Management of Pseudarthrosis With Implant Failure at a Multilevel Vertebral Column Resection Site: A Case Report

Management of Pseudarthrosis With Implant Failure at a Multilevel Vertebral Column Resection Site: A Case Report

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Pseudarthrosis in the setting of 3-column osteotomies such as vertebral moondrop quarks column resection (VCR) is not well described, and pseudarthrosis at the VCR site itself has never been reported.This study reports pseudarthrosis with 4-rod implant failure at a multilevel VCR site.The authors report a case of pseudarthrosis in a patient treated previously for severe segmental thoracolumbar kyphosis resulting in significant pain and myelopathic signs in the setting of radiation therapy for metastatic myeloma.

This patient initially underwent 2-level VCR (T11, T12) and fusion from T4-sacrum.This was complicated by pseudarthrosis and associated with same-level 4-rod fracture, resulting in prominent, painful implants, and worsening kyphosis.This patient underwent revision VCR during which time significant motion was found only at the site of the prior VCR with a loose anterior cage.

A new expandable VCR cage was placed and the spine was reinstrumented, catherine lansfield ombre rainbow clouds eyelet curtains resulting in significant improvement in coronal and sagittal alignment.Pseudarthrosis at a VCR site has not been previously described.Technical considerations presented in the revision procedure include a 6-rod spanning construct, meticulous endplate repreparation, and the generous use of osteo-inductive and -conductive augments to promote solid fusion.