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  • Avatarwestie10801
    Participant
    Post count: 92

    Good evening Dr. Corenman,

    I keep forgetting to ask and just remembered (very sorry). A Pseudarthrosis at T1-T2 revision posterior surgery, two surgeon’s, first wants to break and reset and use autograft rods and screws, second adding allograft and using bigger screws in previous screw tracks and rods. Is the breaking and resetting typically necessary to realign the bone and if so, would this help with cervical thoracic kyphosis deformity?

    Thanks always in advance!

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7682

    I’m confused. If you have a pseudoarthrosis, this means a failure of fusion. There is no reason to “break” the bone at this level to realign the bone as it never healed in the first place. If you already have screws and rods associated with a pseudoarthrosis, I would think these are already loose and need to be replaced with larger diameter screws.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarwestie10801
    Participant
    Post count: 92

    Good Morning Dr. Corenman,

    At this point all posterior hardware were removed back in 2018. A few months ago, I decided to have a second opinion and it was determined that I have pseudoarthrosis at T1-T2, however the surgeon stated that he does not perform cervicothoracic deformity surgery and is not a deformity specialist. He referred me to another surgeon and mentioned this kind of procedure will require breaking and resetting. The deformity specialist confirmed pseudoarthrosis at T1-T2 and stated he could repair with autograft, rods and screws. My spouse and I were going over procedure and didn’t know why breaking and resetting would be required? The only thing that I could think of was maybe only part of the bone is not fused and is not aligned?

    My last follow-up with my neurosurgeon, he never mentioned anything about breaking and resetting. The procedure he described was placing allograft and adding hardware and screws. It sounds like a revision surgery should be straight forward in terms of repairing non union? I also know that I’ve developed post laminectomy kyphosis, so I was thinking if there was some kind of realignment of bone, maybe it would help with kyphosis, sounds like it was just wishful thinking?

    Avatarwestie10801
    Participant
    Post count: 92

    Good Morning Dr. Corenman,

    At this point all posterior hardware were removed back in 2018. A few months ago, I decided to have a second opinion and it was determined that I have pseudoarthrosis at T1-T2, however the surgeon stated that he does not perform cervicothoracic deformity surgery and is not a deformity specialist. He referred me to another surgeon and mentioned this kind of procedure will require breaking and resetting. The deformity specialist confirmed pseudoarthrosis at T1-T2 and stated he could repair with autograft, rods and screws. My spouse and I were going over procedure and didn’t know why breaking and resetting would be required? The only thing that I could think of was maybe only part of the bone is not fused and is not aligned?

    My last follow-up with my neurosurgeon, he never mentioned anything about breaking and resetting. The procedure he described was placing allograft and adding hardware and screws. It sounds like a revision surgery should be straight forward in terms of repairing non union? I also know that I’ve developed post laminectomy kyphosis, so I was thinking if there was some kind of realignment, maybe it would help with kyphosis, sounds like it was just wishful thinking?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7682

    You note; “I’ve developed post laminectomy kyphosis”. So your pseudoarthrosis at T1-2 is associated with a kyphosis (abnormal curve that is bent forward). This would require not just a repair of the non-union, but an osteotomy (a removal of some additional bone to allow the curve to return to a normal alignment).

    This surgeon has the right plan; “The deformity specialist confirmed pseudoarthrosis at T1-T2 and stated he could repair with autograft, rods and screws”. Allograft (donor bone) is generally not effective to create a fusion. Either your own bone or BMP (bone morphogenic protein) or both should be used to create a posterior fusion in the face of a non-union.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarwestie10801
    Participant
    Post count: 92

    Dr. Corenman,

    Thanks so much! I appreciate your prompt response. Have a great day

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