J Korean Neurosurg Soc.  2020 Jan;63(1):99-107. 10.3340/jkns.2018.0170.

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

• Choi HY
• Hyun SJ
• Kim KJ
• Jahng TA
• Kim HJ

• KMID: 2501697
• DOI: http://doi.org/10.3340/jkns.2018.0170

Abstract

Objective
: The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO.
Methods
: A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed.
Results
: The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to -50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively, -16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications.
Conclusion
: PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.

Keyword

Osteotomy; Spinal curvatures; Follow-up studies; Kyphosis; Spinal fusion

Figure

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  Fig. 1. A 77-year old female patient presenting with stooped posture and pain on her back and lower extremities. A : Preoperative sagittal whole spine X-ray showed sagittal imbalance with lumbar kyphosis. PSO with posterior instrumented fusion from T10 to pelvis was done. B : Sagittal balance was improved at final follow-up. Owing to multiple posterior column osteotomies in addition to PSO, the correction amount of lumbar lordosis (70.2°) is far greater than that of PSO angle (41.7°). PI : pelvic incidence, TK : thoracic kyphosis, LL : lumbar lordosis, SVA : sagittal vertical axis, PSO : pedicle subtraction osteotomy

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  Fig. 2. A 71-year-old female patient presenting with stooped posture and pain on her back and lower extremities. She underwent prior lumbar spine surgeries at another hospital. A : Preoperative sagittal whole spine X-ray showed spinal instrumentation from L1 to L5 with bone cement materials at multiple levels. L4 PSO with posterior instrumented fusion from T9 to pelvis, and prophylactic vertebroplasties at T8 and T9 were done. B : Because of nearly fused posterior element of the lumbar spine, the correction amount of lumbar lordosis (36.5°) is almost same with PSO angle (34.8°). PI : pelvic incidence, TK : thoracic kyphosis, LL : lumbar lordosis, SVA : sagittal vertical axis, PSO : pedicle subtraction osteotomy.

Reference

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