scholarly journals A Novel 4-Rod Technique Offers Potential to Reduce Rod Breakage and Pseudarthrosis in Pedicle Subtraction Osteotomies for Adult Spinal Deformity Correction

2017 ◽  
Vol 14 (4) ◽  
pp. 449-456 ◽  
Author(s):  
Sachin Gupta ◽  
Murat Sakir Eksi ◽  
Christopher P Ames ◽  
Vedat Deviren ◽  
Blythe Durbin-Johnson ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Posterior Instrumentation ◽  
Adult Spinal Deformity ◽  
Wedge Resection ◽  
Deformity Correction ◽  
Study Groups ◽  
Pedicle Subtraction Osteotomy ◽  
Radiographic Measurements ◽  
Rod Breakage ◽  
Group 1

Abstract BACKGROUND Pedicle subtraction osteotomy (PSO) can be used to treat rigid sagittal plane deformities. Nonunions and rod breakages are known complications of PSO. OBJECTIVE To assess outcomes of 2 methods of posterior instrumentation for PSO, traditional 2 rods vs a novel 4-rod technique in which 2 additional rods span only the osteotomy level. METHODS This study was a retrospective, radiographic review of consecutive PSOs performed at 2 centers. The primary difference in technique between the centers was the use of 4 rods including 2 independent rods attached only to the vertebral levels immediately adjacent to the PSO (group 1, n = 29 patients) vs the traditional 2-rod technique (group 2, n = 20 patients). RESULTS Demographics and preoperative to postoperative radiographic measurements were similar between the study groups, including the PSO wedge resection angle (P = .56). The rod breakage rate was 25% with 2 rods and 0% with 4 rods (P = .008), and the pseudarthrosis rate with 2 rods was 25% and with 4 rods was 3.4% (P = .035). The patient with pseudarthrosis from group 1 had an infection and developed pseudarthrosis only after instrumentation removal. Rates of other complications did not differ significantly between the study groups. CONCLUSION This study provides a comparison between 2 techniques for rod placement across a PSO and suggests that the described novel 4-rod technique may help to reduce the rates of pseudarthrosis and rod failure. It will be important to confirm these findings in a prospectively designed study with multiple institutions in order to better control for potentially confounding factors.

scholarly journals Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

2017 ◽  
Vol 43 (2) ◽  
pp. E15 ◽  
Author(s):  
Jean-Christophe Leveque ◽  
Vijay Yanamadala ◽  
Quinlan D. Buchlak ◽  
Rajiv K. Sethi
Keyword(s):  
Blood Loss ◽  
Spinal Deformity ◽  
Operative Time ◽  
Sagittal Plane ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Deformity Correction ◽  
Pedicle Subtraction Osteotomy ◽  
Estimated Blood Loss ◽  
The Mean

