Multilevel Schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity

2017 ◽  
Vol 17 (11) ◽  
pp. 1594-1600 ◽  
Author(s):  
George M. Ghobrial ◽  
Nathan H. Lebwohl ◽  
Barth A. Green ◽  
Joseph P. Gjolaj
Keyword(s):  
Spinal Deformity ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Grade Ii

scholarly journals The Natural History of Progression in Adult Spinal Deformity: A Radiographic Analysis

2019 ◽  
Vol 10 (3) ◽  
pp. 272-279 ◽  
Author(s):  
Sayf S. A. Faraj ◽  
Niek te Hennepe ◽  
Miranda L. van Hooff ◽  
Martin Pouw ◽  
Marinus de Kleuver ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Coronal Plane ◽  
Historical Cohort ◽  
Curve Magnitude ◽  
Nonsurgical Patients

Study Design: Historical cohort study. Objective: To evaluate progression in the coronal and sagittal planes in nonsurgical patients with adult spinal deformity (ASD). Methods: A retrospective analysis of nonsurgical ASD patients between 2005 and 2017 was performed. Magnitude of the coronal and sagittal planes were compared on the day of presentation and at most recent follow-up. Previous reported prognostic factors for progression in the coronal plane, including the direction of scoliosis, curve magnitude, and the position of the intercrest line (passing through L4 or L5 vertebra), were studied. Results: Fifty-eight patients were included with a mean follow-up of 59.8 ± 34.5 months. Progression in the coronal plane was seen in 72% of patients. Mean Cobb angle on the day of presentation and most recent follow-up was 37.2 ± 14.6° and 40.8° ± 16.5°, respectively. No significant differences were found in curve progression in left- versus right-sided scoliosis (3.3 ± 7.1 vs 3.7 ± 5.4, P = .81), Cobb angle <30° versus ≥30° (2.6 ± 5.0 vs 4.3 ± 6.5, P = .30), or when the intercrest line passed through L4 rather than L5 vertebra (3.4 ± 5.0° vs 3.8 ± 7.1°, P = .79). No significant differences were found in the sagittal plane between presentation and most recent follow-up. Conclusions: This is the first study that describes progression in the coronal and sagittal planes in nonsurgical patients with ASD. Previous reported prognostic factors were not confirmed as truly relevant. Although progression appears to occur, large variation exists and these results may not be directly applicable to the individual patient.

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

Changes in Cervical Alignment after Multilevel Schwab Grade II Thoracolumbar Osteotomies for Adult Spinal Deformity

Spine ◽  
2018 ◽  
Vol 43 (2) ◽  
pp. E82-E91 ◽  
Author(s):  
George M. Ghobrial ◽  
Nathan H. Lebwohl ◽  
Barth A. Green ◽  
Joseph P. Gjolaj
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Cervical Alignment ◽  
Grade Ii

scholarly journals The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery

2014 ◽  
Vol 36 (5) ◽  
pp. E6 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Christopher I. Shaffrey ◽  
Lawrence G. Lenke ◽  
Paul Park ◽  
Michael Y. Wang ◽  
...  
Keyword(s):  
Decision Making ◽  
Minimally Invasive ◽  
Spinal Deformity ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Interobserver Reliability ◽  
Open Approach ◽  
Case Review ◽  
Indirect Decompression ◽  
Spinal Deformity Surgery

Object Minimally invasive surgery (MIS) is an alternative to open deformity surgery for the treatment of patients with adult spinal deformity. However, at this time MIS techniques are not as versatile as open deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. Methods A team of experienced spinal deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 20 cases to establish interobserver reliability. They then resurveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and tabulated. Fleiss' analysis was performed using MATLAB software. Results Over a 3-month period, 11 surgeons completed the surveys. Responses for MISDEF algorithm case review demonstrated an interobserver kappa of 0.58 for the first round of surveys and an interobserver kappa of 0.69 for the second round of surveys, consistent with substantial agreement. In at least 10 cases there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.86 ± 0.15 (± SD) and ranged from 0.62 to 1. Conclusions The use of the MISDEF algorithm provides consistent and straightforward guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity. The MISDEF algorithm was found to have substantial inter- and intraobserver agreement. Although further studies are needed, the application of this algorithm could provide a platform for surgeons to achieve the desired goals of surgery.

scholarly journals Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gen Inoue ◽  
Wataru Saito ◽  
Masayuki Miyagi ◽  
Takayuki Imura ◽  
Eiki Shirasawa ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Major Complication ◽  
Global Alignment ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Cage Subsidence ◽  
Oblique Lumbar Interbody Fusion

Abstract Background Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment. Methods We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated. Results Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence. Conclusion Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.

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.

Photographic sagittal plane analysis and its clinical correlation after surgery for adult spinal deformity: a preliminary study

2020 ◽  
Author(s):  
Alejandro Gomez-Rice ◽  
Cristina Madrid ◽  
Enrique Izquierdo ◽  
Fernando Marco-Martínez ◽  
Jesús A. F. Tresguerres ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Clinical Correlation ◽  
Plane Analysis ◽  
Preliminary Study

scholarly journals Risk factors of unintended return to the operating room in adult spinal deformity

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lung Chan ◽  
Yue Li ◽  
Yong Hai ◽  
Yuzeng Liu ◽  
Yangpu Zhang
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Operating Room ◽  
Spinal Deformity ◽  
Neurological Symptom ◽  
Adult Spinal Deformity ◽  
Neurologic Deficit ◽  
Lower Limbs ◽  
Old Patients ◽  
Grade Ii

Abstract Background To evaluate the incidence and risk factors associated with unintended return to the operating room in adult spinal deformity after spinal deformity corrective surgery. Methods Retrospect of 141 adult spinal deformity patients in a single institution between January 2017 and December 2019. Inclusion criteria enrolled 18 to 80 years old patients who diagnosed with congenital/idiopathic/syndromic/acquired spinal deformity underwent posterior corrective spinal surgery. The surgical details and complications were recorded. The rate of unintended return to the operating room (UIROR) during hospitalization was examined, and the risk factors of unintended return to the operating room were investigated via multivariate analysis. Results This is a retrospective study. One hundred and forty-one patients who underwent spinal deformity surgery with a mean age of 31.8 years (range 18-69 years) were studied. The rate of unintended return to the operating room was 10.64% (15/141). Two of 15 patients had twice unintended surgery during hospitalization (13.33%). The most principal complication was neurologic deficit (73.3%); six of 15 postoperative present implants deviation causes severe lower limbs radiating pain (40%). The multivariate analysis shows higher apical vertebral rotation (AVR>grade II, odds ratio [OR] = 9.362; 95% CI= 1.930-45.420; P= .006), obesity (OR = 11.448; 95% CI= 1.320-99.263; P= .027), and previous neurological symptom (OR = 7.358; 95% CI= 1.798-30.108; P= .006) were independent predictors of unintended return to the operating room. Conclusion Postoperative neurologic deficit and short-term implant malposition are essential causes of unintended return to the operating room in adult spinal deformity patients. Preoperative factors such as higher AVR (> grade II), obesity, and previous neurological symptom may significantly increase the risk of morbidity in UIROR. Spine surgeons should be alert to these risk factors and require adequate preoperative evaluations to reduce the incidence of unintended return to the operating room.

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.

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