Optimizing Pedicle Subtraction Osteotomy Techniques: A New Reduction Plier to Increase Technical Safety and Angular Reduction Efficiency

2018 ◽  
Vol 16 (3) ◽  
pp. 383-388 ◽  
Author(s):  
Antonio Faundez ◽  
Jean-Charles Le Huec ◽  
Lars V Hansen ◽  
Fong Poh Ling ◽  
Martin Gehrchen
Keyword(s):  
Sagittal Balance ◽  
Intraoperative Complications ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Neurologic Complication ◽  
Angular Correction ◽  
The Mean ◽  
Osteotomy Line

Abstract BACKGROUND Pedicle subtraction osteotomy (PSO) is a technically demanding surgery. There is room for development of osteotomy reduction instruments like the one we present in this study, to better guide angular correction and closure of the osteotomy line. OBJECTIVE To present a new surgical instrument that optimizes PSOs of the thoracolumbar spine. METHODS Seventeen consecutive patients have been treated at 3 different European University Hospitals. All underwent a PSO of the lumbar spine to treat major sagittal imbalance. The amount of vertebral angular correction needed was calculated using the full balance integrated (FBI) method. A special plier, which allows to safely control the angular correction, was used intraoperatively. Preoperative and early postoperative global sagittal balance parameters were compared. RESULTS The mean preoperative calculated correction angle (FBI) was 33.8°; the mean postoperative correction obtained was 32.1°. Lumbar lordosis was statistically greater than preoperatively (55.8° vs 19.4°, P < .0001). The global sagittal balance was improved, as shown by the increase of the spino-sacral angle from 122° preoperatively to 128° postoperatively (P = .0547). None of the patients had an intraoperative or early postoperative neurologic complication. There were no mechanical intraoperative complications during correction nor at the first postoperative follow-up. CONCLUSION The advantages of the instrument are safe, precise, and efficient reduction, by a rotation of the pedicle screws close to the osteotomy line, thus avoiding collapse and lack of correction, complications usually seen with the conventional technique. Further prospective studies are needed to confirm these results.

scholarly journals Feasibility and safety of using thoracic and lumbar cortical bone trajectory pedicle screws in spinal constructs in children: technical note

2018 ◽  
Vol 21 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Jonathan N. Sellin ◽  
Jeffrey S. Raskin ◽  
Kristen A. Staggers ◽  
Alison Brayton ◽  
Valentina Briceño ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Spine Surgery ◽  
Intraoperative Complications ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Instrumented Fusion ◽  
Cortical Bone Trajectory ◽  
Estimated Blood Loss ◽  
Posterior Instrumented Fusion

Thoracic and lumbar cortical bone trajectory pedicle screws have been described in adult spine surgery. They have likewise been described in pediatric CT-based morphometric studies; however, clinical experience in the pediatric age group is limited. The authors here describe the use of cortical bone trajectory pedicle screws in posterior instrumented spinal fusions from the upper thoracic to the lumbar spine in 12 children. This dedicated study represents the initial use of cortical screws in pediatric spine surgery.The authors retrospectively reviewed the demographics and procedural data of patients who had undergone posterior instrumented fusion using thoracic, lumbar, and sacral cortical screws in children for the following indications: spondylolysis and/or spondylolisthesis (5 patients), unstable thoracolumbar spine trauma (3 patients), scoliosis (2 patients), and tumor (2 patients).Twelve pediatric patients, ranging in age from 11 to 18 years (mean 15.4 years), underwent posterior instrumented fusion. Seventy-six cortical bone trajectory pedicle screws were placed. There were 33 thoracic screws and 43 lumbar screws. Patients underwent surgery between April 29, 2015, and February 1, 2016. Seven (70%) of 10 patients with available imaging achieved a solid fusion, as assessed by CT. Mean follow-up time was 16.8 months (range 13–22 months). There were no intraoperative complications directly related to the cortical bone trajectory screws. One patient required hardware revision for caudal instrumentation failure and screw-head fracture at 3 months after surgery.Mean surgical time was 277 minutes (range 120–542 minutes). Nine of the 12 patients received either a 12- or 24-mg dose of recombinant human bone morphogenic protein 2. Average estimated blood loss was 283 ml (range 25–1100 ml).In our preliminary experience, the cortical bone trajectory pedicle screw technique seems to be a reasonable alternative to the traditional trajectory pedicle screw placement in children. Cortical screws seem to offer satisfactory clinical and radiographic outcomes, with a low complication profile.

