T9-to-pelvis reconstruction after failed fusion — Case C-07

BeforeAfter

Before treatment — de-identified imaging

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The films

Pre-op full-length AP — stimulator in place, spine collapsing — de-identified — Pre-op full-length AP — stimulator in place, spine collapsing

Pre-op lateral — sagittal collapse — de-identified — Pre-op lateral — sagittal collapse

Full-body standing alignment film — de-identified — Full-body standing alignment film

Post-op lateral — T9-pelvis construct — de-identified — Post-op lateral — T9-pelvis construct

Post-op AP — spine realigned — de-identified — Post-op AP — spine realigned

Where in the spine

Cervical

Thoracic

◀ top of the new construct

T10

T11

T12

Lumbar

◀ prior L5-S1 fusion

Sacrum & pelvis

◀ anchored into the pelvis

Rebuilt from the mid-back to the pelvis.

The problem wasn’t one disc — it was alignment. Above the old L5-S1 fusion the spine drifted out of line for years, and a stimulator masked pain without fixing structure.

Correcting that means realigning the whole column and anchoring it where it can’t pull loose: instrumentation from T9 down into the pelvis itself.

New T9 → pelvis construct

Prior L5-S1 fusion

The course, in order

Years agoL5-S1 fusionPain persisted after the original operation, then worsened with leg pain.
LaterStimulator placedA device to mask pain — the structural problem was still there.
WorkupFull-length standing filmsThe collapse above the old fusion finally measured, not guessed.
SurgeryT9-to-pelvis reconstructionCollapsing segments realigned and stabilized, mid-back to pelvis.

Presentation

Years after an L5-S1 fusion, pain persisted and gradually worsened with leg pain. A spinal cord stimulator was placed — symptoms continued.

Imaging

Full-length standing films show the whole story: the old fusion, the stimulator hardware, and the spine drifting out of alignment above it.

Decision

When a device masks pain instead of fixing structure, the structural problem is still there. This is deformity-scale revision surgery — planned on full-length imaging, not a single MRI slice.

What was done

T9-to-pelvis posterior spinal fusion: the collapsing segments realigned and stabilized from the mid-back to the pelvis.

Failed prior fusionStimulator didn't solve itFull-length realignment

"Full-length films first — you can't fix alignment you never measured."

All cases shown are real patients treated by Dr. Andrew Pugely, presented with de-identified imaging for education. Every spine — and every recovery — is different: individual results vary, and nothing on this page is a guarantee of outcome or a substitute for an in-person evaluation.

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