Spondylolisthesis following a pedicle subtraction osteotomy

2010 ◽  
Vol 28 (3) ◽  
pp. E16 ◽  
Author(s):  
Cheerag D. Upadhyaya ◽  
Sigurd Berven ◽  
Praveen V. Mummaneni
Keyword(s):  
Sagittal Plane ◽  
Deformity Correction ◽  
Pedicle Subtraction Osteotomy ◽  
Pedicle Screw Fixation ◽  
History Of ◽  
Plane Deformity ◽  
Correction Surgery ◽  
Flat Back ◽  
Rod Fracture ◽  
Rare Instance

Pedicle subtraction osteotomy (PSO) is a powerful technique for correcting a fixed sagittal plane deformity. The authors report the case of a 51-year-old man with a history of multiple prior lumbar operations, flat-back syndrome, thoracic kyphosis, and radiculopathy, who underwent deformity correction surgery with T3–S1 pedicle screw fixation and L-3 PSO. Progressive spondylolisthesis of the PSO segment associated with rod fracture then developed. The patient subsequently underwent anterior and posterior revision surgery. This case is a rare instance of spondylolisthesis following PSO.

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

scholarly journals Surgical management of global sagittal deformity in ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E8 ◽  
Author(s):  
Charles A. Sansur ◽  
Kai-Ming G. Fu ◽  
Rod J. Oskouian ◽  
Jay Jagannathan ◽  
Charles Kuntz ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Preoperative Planning ◽  
Sagittal Plane ◽  
Axial Skeleton ◽  
Pedicle Subtraction Osteotomy ◽  
Review Article ◽  
Cervicothoracic Junction ◽  
Plane Deformity ◽  
Sagittal Deformity ◽  
Review Current

✓ Ankylosing spondylitis (AS) is an inflammatory rheumatic disease whose primary effect is on the axial skeleton, causing sagittal-plane deformity at both the thoracolumbar and cervicothoracic junctions. In the present review article the authors discuss current concepts in the preoperative planning of patients with AS. The authors also review current techniques used to treat sagittal-plane deformity, focusing on pedicle subtraction osteotomy at the thoracolumbar junction, as well as cervical extension osteotomy at the cervicothoracic junction.

scholarly journals Biomechanical comparison between titanium and cobalt chromium rods used in a pedicle subtraction osteotomy model

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Kalpit N. Shah ◽  
Gregory Walker ◽  
Sarath C. Koruprolu ◽  
Alan H. Daniels
Keyword(s):  
Corrective Osteotomy ◽  
Deformity Correction ◽  
Pedicle Subtraction Osteotomy ◽  
Osteotomy Site ◽  
Cobalt Chromium ◽  
Hardware Failure ◽  
Spinal Reconstruction ◽  
Instrumentation Failure ◽  
Biomechanical Comparison ◽  
Rod Fracture

Instrumentation failure is a common complication following complex spinal reconstruction and deformity correction. Rod fracture is the most frequent mode of hardware failure and often occurs at or near a 3-column osteotomy site. Titanium (Ti) rods are commonly utilized for spinal fixations, however, theoretically stiffer materials, such as cobalt-chrome (CoCr) rods are also available. Despite ongoing use in clinical practice, there is little biomechanical evidence that compares the construct ability to withstand fatigue stress for Ti and Co-Cr rods. Six models using 2 polyethylene blocks each were used to simulate a pedicle subtraction osteotomy. Within each block 6.0×45 mm polyaxial screws were placed and connected to another block using either two 6.0×100 mm Ti (3 models) or CoCr rods (3 models). The rods were bent to 40° using a French bender and were secured to the screws to give a vertical height of 1.5 cm between the blocks. The blocks were fatigue tested with 700N at 4 Hz until failure. The average number of cycles to failure for the Ti rod models was 12840 while the CoCr rod models failed at a significantly higher, 58351 cycles (P=0.003). All Ti models experienced rod fracture as the mode of failure. Two out of the three CoCr models had rod fractures while the last sample failed via screw fracture at the screw-tulip junction. The risk of rod failure is substantial in the setting of long segment spinal arthrodesis and corrective osteotomy. Efforts to increase the mechanical strength of posterior constructs may reduce the occurrence of this complication. Utilizing CoCr rods in patients with pedicle subtraction osteotomy may reduce the rate of device failure during maturation of the posterior fusion mass and limit the need for supplemental anterior column support.

Anterior Column Reconstruction vs Pedicle Subtraction Osteotomy for Severe Sagittal Plane Deformity: Early Clinical and Radiographic Outcomes Using a Hyperlordotic Expandable Lateral Interbody Device

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lara Walsh Massie ◽  
Mohamed Macki ◽  
Hesham M Zakaria ◽  
Michelle Gilmore ◽  
Azam Basheer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Sagittal Plane ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Significant Difference ◽  
Sagittal Parameters ◽  
Plane Deformity ◽  
Lateral Interbody ◽  
Anterior Column Reconstruction