scholarly journals Blood Loss of Pedicle Subtraction Osteotomy for Sagittal Imbalance Spinal Deformity

2019 ◽  
Vol 69 (12) ◽  
pp. 3680-3682
Author(s):  
Abu Awwad Ahmed ◽  
Radu Prejbeanu ◽  
Dinu Vermesan ◽  
Ioan Branea ◽  
Bogdan Deleanu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operating Time ◽  
Pedicle Subtraction Osteotomy ◽  
Neurological Deficits ◽  
Sagittal Imbalance ◽  
Female Patients ◽  
Fixed Sagittal Imbalance ◽  
Male Patients ◽  
The Mean ◽  
Extensive Surgery

Pedicle subtraction osteotomies (PSO) have been used in the treatment of multiple spinal conditions involving a fixed sagittal imbalance. It is a complex, extensive surgery most often performed in the revision settings. The aim of our study is to review the major complications of this surgical technique with a focus on blood loss. Twenty patients were included, treated using PSO for sagittal imbalance, out of 255 corrective surgeries. Of the 12 female patients included in the study, the mean age was 64.33. Of the 8 male patients included in the study, the mean age was 51.85. For female patients, the mean blood loss was 2122.5 mL in comparison with male patients, with mean blood loss 1737.5 mL. The female patients had an operating time of 357.25 minutes in comparasion with male patients with an 328.5 minute operating time. Eight (5 female and 3 male) had postoperative neurological deficits and 6 (5 female and 1 male) had pseudarthrosis of adjacent levels.

Walking sagittal balance correction by pedicle subtraction osteotomy in adults with fixed sagittal imbalance

2016 ◽  
Vol 25 (8) ◽  
pp. 2488-2496 ◽  
Author(s):  
Mitsuru Yagi ◽  
Shinjiro Kaneko ◽  
Yoshiyuki Yato ◽  
Takashi Asazuma ◽  
Masafumi Machida
Keyword(s):  
Sagittal Balance ◽  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Fixed Sagittal Imbalance ◽  
Balance Correction

scholarly journals Sitting Position as an Alternative for Sagittal Balance Assessment: A Cross-Sectional Study

2021 ◽  
Author(s):  
Danaithep Limskul ◽  
Asadapong Srinawa ◽  
Aticha Ariyachaipanich ◽  
Kenny Yat Hong Kwan ◽  
Wicharn Yingsakmongkol ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Mean Difference ◽  
Sagittal Imbalance ◽  
Sitting Position ◽  
Sagittal Vertical Axis ◽  
Parameter Correlation ◽  
Standard Position ◽  
Hands On ◽  
The Mean ◽  
Whole Spine

Abstract Background: The sagittal vertical axis (SVA) is used for spinal sagittal balance evaluation. Patients with sagittal imbalance are assessed by whole spine standing lateral radiography, with some patients demonstrating standing difficulty during the examination. We propose new positioning methods to facilitate SVA assessment in patients with sagittal imbalance who cannot tolerate the standing position.Methods: Thirty healthy subjects had their SVA evaluated by whole spine lateral radiography in four positions: standard position by standing with the hands on the clavicles with elbows touching the trunk (TC), standing with the hands holding on to a front stationary railing within arm’s reach (TS), sitting with the hands on the clavicles (IC), and sitting with the hands holding on to a stationary railing (IS). The SVA was evaluated for differences and correlations between the standard position (TC) and the new proposed positions.Results: The mean difference in the SVA between the TC and TS group was 1.55 mm, with a limit of agreement of -36.62 to 39.72 mm and Lin’s correlation of 0.63. The mean difference in the SVA between the TC and IC or IS positions indicated greater positive SVA difference with no correlation. The TS position had good regional spinal parameter correlation with the TC position, as well as pelvic parameter correlation. The IC and IS positions showed poor pelvic and other regional spinal parameter correlations. Conclusions: The TS position can be used as an alternative method in measuring the SVA in patients with standing difficulty during radiography. Though measurement using the sitting position can be conveniently performed, this position does not correlate well with the standard SVA measurement.

