Surgery and Related Research 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661020/
https://www.ncbi.nlm.nih.gov/pubmed/33195859
http://dx.doi.org/10.22603/ssrr.2020-0015
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author Kanbara, Shunsuke
Nohara, Ayato
Ohara, Tetsuya
Saito, Toshiki
Tauchi, Ryoji
Imagama, Shiro
Kawakami, Noriaki
author_facet Kanbara, Shunsuke
Nohara, Ayato
Ohara, Tetsuya
Saito, Toshiki
Tauchi, Ryoji
Imagama, Shiro
Kawakami, Noriaki
author_sort Kanbara, Shunsuke
collection PubMed
description INTRODUCTION: In patients with lumbosacral agenesis (SA), Renshaw type III or IV, lumbosacral instability is the primary cause of major clinical complications. Although they are usually treated with spinopelvic fusion, nonunion at the spinopelvic junction is a major complication due to the congenital sacropelvic abnormalities. The purpose of this study was to evaluate whether a combination of lumbosacral fixation and rigid fixation at the pubic symphysis could lead to postoperative bone union in patients with SA (Renshaw type III). METHODS: Retrospective case series study. We present the cases of two patients with SA, Renshaw type III, who were surgically treated by lumbosacral fusion using a posterior approach, and they exhibited nonunion at the lumbosacral junction. RESULTS: Case 1. A 10-year-old male underwent T8-S posterior fixation followed by multiple augmentations using allografts at the lumbosacral junction for delayed union. All additional procedures with bone graft using a posterior approach failed to achieve bone union; however, additional rigid fixation at the pubic symphysis resulted in a successful lumbosacral bone union. Case 2. A 6-year-old male underwent vertical expandable prosthetic titanium rib (VEPTR) surgery with multiple rod extension procedures. Subsequently, at the age of 10 years, a combined two-stage anterior (L1-3) and posterior (T8-iliac) fixation with T9 hemivertebrectomy was performed. As a result of subsequent nonunion with screw loosening, additional rigid fixation at the pubic symphysis was performed 1 month after posterior fixation. Bone union was finally achieved 1 year after all the surgical interventions. CONCLUSIONS: Rigid fixation at the pubic symphysis may play a significant role in achieving rigid bone union for unstable lumbopelvic connection, such as SA, Renshaw type III or IV.
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spelling pubmed-76610202020-11-13 Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis Kanbara, Shunsuke Nohara, Ayato Ohara, Tetsuya Saito, Toshiki Tauchi, Ryoji Imagama, Shiro Kawakami, Noriaki Spine Surg Relat Res Original Article INTRODUCTION: In patients with lumbosacral agenesis (SA), Renshaw type III or IV, lumbosacral instability is the primary cause of major clinical complications. Although they are usually treated with spinopelvic fusion, nonunion at the spinopelvic junction is a major complication due to the congenital sacropelvic abnormalities. The purpose of this study was to evaluate whether a combination of lumbosacral fixation and rigid fixation at the pubic symphysis could lead to postoperative bone union in patients with SA (Renshaw type III). METHODS: Retrospective case series study. We present the cases of two patients with SA, Renshaw type III, who were surgically treated by lumbosacral fusion using a posterior approach, and they exhibited nonunion at the lumbosacral junction. RESULTS: Case 1. A 10-year-old male underwent T8-S posterior fixation followed by multiple augmentations using allografts at the lumbosacral junction for delayed union. All additional procedures with bone graft using a posterior approach failed to achieve bone union; however, additional rigid fixation at the pubic symphysis resulted in a successful lumbosacral bone union. Case 2. A 6-year-old male underwent vertical expandable prosthetic titanium rib (VEPTR) surgery with multiple rod extension procedures. Subsequently, at the age of 10 years, a combined two-stage anterior (L1-3) and posterior (T8-iliac) fixation with T9 hemivertebrectomy was performed. As a result of subsequent nonunion with screw loosening, additional rigid fixation at the pubic symphysis was performed 1 month after posterior fixation. Bone union was finally achieved 1 year after all the surgical interventions. CONCLUSIONS: Rigid fixation at the pubic symphysis may play a significant role in achieving rigid bone union for unstable lumbopelvic connection, such as SA, Renshaw type III or IV. The Japanese Society for Spine Surgery and Related Research 2020-03-19 /pmc/articles/PMC7661020/ /pubmed/33195859 http://dx.doi.org/10.22603/ssrr.2020-0015 Text en Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research https://creativecommons.org/licenses/by-nc-nd/4.0/ Spine Surgery and Related Research is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Kanbara, Shunsuke
Nohara, Ayato
Ohara, Tetsuya
Saito, Toshiki
Tauchi, Ryoji
Imagama, Shiro
Kawakami, Noriaki
Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis
title Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis
title_full Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis
title_fullStr Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis
title_full_unstemmed Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis
title_short Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis
title_sort impact of rigid fixation of the pubic symphysis for spinopelvic fixation in two cases of lumbosacral agenesis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661020/
https://www.ncbi.nlm.nih.gov/pubmed/33195859
http://dx.doi.org/10.22603/ssrr.2020-0015
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