OBJECTIVEPedicle subtraction osteotomy (PSO) provides extensive correction in patients with fixed sagittal plane imbalance but is associated with high estimated blood loss (EBL). Anterior column realignment (ACR) with lateral graft placement and sectioning of the anterior longitudinal ligament allows restoration of lumbar lordosis (LL). The authors compare peri- and postoperative measures in 2 groups of patients undergoing correction of a sagittal plane imbalance, either through PSO or the use of lateral lumbar fusion and ACR with hyperlordotic (20°–30°) interbody cages, with stabilization through standard posterior instrumentation in all cases.METHODSThe authors performed a retrospective chart review of cases involving a lumbar PSO or lateral lumbar interbody fusion and ACR (LLIF-ACR) between 2010 and 2015 at the authors’ institution. Patients who had a PSO in the setting of a preexisting fusion that spanned more than 4 levels were excluded. Demographic characteristics, spinopelvic parameters, EBL, operative time, and LOS were analyzed and compared between patients treated with PSO and those treated with LLIF-ACR.RESULTSThe PSO group included 14 patients and the LLIF-ACR group included 13 patients. The mean follow-up was 13 months in the LLIF-ACR group and 26 months in the PSO group. The mean EBL was significantly lower in the LLIF-ACR group, measuring approximately 50% of the mean EBL in the PSO group (1466 vs 2910 ml, p < 0.01). Total LL correction was equivalent between the 2 groups (35° in the PSO group, 31° in the LLIF-ACR group, p > 0.05), as was the preoperative PI-LL mismatch (33° in each group, p > 0.05) and the postoperative PI-LL mismatch (< 1° in each group, p = 0.05). The fusion rate as assessed by the need for reoperation due to pseudarthrosis was lower in the LLIF-ACR group but not significantly so (3 revisions in the PSO group due to pseudarthrosis vs 0 in the LLIF-ACR group, p > 0.5). The total operative time and LOS were not significantly different in the 2 groups.CONCLUSIONSThis is the first direct comparison of the LLIF-ACR technique with the PSO in adult spinal deformity correction. The study demonstrates that the LLIF-ACR provides equivalent deformity correction with significantly reduced blood loss in patients with a previously unfused spine compared with the PSO. This technique provides a powerful means to avoid PSO in selected patients who require spinal deformity correction.

scholarly journals Pedicle subtraction osteotomy: a comprehensive analysis in 104 patients. Does the cause of deformity influence the outcome?

2017 ◽  
Vol 27 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Karin Eskilsson ◽  
Deep Sharma ◽  
Christer Johansson ◽  
Rune Hedlund
Keyword(s):  
Clinical Outcomes ◽  
Sagittal Plane ◽  
Lumbar Fusion ◽  
Adult Spinal Deformity ◽  
Surgical Site Infections ◽  
Pedicle Subtraction Osteotomy ◽  
Entire Group ◽  
Sagittal Vertical Axis ◽  
Suboptimal Outcome

OBJECTIVEThe clinical outcomes and complications of patients who underwent pedicle subtraction osteotomy (PSO) for various diagnoses were compared. More specifically, the purpose was to identify if outcomes differed between patients with flat-back syndrome after lumbar fusion (FBS-LF) versus patients who underwent surgery for adult spinal deformity (ASD).METHODSA retrospective analysis of 104 patients who underwent a PSO for sagittal plane imbalance was performed. There were 28 patients with FBS-LF and 76 patients with various forms of ASD. Outcome was measured using visual analog scale (VAS)-back, VAS-leg, Oswestry Disability Index (ODI) (range 0–100 for all scales), and EQ-5D scores (range 0–1). Patients also rated their global outcomes as much better, better, unchanged, or worse at follow-up. The minimum follow-up was 1 year (range 1–4 years). Clinical outcomes and complications were compared between the 2 groups of patients.RESULTSThe most common level of PSO was L-3 and L-2; 100 single and 4 double PSOs were performed. The average local correction by PSO itself was 27.2°. The sagittal vertical axis (SVA) improved from a mean preoperative value of 74 ± 23 mm to 49 ± 20 mm at the final follow-up. The VAS-back, ODI, and EQ-5D scores improved significantly for the entire group by 33, 16, and 0.31 points, respectively. In total, 57% of patients reported that they were “much better” or “better” than before surgery. Preoperatively, as well as postoperatively, the FBS-LF patients reported significantly worse VAS scores. According to VAS-back results, the ASD group improved by 34 points compared with 29 points in FBS-LF patients. ODI scores were similar between the 2 groups preoperatively but improved significantly more in the ASD group (18 points) compared with the FBS-LF group (13 points). The EQ-5D scores improved from 0.07 to 0.35 in FBS-LF patients, and from 0.21 to 0.56 on average in ASD patients. Similarly, a “much better” or “better” outcome compared with before surgery was reported by 72% of patients in the ASD group compared with 24% of patients in the FBS-LF group (p < 0.001). The overall reoperation rate was 31%: 46% of patients in the FBS-LF group compared with 25% of patients in the ASD group. There were 19 (18%) dural tears, 14 (13.5%) surgical site infections, 12 (11.5%) instances of pseudarthrosis, 15 (14%) proximal junctional failures, and 2 distal junctional failures. The 12 (11%) neurological complications were dominated by partial weakness of hip flexion and knee extension, and all but 2 of these were temporary.CONCLUSIONSPSO is a safe and effective method for correcting sagittal plane imbalance due to multiple etiologies. The authors found patient satisfaction to be high, and health-related quality of life was greatly improved by the procedure in patients with ASD. In contrast, in FBS-LF patients, a suboptimal outcome was observed and the cautious use of PSO seems warranted in this subset of patients.