Extended L5 pedicle subtraction osteotomy for neglected sacropelvic dissociation injury: case report

2019 ◽  
Vol 31 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Vishwajeet Singh ◽  
Tarush Rustagi ◽  
Robert Hart
Keyword(s):  
Case Report ◽  
Sagittal Balance ◽  
Pedicle Subtraction Osteotomy ◽  
Significant Alteration ◽  
Sagittal Imbalance ◽  
Pelvic Parameters ◽  
Lumbar Osteotomy ◽  
Pelvis Fractures

The sacrum forms the distal end of the spine and communicates with the pelvis. Fractures involving the sacrum are complex and may disrupt this vital communication. Neglecting these fractures may result in malunion, which often causes significant alteration in the pelvic parameters and sagittal balance. Management of ensuing deformities is complex and poorly described. The authors present a case of sacral malunion with sagittal imbalance treated with a low lumbar osteotomy.

Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance

2006 ◽  
Vol 5 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Benson P. Yang ◽  
Stephen L. Ondra ◽  
Larry A. Chen ◽  
Hee Soo Jung ◽  
Tyler R. Koski ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Late Complication ◽  
Pedicle Subtraction Osteotomy ◽  
Research Society ◽  
Late Complications ◽  
Neurological Injury ◽  
Sagittal Imbalance ◽  
Complication Rates ◽  
Scoliosis Research Society

Object he authors conducted a study to evaluate the radiographically documented and functional outcomes obtained in patients who underwent pedicle subtraction osteotomy (PSO). They also compared outcomes after classification of cases into thoracic and lumbar PSO subgroups. Methods he authors analyzed data obtained in 35 consecutive PSO-treated patients with sagittal imbalance. One surgeon performed all surgeries. The minimal follow-up period was 2 years. Events during the perioperative course and complications were noted. Standing long-film radiographs of the spine were obtained and measurements were made preoperatively, immediately postoperatively, and at most recent follow-up examination. The modified Prolo Scale and the 22-item Scoliosis Research Society (SRS-22) Outcomes Questionnaire were administered. Early complications after PSO included neurological injury, wound-related problems, and nosocomial infections. Late complications were limited to pseudarthrosis and attendant instrumentation failure. Early and late complication rates ranged from 10 to 30% for both thoracic and lumbar PSO cohorts. Lumbar PSO was associated with improvements in local, segmental, and global measures of sagittal balance, whereas thoracic PSO was only associated with local improvement. Most patients rated their functional status as fair to good according to the modified Prolo Scale and reported, according to the SRS-22 Outcomes Questionnaire, that they were satisfied with the overall treatment of their back condition. Conclusions The ability to perform a PSO at both lumbar and thoracic levels is a powerful asset for the spine surgeon treating spinal deformity. In the present study radiographic and clinical outcomes were superior when PSO was used to treat lumbar deformity rather than thoracic deformity because of several anatomical and technical obstacles that hindered the thoracic procedure. Nevertheless, the thoracic PSO proved a useful addition with which to produce regional improvement in sagittal balance for patients with a fixed thoracic kyphosis.

Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases

2011 ◽  
Vol 15 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Vedat Deviren ◽  
Justin K. Scheer ◽  
Christopher P. Ames
Keyword(s):  
Neck Disability Index ◽  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Cervicothoracic Junction ◽  
Analog Scale ◽  
Radiographic Measurements ◽  
Sf 36 ◽  
The Mean ◽  
Neck Disability

Object Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but has been infrequently reported in the literature. This study details the cervicothoracic PSO technique in 11 cases and correlates clinical kyphosis (chin-brow to vertical angle [CBVA]) with radiographic measurements. Methods Between February 2008 and September 2010, 11 patients (mean age 70 years) underwent a modified PSO (10 at C-7, 1 at T-1) for treatment of sagittal imbalance. Preoperative and postoperative sagittal plane radiographic measurements were made. The CBVA was measured on clinical photographs. Operative technique and perioperative correction were reported for all 11 patients and long-term follow-up data was reported for 9 patients, in whom the mean duration of follow-up was 23 months. Outcome measures used for these 9 patients were the Neck Disability Index, the 36-Item Short Form Health Survey (SF-36), and a visual analog scale for neck pain. Results The mean values for estimated blood loss, surgical time, and hospital stay in the 11 patients were 1100 ml, 4.3 hours, and 9.9 days, respectively. The mean preoperative and immediate postoperative values (± SD) for cervical sagittal imbalance were 7.9 ± 1.4 cm and 3.4 ± 1.7 cm. The mean overall correction was 4.5 ± 1.5 cm (42.8%), the mean PSO correction 19.0°, and the mean CBVA correction 36.7°. There was essentially no correlation between preoperative C2–T1 radiographic kyphosis and preoperative CBVA (R2 = 0.0165). There was a moderate correlation with PSO correction angle and postoperative CBVA (R2 = 0.38). There was a significant decrease in both the Neck Disability Index (51.1 to 38.6, p = 0.03) and visual analog scale scores for neck pain (8.1 to 3.9, p = 0.0021). The SF-36 physical component summary scores increased by 18.4% (30.2 to 35.8) with no neurological complications. Conclusions The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in health-related quality-of-life measures even at early time points.

