Revision surgery after PSO failure with rod breakage: a comparison of different techniques.

Study Design: Author experience and literature review.
Objectives: To compare different revision techniques in the treatment of implant failure after pedicle subtraction osteotomy (PSO). The complication rate of pedicle subtraction osteotomy is substantially higher than other corrective procedures available for the treatment of spinal sagittal imbalance: in particular, hardware failures and mechanical complications affect this technique and their biomechanical explanation is still purely speculative.
Methods: The author's experience and the literature regarding the revision techniques for PSO failures are discussed.
Results: In this paper, eight consecutive revision cases due to rod breakage after PSO surgery are reported. In our experience, the main goals are to restore the spinal balance, through a posterior approach (correction and hardware revision and implementation) and to get a solid anterior fusion (both through a traditional anterior approach or minimally invasive transpsoas approach).
Conclusion: The efficacy of PSO should be balanced with the high risk of the procedure reported in the literature. Management of revision surgery after PSO may require the addition of anterior column support to maintain correction and reduce complications.