Patient Testimonials

Iatrogenic Fixed Sagittal Imbalance

Dr. Rinella and Nancy
Dr. Rinella and Nancy

Nancy is a wonderful woman who unfortunately found herself is a situation I see all too often in my practice, a surgical "domino effect". Some surgeons call it "failed back syndrome", but I believe this is a misnomer. Sometimes spinal surgery fails to have the results we hope to achieve, but other times surgeons either lack the knowledge or experience to do what is necessary. Many patients wish they could back up the clock and avoid the first surgery if they knew what would happen down the road. Nancy was on a path more frightening than the thought of a major reconstructive spine surgery - she could not stand up and walk long distances after multiple spine surgeries destabilized her spine.

Nancy developed "iatrogenic fixed sagittal imbalance". No amount of physical therapy or bracing would allow her to stand up straight. Our options were to consider a major reconstructive spinal surgery, or continue on her path at the time. As frightening as a staged 12-hour procedure sounded, Nancy realized her path without surgery was equally dangerous. She was 63 years old and could barely walk.

Pre-Op AP X-ray
Pre-Op AP
Pre-Op lateral X-ray
Pre-Op Lateral
Post-Op AP X-ray
Post-Op AP
Post-Op lateral X-ray
Post-Op Lateral

The first step when considering a major revision spine surgery was to understand all the pain generators. Nancy's lumbar spine (low back) curved forward causing a lot of pain, and made it impossible to stand up straight. She required a long posterior spinal fusion from T2 (shoulders) to her pelvis. The risks of surgery, especially infection, were higher in the revision setting and after long procedures. Nancy developed an infection, but we were able to cure her and allow her to stand up straight, pain free. When I think of Nancy, and other patients with a similar story, I remember how important it is to perform the right surgery the first time. Although I am happy to help patients in her scenario and enjoy the challenge, the biggest challenge is to keep the spine balanced so it is less likely to deteriorate into a situation much worse than the initial problem. I believe my experiences with adult kyphosis and scoliosis, and the very difficult cases I treat in children around the world give me important perspective when facing challenging problems.