A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

2015 ◽  
Vol 15 (10) ◽  
pp. S126-S127
Author(s):  
International Spine Study Group ◽  
Gregory M. Mundis ◽  
Jay D. Turner ◽  
Vedat Deviren ◽  
Juan S. Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Critical Analysis ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Follow Up Study ◽  
Spinal Deformity Surgery ◽  
Plane Deformity

Multilevel Pedicle Subtraction Osteotomy for Correction of Severe Rigid Adult Spinal Deformities: A Case Series, Indications, Considerations, and Literature Review

2020 ◽  
Author(s):  
Darryl Lau ◽  
Alexander F Haddad ◽  
Marissa T Fury ◽  
Vedat Deviren ◽  
Christopher P Ames
Keyword(s):  
Pain Relief ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Pedicle Subtraction Osteotomy ◽  
Spinal Deformities ◽  
Spinal Region ◽  
Spinal Imbalance

Abstract BACKGROUND Rigid and ankylosed thoracolumbar spinal deformities require three-column osteotomy (3CO) to achieve adequate correction. For severe and multiregional deformities, multilevel 3CO is required but its use and outcomes are rarely reported. OBJECTIVE To describe the use of multilevel pedicle subtraction osteotomy (PSO) in adult spinal deformity (ASD) patients with severe, rigid, and ankylosed multiregional deformity. METHODS Retrospective review of 5 ASD patients who underwent multilevel PSO for the correction of severe fixed deformity and review the literature regarding the use of multilevel PSO. RESULTS Five patients presented with spinal imbalance secondary to regional and multiregional spinal deformities involving the thoracolumbar spine. All patients underwent a single-stage two-level noncontiguous PSO, and 2 of the patients underwent a staged third PSO to treat deformity involving a separate spinal region. Significant radiographic correction was achieved with normalization of spinal alignment and parameters. Two-level PSO was able to provide greater than 80 degrees of sagittal plane correction in both the lumbar and thoracic spine. Two patients experienced new postoperative weakness which recovered to preoperative baseline at 3 to 6 mo follow-up. At most recent follow-up, 4 of the 5 patients gained significant pain relief and had improved functionality. CONCLUSION Noncontiguous multilevel PSO is a formidable surgical technique. Additional risk (compared to single-level 3CO) comes in the form of greater blood loss and higher risk for postoperative weakness. Nonetheless, multilevel PSO is feasible and effective for correcting severe multiplanar and multiregional ASD, and patients gain significant benefits in increased functionality and pain relief.

scholarly journals Analysis of Shortening and Elevation of the First Ray With Instrumented Triplane First Tarsometatarsal Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096067
Author(s):  
Daniel J. Hatch ◽  
Paul Dayton ◽  
William DeCarbo ◽  
Jody P. McAleer ◽  
Justin J. Ray ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Deformity Correction ◽  
Segment Length ◽  
Plane Angle ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Radiographic Measurements ◽  
Bone Segment ◽  
First Ray ◽  
Prospective Comparative Study

