Lumbar scoliosis (degenerative) MIS surgery (PSO/TLIF) complication

Peng Yuan Chang, Michael Y. Wang

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations


Pedicle subtraction osteotomy (PSO) is a highly effective procedure in the context of adult spinal deformity (ASD) surgery to achieve lordosis at the index segment. Traditional open PSO procedure can be associated with high perioperative morbidity and complication rates, which may be substantially reduced with the development of minimally invasive techniques. However, in long-term follow-up, pseudarthrosis still affects 9-24% of the patients after a PSO procedure. This chapter describes a case with the typical presentation of pseudarthrosis in terms of the clinical symptoms, presentation time, and radiographic progression. The patient underwent revision surgery with replacement of the broken instrumentation and extension of the original fusion segments cranially and caudally. Proper realignment of the sagittal curvature was achieved, and the patient had an uneventful recovery after the revision surgery. Pseudarthrosis is a major concern after an extensive procedure such as PSO and long fusion in ASD surgery. Due to the insidious presentation, patient should be monitored closely with caution, especially those who fail to achieve expected clinical outcomes. All efforts should be made to tailor the surgical plan on an individual basis with long-term follow-up to avoid such complications.

Original languageEnglish (US)
Title of host publicationSpinal Deformity
Subtitle of host publicationA Case-Based Approach to Managing and Avoiding Complications
PublisherSpringer International Publishing
Number of pages7
ISBN (Electronic)9783319600833
ISBN (Print)9783319600826
StatePublished - Jan 1 2017


  • Adult spinal deformity (ASD)
  • Complication
  • Implantation failure
  • Lumbar lordosis
  • Minimally invasive surgery (MIS)
  • Pedicle subtraction osteotomy (PSO)
  • Pseudarthrosis
  • Rod breakage
  • Sagittal balance
  • Screw breakage
  • Spino-pelvic parameter

ASJC Scopus subject areas

  • Medicine(all)


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