Revision with S1 Stacked S2AI Revision

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Practicing at Halifax Health Medical Center in Daytona Beach, Florida.

Provider: Paul Krafft, MD*

Speciality: Neurosurgeon, Spine Surgeon

Facility: Halifax Health Medical Center

Bio: Fellowship: University of South Florida, Complex and Reconstructive Spine Surgery
Residency: University of South F... More

Fellowship: University of South Florida, Complex and Reconstructive Spine Surgery
Residency: University of South Florida, Neurosurgery
Medical School: Johann Wolfgang Goethe University School of Medicine, Germany

Dr. Paul Krafft is a board-certified neurosurgeon practicing at Halifax Health Medical Center in Daytona Beach, Florida. He is affiliated with the University of Florida, Department of Neurosurgery. His clinical interests include complex and revision spine surgery, spinal trauma and deformity surgery, minimally invasive spine surgery, traumatic brain injury as well as stroke. Less

Case Details

Condition: Spinopelvic Fixation

Product(s): iFuse Bedrock Granite

Patient: 73 y/o male

Revision with S1 Stacked S2AI Revision

Patient History:

73 y/o male; BMI: 34.7; T-Value: Not obtained
History of diabetes mellitus, chronic neck & back pain
Presented with:
- Low back pain
- Neurogenic claudication
- Bilateral L4/5 radiculopathy
- Severe lumbar spondylosis from L3-S1, with central and bilateral neuroforaminal stenosis

Initial Treatment & Outcomes:

L3-S1 decompressive laminectomy, L4-S1 TLIF, L3-S1 PSF Developed bilaterial SIJ pain
Developed progressive axial/mechanical back pain
Pseudoarthrosis formation at L4/5 and L5/S1
Loosening/haloing of L3 and S1 pedicle screws
Failed conservative management

Surgical Decision Making:

Provide additional fixation/stability – extension of construct proximally to L2 and distally to pelvis
- Elected to extend construct proximally and distally to span pathology and to increase stability of construct as opposed to simply upsizing to larger diameter pedicle screws.
Improve pedicle screw purchase:
- Fenestrated pedicle screws & cement augmentation where possible
- Stack Granite for additional support/stability at construct base, and to relieve SI-joint pain (favorable patient anatomy allows two implants across both SI joints)

Surgical Treatment:

Removal of previous hardware
Fusion/revision fusion L2 to pelvis, instrumentation with navigation
Fenestrated pedicle screws at L2-L5 with cement
augmentation
Bilateral placement of iFuse Bedrock Granite^®:
- S1 Pedicles: 9.5x40 mm
- Stacked SAI: 9.5x70 mm & 9.5x80 mm

Post-op (3-month follow-up):

Pre-op pain was intermittent 10/10 on the VAS, and improved to intermittent 0/10 at follow-up¹

1. Multilevel deformity constructs have been performed for many years. Reported outcomes reflect entirety of the procedure and cannot be attributed to a single component. This case study represents a single patient's experience and results may vary.

Healthcare professionals should refer to the Instructions For Use for indications, contraindications, warnings, and precautions at https://si-bone.com/label.

There are potential risks associated with iFuse procedures. They may not be appropriate for all patients and all patients may not benefit.
For information about the risks, visit https://si-bone.com/risks.

Short Construct Revision

Dr. Paul Krafft places iFuse Bedrock Granite^® in the S1 pedicle and S2AI trajectories following L5-S1 hardware loosening and pseudarthrosis.