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Postsurgical Deformity
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Iatrogenic deformity, iatrogenic instability, postsurgical instability
            • Definitions

              • Deformity: Abnormality of alignment, angulation, or shape of vertebral column following surgery
                • May be associated with clinically significant findings such as instability
              • Instability: Postoperative loss of spine motion segment stiffness, in which applied force produces greater displacement than normal, with pain/deformity

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Blondel B et al: Posterior global malalignment after osteotomy for sagittal plane deformity: it happens and here is why. Spine (Phila Pa 1976). 38(7):E394-401, 2013
                                        2. Hassanzadeh H et al: Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine (Phila Pa 1976). 38(9):726-31, 2013
                                        3. Chau AM et al: Bone graft substitutes in anterior cervical discectomy and fusion. Eur Spine J. 18(4):449-64, 2009
                                        4. Crostelli M et al: Cervical fixation in the pediatric patient: our experience. Eur Spine J. 18 Suppl 1:20-8, 2009
                                        5. Gottfried ON et al: Spinopelvic parameters in postfusion flatback deformity patients. Spine J. 9(8):639-47, 2009
                                        6. Park DK et al: Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect. 58:737-45, 2009
                                        7. Rahme R et al: Acute swan-neck deformity and spinal cord compression after cervical laminectomy. Can J Neurol Sci. 36(4):504-6, 2009
                                        8. Schwab F et al: Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 34(17):1828-33, 2009
                                        9. Heary RF et al: The history of spinal deformity. Neurosurgery. 63(3 Suppl):5-15, 2008
                                        10. Jagannathan J et al: Iatrogenic spinal deformity. Neurosurgery. 63(3 Suppl):104-16, 2008
                                        11. Jang JS et al: Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome. J Neurosurg Spine. 7(4):387-92, 2007
                                        12. Papagelopoulos PJ et al: Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine. 22(4):442-51, 1997
                                        13. Mullin BB et al: The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord. 9(2):107-16, 1996
                                        14. An HS et al: Spinal disorders at the cervicothoracic junction. Spine. 19(22):2557-64, 1994
                                        15. Stromqvist B: Postlaminectomy problems with reference to spinal fusion. Acta Orthop Scand Suppl. 251:87-9, 1993
                                        16. Butler JC et al: Postlaminectomy kyphosis. Causes and surgical management. Orthop Clin North Am. 23(3):505-11, 1992
                                        17. Sano S et al: Unstable lumbar spine without hypermobility in postlaminectomy cases. Mechanism of symptoms and effect of spinal fusion with and without spinal instrumentation. Spine. 15(11):1190-7, 1990
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Iatrogenic deformity, iatrogenic instability, postsurgical instability
                                                  • Definitions

                                                    • Deformity: Abnormality of alignment, angulation, or shape of vertebral column following surgery
                                                      • May be associated with clinically significant findings such as instability
                                                    • Instability: Postoperative loss of spine motion segment stiffness, in which applied force produces greater displacement than normal, with pain/deformity

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • Fluoroscopic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Blondel B et al: Posterior global malalignment after osteotomy for sagittal plane deformity: it happens and here is why. Spine (Phila Pa 1976). 38(7):E394-401, 2013
                                                                              2. Hassanzadeh H et al: Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine (Phila Pa 1976). 38(9):726-31, 2013
                                                                              3. Chau AM et al: Bone graft substitutes in anterior cervical discectomy and fusion. Eur Spine J. 18(4):449-64, 2009
                                                                              4. Crostelli M et al: Cervical fixation in the pediatric patient: our experience. Eur Spine J. 18 Suppl 1:20-8, 2009
                                                                              5. Gottfried ON et al: Spinopelvic parameters in postfusion flatback deformity patients. Spine J. 9(8):639-47, 2009
                                                                              6. Park DK et al: Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect. 58:737-45, 2009
                                                                              7. Rahme R et al: Acute swan-neck deformity and spinal cord compression after cervical laminectomy. Can J Neurol Sci. 36(4):504-6, 2009
                                                                              8. Schwab F et al: Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 34(17):1828-33, 2009
                                                                              9. Heary RF et al: The history of spinal deformity. Neurosurgery. 63(3 Suppl):5-15, 2008
                                                                              10. Jagannathan J et al: Iatrogenic spinal deformity. Neurosurgery. 63(3 Suppl):104-16, 2008
                                                                              11. Jang JS et al: Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome. J Neurosurg Spine. 7(4):387-92, 2007
                                                                              12. Papagelopoulos PJ et al: Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine. 22(4):442-51, 1997
                                                                              13. Mullin BB et al: The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord. 9(2):107-16, 1996
                                                                              14. An HS et al: Spinal disorders at the cervicothoracic junction. Spine. 19(22):2557-64, 1994
                                                                              15. Stromqvist B: Postlaminectomy problems with reference to spinal fusion. Acta Orthop Scand Suppl. 251:87-9, 1993
                                                                              16. Butler JC et al: Postlaminectomy kyphosis. Causes and surgical management. Orthop Clin North Am. 23(3):505-11, 1992
                                                                              17. Sano S et al: Unstable lumbar spine without hypermobility in postlaminectomy cases. Mechanism of symptoms and effect of spinal fusion with and without spinal instrumentation. Spine. 15(11):1190-7, 1990