Abstract INTRODUCTION Anterior Column Reconstruction (ACR) is an increasingly utilized minimally invasive alternative to Pedicle Subtraction Osteotomy (PSO) for correction of sagittal plane deformity in patients with an available unfused lumbar disc. METHODS Fifteen consecutive patients with significant sagittal plane imbalance (SVA > 10 cm or PI-LL mismatch/planned correction > 30?) after prior lumbar fusion were analyzed. Patients underwent either an ACR (N = 11) using an expandable, hyperlordotic lateral interbody device if possible via an unfused disc space, or PSO (n = 4). RESULTS There were no significant differences between the baseline sagittal parameters in the ACR and PSO groups: PI: 59.09? vs 57.67?, P = .88; LL 18.36? vs 28.50?, P = .38; PT: 32.72? vs 37.00?, P = .64; SVA: 12.72 cm vs 11.95 cm P = .77; segmental angulation 2.72? vs 2.75?, P = .99. ACR produced significant improvements in sagittal parameters after surgery compared with preoperative parameters: LL 55.27?, P = .0001; Pi-LL Mismatch 3.45?, P = .0001; PT 22.45?, P = .0254; SVA 4.621 cm P = .0019; segmental angle 25.09?, P < .0001. PSO also produced significant segmental lordosis (29.00?, P = .0032), which was not significantly different from the correction achieved by ACR (25.09? vs 29.00?, P = .47). In ACR, an average of 24.31? of lordosis was achieved at the index level, with an average cage expansion of 24.08?. There was no significant difference in the number of levels fused posteriorly between the ACR and PSO groups (7 vs 8.75 levels, P = .175) or length of surgery (375.25 min vs 370.5 min, P = .47). However, there was significantly less blood loss in the ACR group (311.15 mL vs 962.5 mL, P = .0004) and shorter length of stay (7.41 d vs 11 d, P = .034). CONCLUSION ACR with a hyperlordotic, expandable lateral interbody cage for significant sagittal deformity produced an equivalent degree of sagittal correction to PSO with significantly less blood loss and shorter hospital length of stay.

scholarly journals Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities

2003 ◽  
Vol 14 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Justin F. Fraser ◽  
Russel C. Huang ◽  
Federico P. Girardi ◽  
Frank P. Cammisa
Keyword(s):  
Spinal Fusion ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Deformity Correction ◽  
Potential Benefits ◽  
Risk Of Disease ◽  
Plane Deformity ◽  
Flat Back ◽  
Lumbar Spinal

Sagittal- or coronal-plane deformity considerably complicates the diagnosis and treatment of lumbar spinal stenosis. Although decompressive laminectomy remains the standard operative treatment for uncomplicated lumbar spinal stenosis, the management of stenosis with concurrent deformity may require osteotomy, laminectomy, and spinal fusion with or without instrumentation. Broadly stated, the surgery-related goals in complex stenosis are neural decompression and a well-balanced sagittal and coronal fusion. Deformities that may present with concurrent stenosis are scoliosis, spondylolisthesis, and flatback deformity. The presentation and management of lumbar spinal stenosis associated with concurrent coronal or sagittal deformities depends on the type and extent of deformity as well as its impact on neural compression. Generally, clinical outcomes in complex stenosis are optimized by decompression combined with spinal fusion. The need for instrumentation is clear in cases of significant scoliosis or flatback deformity but is controversial in spondylolisthesis. With appropriate selection of technique for deformity correction, a surgeon may profoundly improve pain, quality of life, and functional capacity. The decision to undertake surgery entails weighing risk factors such as age, comorbidities, and preoperative functional status against potential benefits of improved neurological function, decreased pain, and reduced risk of disease progression. The purpose of this paper is to review the pathogenesis, presentation, and treatment of lumbar spinal stenosis complicated by scoliosis, spondylolisthesis, or flat-back deformity. Specific attention is paid to surgery-related goals, decision making, techniques, and outcomes.

PEDICLE SUBTRACTION OSTEOTOMY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A171-A176 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Sanjay S. Dhall ◽  
Stephen L. Ondra ◽  
Valli P. Mummaneni ◽  
Sigurd Berven
Keyword(s):  
Sagittal Plane ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Pedicle Subtraction Osteotomy ◽  
Morbidity Rate ◽  
Perioperative Morbidity ◽  
The Past ◽  
Avoidance Strategies ◽  
Plane Deformity ◽  
Dural Tears

ABSTRACT OBJECTIVE Pedicle subtraction osteotomy (PSO) is an effective tool for the correction of fixed sagittal plane deformity. However, there is potentially significant perioperative morbidity associated with this technique. We report our perioperative morbidity rate in recently performed PSO cases treated with our present surgical, anesthetic, and monitoring techniques and discuss complication-avoidance strategies. METHODS We conducted a retrospective study of 10 patients (mean age, 56 yr; range, 7–77 yr) undergoing thoracolumbar PSO at a single institution in the past 3 years. Two patients underwent PSO at T12, seven patients underwent PSO at L3, and one patient underwent PSO at L2. Eight of the patients had undergone at least one previous spine surgery in the region of the PSO, and nine of the patients had comorbidities that increased their surgical risk stratification. We identified all causes of perioperative morbidity. RESULTS We classified perioperative complications into two categories: intraoperative and early postoperative. Intraoperative complications included dural tears in two patients, cardiovascular instability in one patient, and coagulopathy in two patients. Early postoperative complications included neurological deficit (one patient), wound infection (two patients), urinary tract infection (one patient), and delirium (two patients). All patients recovered fully from these complications. There was no mortality in this series. CONCLUSION In this series, most patients undergoing PSO had multiple previous spine surgeries and comorbidities. The risk of perioperative morbidity for revision cases undergoing PSO was in excess of 50%. We discuss complication-avoidance strategies.

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