Sagittal imbalance treated with L5 pedicle subtraction osteotomy with short lumbar fusion from L4 to sacrum using four screws into L4 for enhanced fixation two additional vertebral screws: a technical note

2018 ◽  
Vol 28 (1) ◽  
pp. 121-126 ◽  
Author(s):  
Kuenzang Wangdi ◽  
Bungo Otsuki ◽  
Shunsuke Fujibayashi ◽  
Shimei Tanida ◽  
Kazutaka Masamoto ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Pedicle Subtraction Osteotomy ◽  
Technical Note ◽  
Sagittal Imbalance

scholarly journals Sagittal Deformity Correction in a Patient Suffering From Diffuse Idiopathic Skeletal Hyperostosis Who Previously Underwent a Total Hip and Bilateral Knee Replacement

2021 ◽  
Vol 12 ◽  
pp. 215145932199274
Author(s):  
Victor Garcia-Martin ◽  
Ana Verdejo-González ◽  
David Ruiz-Picazo ◽  
José Ramírez-Villaescusa
Keyword(s):  
Knee Replacement ◽  
Spinal Deformity ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Deformity Correction ◽  
Pedicle Subtraction Osteotomy ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
Total Hip ◽  
Correction Technique ◽  
Compensation Mechanisms

Introduction: Physiological aging frequently leads to degenerative changes and spinal deformity. In patients with hypolordotic fusions or ankylosing illnesses such as diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis, compensation mechanisms can be altered causing severe pain and disability. In addition, if a total hip replacement and/or knee replacement is performed, both pelvic and lower limbs compensation mechanisms could be damaged and prosthetic dislocation or impingement syndrome could be present. Pedicle subtraction osteotomy has proven to be the optimal correction technique for spinal deformation in patients suffering from a rigid spine. Case Presentation: A 70-year-old male patient with diffuse idiopathic skeletal hyperostosis criteria and a rigid lumbar kyphosis, who previously underwent a total hip and knee replacement, had severe disability. We then performed corrective surgery by doing a pedicle subtraction osteotomy. The procedure and outcomes are presented here. Conclusion: In symptomatic patients with sagittal imbalance and a rigid spine, pedicle subtraction osteotomy can indeed correct spinal deformity and re-establish sagittal balance.

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.

Comparison of Smith-Petersen Versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance

Spine ◽  
2005 ◽  
Vol 30 (18) ◽  
pp. 2030-2037 ◽  
Author(s):  
Kyu-Jung Cho ◽  
Keith H. Bridwell ◽  
Lawrence G. Lenke ◽  
Annette Berra ◽  
Christy Baldus
Keyword(s):  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Fixed Sagittal Imbalance

scholarly journals Stand-Alone Rod Augmentation for Instrumentation Failure after Pedicle Subtraction Osteotomy: A Case Report with a 2-year Follow-up

2021 ◽  
Author(s):  
Mohammad Zarei ◽  
Mohsen Rostami ◽  
Furqan Mohammed Yaseen Khan
Keyword(s):  
Case Report ◽  
Spine Surgery ◽  
Callus Tissue ◽  
Scar Tissue ◽  
Pedicle Subtraction Osteotomy ◽  
Lumbar Pain ◽  
Sagittal Imbalance ◽  
Complex Procedure ◽  
Instrumentation Failure

Background: Revision surgery of spine can be a complex procedure and has known complications. It involves hardware revision, removal of scar/callus tissue, realignment of sagittal balance, and anterior augmentation. However, through this report, we aim to demonstrate that a stand-alone rod augmentation at the failure site without removal of scar/callus tissue and/or anterior fixation can achieve excellent results in select cases. Case Report: A 66-year-old woman underwent L2 pedicle subtraction osteotomy (PSO) + T9-iliac fixation for fixed sagittal imbalance and osteoporotic collapse of L3. One year later, she developed progressive axial lumbar pain and difficulty in mobilization. The patient was diagnosed with pseudoarthrosis and instrumentation failure and underwent revision spine surgery with stand-alone rod augmentation. She had anuneventful rehabilitation and showed complete radiographic union and excellent clinical outcome in the 2-year follow-up. Conclusion: Stand-alone rod augmentation can provide stable posterior construct to prevent future pseudoarthrosis and/or instrumentation failure after revision spine surgery in selected cases. Anterior augmentation or resection dural scar tissue or dissection through callus tissue is not always necessary.  

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.

P102. Pedicle subtraction osteotomy with the use of an interbody device for the correction of sagittal imbalance

2004 ◽  
Vol 4 (5) ◽  
pp. S79
Author(s):  
John Spears ◽  
Vinod Podichetty ◽  
Robert Biscup ◽  
Robert Isaacs
Keyword(s):  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance

Analysis of Correction Loss after Pedicle Subtraction Osteotomy in Patients with Sagittal Imbalance: Radiologic Aspects

2004 ◽  
Vol 39 (6) ◽  
pp. 629 ◽  
Author(s):  
Whoan Jeang Kim ◽  
Jong Won Kang ◽  
Kyou Hyeun Kim ◽  
Kun Young Park ◽  
Yu Hun Jung ◽  
...  
Keyword(s):  
Pedicle Subtraction Osteotomy ◽  
Sagittal Imbalance ◽  
Correction Loss
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