Pedicle subtraction osteotomy in adult spinal deformity correction: Clinical and radiographic risk factors for early instrumentation failure.

BACKGROUND: Early instrumentation failure (EIF) after pedicle subtraction osteotomy (PSO) is a known complication of adult spine deformity (ASD) correction. In contrast to the more common failure that occurs secondary to pseudarthrosis, early instrumentation failure (<6 months after surgery) and its risk factors are not as well understood. OBJECTIVE: To identify risk factors for EIF in patients undergoing PSO for ASD correction. METHODS: Patients with ASD who underwent correction with PSO from 2013 to 2018 were retrospectively reviewed. Demographic characteristics, number of rods, spinopelvic parameters, bone density derived from computed tomography (CT) attenuation in Hounsfield units (HU), Global Alignment and Proportion (GAP) score, and type of instrumentation failure were evaluated. Potential risk factors for EIF were analyzed. RESULTS: 9 out of 46 (19.5%) patients who underwent PSO had EIF. All 9 patients with EIF had 2-rod constructs and failed secondary to rod fracture. The number of rods used in the EIF group was significantly lower than the non-EIF group (2.00 ± 0.00 vs 2.81 ± 0.995, p = .000. The EIF group demonstrated a significantly higher pre-op PI (77.33 ± 13.23), p = .022, pre-op PT (37.22 ± 6.46),p = .012, and post-op SVA (89.96 ± 23.85), p = .028 compared to the non-EIF group. CONCLUSION: High pre-op PI, pre-op PT, and post-op SVA were significant risk factors associated with EIF after PSO. Use of multiple rod constructs are protective and may help mitigate risk of EIF in these patients.

Rupture of the Proximal Long Head of Biceps Tendon Presenting as a Pectoralis Major Tear: A Case Report.

CASE: We report a case of a 56-year-old man who sustained a ruptured long head of biceps tendon (LHBT) that presented with symptoms typical of a pectoralis major rupture. Magnetic resonance imaging revealed an isolated LHBT tear. Intraoperatively, the biceps tendon had an unusually thick distal segment entrapped under the insertion of the pectoralis major. Surgery led to an excellent outcome. CONCLUSION: A ruptured LHBT with an associated large distal segment producing a mass effect on the pectoralis major can mimic a pectoralis major rupture and may ultimately require surgery to alleviate symptoms.