Removal of Hartshill Rectangle and Wires with Revision Pedicle Screw Fixation: Technical Challenges, Safety Considerations, and Clinical Outcomes in Complex Spinal Reconstruction - A Case Report.

INTRODUCTION

The Hartshill rectangle with sublaminar wiring was a widely used spinal stabilization method, now largely replaced by pedicle screw systems due to superior biomechanical stability and reduced neurological risks. However, removal of such constructs in revision surgeries poses significant challenges, including fibrosis, implant corrosion, and risk of dural injury.

CASE REPORT: We report two cases requiring removal of previously implanted Hartshill constructs. The first patient, a 46-year-old female, presented with acute back pain and radiculopathy due to an L1 burst fracture and prior L2-L4 Hartshill instrumentation. The second patient, a 50-year-old male, presented with myelopathy from implant backout and cord compression at D12. Both underwent implant removal and revision with pedicle screw fixation under O-arm guidance. Intraoperative navigation allowed precise localization and safe removal of broken sublaminar wires, minimizing the risk of neural injury. One sublaminar wire adherent to fibrotic tissue was left in situ in the second case to avoid complications.

CONCLUSION

Hartshill construct removal can be technically demanding due to fibrosis, metallosis, and broken sublaminar wires. The use of intraoperative navigation enhances safety and precision in revision spine surgery, making it a valuable adjunct in managing such complex cases.