scholarly journals Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes

2017 ◽  
Vol 26 (3) ◽  
pp. 368-373 ◽  
Author(s):  
Ning Liu ◽  
Kirkham B. Wood
Keyword(s):  
Spinal Deformity ◽  
Perioperative Complications ◽  
Pedicle Screws ◽  
Technical Note ◽  
Sagittal Imbalance ◽  
Anatomical Landmarks ◽  
Spinal Deformity Surgery ◽  
The Mean ◽  
Multilevel Fusion

OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4–ilium (4 cases), T7–ilium (1 case), T6–S1 (1 case), T12–S1 (1 case), and T9–L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

scholarly journals Short lever arm, bipedicular handlebar construct for correction of acute angular kyphosis in spondylodiscitis-induced kyphotic deformity: illustrative case

2021 ◽  
Vol 1 (24) ◽  
Author(s):  
Meng Huang ◽  
Iahn Cajigas ◽  
Steven Vanni
Keyword(s):  
Structural Integrity ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Sagittal Imbalance ◽  
Illustrative Case ◽  
Effective Treatment Option ◽  
Pyogenic Spondylodiscitis ◽  
Lever Arm ◽  
Angular Correction ◽  
Angular Kyphosis

BACKGROUND Pyogenic spondylodiscitis diminishes spinal structural integrity via disruption of the anterior and middle column, sometimes further compounded by iatrogenic violation of the posterior tension band during initial posterior decompressive surgeries. Although medical management is typically sufficient, refractory infection or progressive deformity may require aggressive debridement and reconstructive arthrodesis. Although anterior debridement plus reconstruction with posterior stabilization is an effective treatment option, existing techniques have limited efficacy for correcting focal deformity, leaving patients at risk for long-term sagittal imbalance, pain, and disability. OBSERVATIONS The authors present a case of chronic lumbar pyogenic spondylodiscitis in a patient in whom initial surgical debridement failed and pronounced angular kyphosis and intractable low back pain developed. A novel bipedicular handlebar construct was used to achieve angular correction of the kyphosis through simultaneous anterior interbody grafting and posterior instrumentation with the patient in the lateral position. LESSONS Leveraging both pedicle screws at the same level to transmit controlled corrective distraction forces through the segment allows for kyphosis correction without relying on long posterior constructs for cantilever reduction. Simultaneous anterior reconstruction with a posterior short lever arm, bipedicular handlebar construct is an effective technique for achieving high angular correction during circumferential reconstructive approaches to postinfectious focal kyphotic deformities.

Sacral pedicle subtraction osteotomy for an extreme case of positive sagittal balance: case report

2018 ◽  
Vol 28 (5) ◽  
pp. 532-535 ◽  
Author(s):  
Ali K. Ozturk ◽  
Patricia Zadnik Sullivan ◽  
Vincent Arlet
Keyword(s):  
Case Report ◽  
Sagittal Balance ◽  
Vertebral Column ◽  
Extreme Case ◽  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Review Of The Literature ◽  
Spinal Balance ◽  
Balance Case ◽  
Sagittal Spinal Balance

The importance of sagittal spinal balance and lumbopelvic parameters is now well understood. The popularization of various osteotomies, including Smith-Peterson, Ponte, and pedicle subtraction osteotomies (PSOs), as well as vertebral column resections, have greatly enhanced the spine surgeon’s ability to recognize and effectively treat sagittal imbalance. Yet rare circumstances remain, most notably in distal kyphotic deformities and patients with extremely elevated pelvic incidences, where these techniques remain inadequate. In this article, the authors describe a patient with severe sagittal imbalance despite multiple prior anterior and posterior reconstructive surgeries in which a sacral PSO was performed with good results. A description of this technique as well as a brief review of the literature is provided.

Sign in / Sign up

Export Citation Format

Share Document