Background: The Lapidus procedure using planar saw resection has often been criticized for complications related to excessive shortening and elevation of the first ray. The goal of this study was to assess the amount of shortening that occurs when using a cutting guide for controlled saw resection of the first tarsometatarsal (TMT) joint surfaces, along with assessment of deformity correction in all 3 anatomic planes. Methods: A prospective multicenter study with IRB approval included 35 hallux valgus subjects evaluated at baseline and 6 months following instrumented triplane first TMT arthrodesis without lesser metatarsal osteotomies. Results: The average first ray bone segment length loss was 3.1 mm (95% confidence interval [CI] 2.4-3.7) in the anteroposterior (AP) radiographic assessment and 2.4 mm (95% CI 1.7-3.1) in the sagittal plane. The mean preoperative radiographic measurements were 1.7 degrees (dorsiflexion) for sagittal plane angle, 13.8 degrees for intermetatarsal angle (IMA), and 5.1 for tibial sesamoid position (TSP). Improvements were seen postoperatively for all measures with a mean difference of –0.2 degrees (95% CI –1.0 to 0.6) for sagittal plane angle, –9.2 degrees (95% CI –10.1 to –8.3 degrees) for IMA, and –3.5 (95% CI –4.0 to –3.1) for TSP. Five of the patients reported lesser metatarsal pain preoperatively, and no patients complained of lesser metatarsalgia at 6-month follow-up. Conclusions: Minimal length loss of the first ray can be expected following instrumented triplane TMT arthrodesis while achieving full 3-dimensional deformity correction and reducing the risk of lesser metatarsalgia. Level of Evidence: Level II, prospective comparative study.

Sagittal plane correction in pedicle subtraction osteotomy using the Xia 3 SUK Direct Vertebral Rotation System

2013 ◽  
Vol 19 (4) ◽  
pp. 507-514 ◽  
Author(s):  
Masahiro Kanayama
Keyword(s):  
Spinal Deformity ◽  
Surgical Procedure ◽  
Vertebral Column ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Pedicle Subtraction Osteotomy ◽  
Vertebral Rotation ◽  
Osteotomy Site ◽  
Sagittal Imbalance ◽  
Scoliosis Surgery

The Xia 3 SUK Direct Vertebral Rotation (DVR) System was developed for performing the vertebral derotation maneuver in scoliosis surgery. The author applied this device to sagittal plane correction in pedicle subtraction osteotomy for adult spinal deformity. The surgical procedure included 1) preparing secure proximal and distal foundations for correction using mutisegmental pedicle screw-rod fixation (to avoid stress concentration to a specific screw-bone interface), 2) decancellating only the posterior two-thirds of the vertebral column, 3) providing supplemental interbody fusion above and below the osteotomy site (the anterior one-third of the vertebral column and interbody cages serve as an anterior column support and a pivot of correction), 4) closing the osteotomy by gradual approximation of SUK tubes secured to the proximal- and distal-most screw heads, and 5) connecting rods between the proximal and distal screw-rod constructs. Eight consecutive patients with fixed sagittal imbalance were treated using this surgical procedure. No patient required distal fixation points extending to the sacrum and/or pelvis. The sagittal plane correction was 43°. The mean anterior deviation of the C-7 plumb line was improved from 12.7 cm to 4.0 cm immediately after surgery, and it was 6.0 cm at the final follow-up. A pedicle subtraction osteotomy using the Xia 3 SUK DVR System ensures a safe and secure sagittal plane correction in adult spinal deformity.

