Failures in Thoracic Spinal Fusions and Their Management

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Biomedical Engineering

Background:

• Instrumented fixation and fusion of the thoracic spine are complex procedures.
• Complications such as pseudarthrosis and junctional kyphosis can lead to significant patient morbidity.
• Failure of instrumentation constructs and iatrogenic spinal deformity are potential adverse outcomes.

Purpose of the Study:

• To explore the challenges and complications associated with instrumented thoracic spine fusion.
• To investigate the multifactorial causes of fusion failure, including biomechanical and biologic factors.
• To outline the complexities of revision surgery for thoracic fusion failures.

Main Methods:

• Review of existing literature on thoracic spine fusion complications.
• Analysis of biomechanical and biologic factors contributing to fusion failure.
• Discussion of surgical techniques for revision procedures.

Main Results:

• Pseudarthrosis and junctional kyphosis are common complications.
• Patient morbidity can be significant, including neurologic injury and construct failure.
• Fusion failure is multifactorial, involving both biomechanical and biologic elements.

Conclusions:

• Thoracic spine fusion presents unique challenges requiring careful management.
• Understanding the multifactorial causes of failure is crucial for successful revision surgery.
• Revision strategies often involve instrumentation revision/extension and soft tissue manipulation.