scholarly journals Negative Sagittal Balance Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 8 (2) ◽  
pp. 149-155
Author(s):  
Robert K. Merrill ◽  
Jun S. Kim ◽  
Ian T. McNeill ◽  
Samuel C. Overley ◽  
James E. Dowdell ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Balance ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Deformity Correction ◽  
Sagittal Vertical Axis ◽  
Spinal Deformity Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Study Design: Retrospective cohort study. Objective: Elucidate negative sagittal balance following adult spinal deformity surgery. Methods: We conducted a retrospective review of adult spinal deformity patients who underwent long fusion (>5 levels) to the sacrum by a single surgeon at a single institution between 2011 and 2015. Patients were divided into cohorts of postoperative sagittal vertical axis (SVA) <−10 mm, between −10 and +10 mm, or >+10 mm, denoted as groups 1, 2, and 3, respectively. Univariate analysis compared preoperative factors between the groups, and a multivariable logistic regression model was used to determine independent risk factors for developing a negative sagittal balance (SVA<−10 mm) following adult spinal deformity correction. Results: We reviewed 8 patients in group 1, 9 patients in group 2, and 25 patients in group 3. The average postoperative SVA for group 1, group 2, and group 3 were −30.99, +3.67, and +55.56 mm, respectively. There was a trend toward higher upper-instrumented vertebra (UIV) in group 1 (T2) compared with group 2 (T10) and group 3 (T9) ( P = .05). A trend toward lower preoperative SVA in groups 1 and 2 compared with group 3 was also seen (+53.36 vs +71.73 vs +122.80 mm) ( P = .06). Finally, we found a trend toward lower body mass index in group 1 compared with groups 2 and 3 (24.71 vs 25.92 vs 29.33 kg/m2) ( P = .07). Based on multivariable regression, higher UIV was found to be a statistically significant independent predictor for developing a postoperative negative sagittal balance of <−10 mm ( P = .02, odds ratio = 0.67). Conclusions: Our results demonstrate that a higher UIV may predispose patients undergoing adult spinal deformity correction to have a postoperative negative sagittal balance.

scholarly journals Factors for the acquisition of 10° angular change at the lumbar spine through posterior column osteotomy in adult spinal deformity surgery

2018 ◽  
Vol 29 (6) ◽  
pp. 667-673 ◽  
Author(s):  
Sanghyun Han ◽  
Seung-Jae Hyun ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
Hyun-Jib Kim
Keyword(s):  
Lumbar Spine ◽  
Spinal Deformity ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Posterior Column ◽  
Control Group ◽  
Disc Space ◽  
Radiographic Measurements ◽  
Angular Change ◽  
Space Angle

OBJECTIVEPosterior column osteotomy (PCO) has been known to provide an angular change (AC) of approximately 10° in sagittal plane deformity. However, whether PCO can actually obtain an AC of ≥ 10° depending on the particular level in the lumbar spine and which factors can effect a gain of ≥ 10° AC after PCO remain to be elucidated. The aim of this study was to identify the factors that effect a gain of ≥ 10° AC through PCO by comparing radiographic measurements between an AC group and a control group before and after adult spinal deformity (ASD) surgery.METHODSForty consecutive patients who underwent multilevel PCOs for ASD at a single institution between 2012 and 2016 were included in this study. PCO was performed in 142 disc space levels in the lumbar spine. The authors defined the disc space level that obtained ≥ 10° AC in the sagittal plane by PCO as the AC group and the remaining patients as controls. The modified Pfirrmann grade, surgical level, implementation of the transforaminal lumbar interbody fusion (TLIF), and radiographic measurements were compared between the groups.RESULTSThere were 67 levels in the AC group and 75 in the control group. Multivariate analysis identified the surgical level at L4–5 (OR 3.802, 95% CI 1.127–12.827, p = 0.031), performing TLIF with PCO (OR 3.303, 95% CI 1.258–8.674, p = 0.015), and a preoperative kyphotic disc space angle (OR 1.397, 95% CI 1.231–1.585, p < 0.001) as the factors that significantly effected ≥ 10° AC in the sagittal plane after PCO.CONCLUSIONSIn ASD surgery, PCO cannot always achieve ≥ 10° AC in the sagittal plane. The factors that effected ≥ 10° AC in PCO for ASD were surgical level at L4–5, performing TLIF with PCO, and the preoperative kyphotic disc space angle.

Sign in / Sign up

Export Citation Format

Share Document