Hybrid Anterior Column Realignment – Pedicle Subtraction Osteotomy for Severe Rigid Sagittal Deformity

2021 ◽  
Author(s):  
Saeed S. Sadrameli ◽  
Vitaliy Davidov ◽  
Jonathan J. Lee ◽  
Meng Huang ◽  
Dominic J. Kizek ◽  
...  
Keyword(s):  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Sagittal Deformity

Multistage Hybrid Approach to Management of Significant Sagittal Malalignment: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Jakub Godzik ◽  
Cory Hartman ◽  
Joshua T Wewel ◽  
Corey T Walker ◽  
David S Xu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Adult Spinal Deformity ◽  
Hybrid Approach ◽  
Surgical Techniques ◽  
Pedicle Screws ◽  
Pedicle Subtraction Osteotomy ◽  
Surgical Staging ◽  
Hybrid Techniques ◽  
Institutional Review ◽  
Sagittal Deformity

Abstract Minimally invasive surgery (MIS) approaches for the correction of adult spinal deformity have gained popularity in the past decade. MIS approaches can result in decreased hospitalization times and decreased morbidity. However, compared to open techniques, MIS approaches are challenging in the setting of fixed sagittal deformity and strategic surgical staging. Combined MIS and miniopen techniques are described as “hybrid” techniques. We report on the surgical approach for a fixed sagittal deformity using both MIS and miniopen techniques, specifically a miniopen pedicle subtraction osteotomy (PSO) and an anterior column release (ACR). The patient gave written informed consent for surgical treatment; institutional review board approval was not required. The patient first underwent the placement of percutaneous modular pedicle screws from T12 to the pelvis as well as a mini-PSO across the previously fused L5 vertebral body, with the placement of a temporary rod. The following day, the patient underwent lateral transpsoas interbody fusion and ACR at L2/3; a percutaneous rod was then passed from T12 to the pelvis for segmental fixation. The patient recovered well and was discharged home without complication 6 d after the initial day of surgery. The combined use of surgical staging and traditional open techniques in a selective, minimalistic fashion and adherence to minimally invasive principles provide for a powerful set of surgical techniques that capitalize on less invasive approaches to deformity management. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

A novel approach to sagittal balance restoration following iatrogenic sacral fracture and resulting sacral kyphotic deformity

2007 ◽  
Vol 6 (4) ◽  
pp. 368-372 ◽  
Author(s):  
Patrick C. Hsieh ◽  
Stephen L. Ondra ◽  
Robert J. Wienecke ◽  
Brian A. O'Shaughnessy ◽  
Tyler R. Koski
Keyword(s):  
Sagittal Balance ◽  
Pelvic Incidence ◽  
Morphological Characteristics ◽  
Pedicle Subtraction Osteotomy ◽  
Sacral Fracture ◽  
Novel Approach ◽  
Sagittal Spinal Alignment ◽  
Fixed Parameter ◽  
Lumbar Hyperlordosis ◽  
Sagittal Deformity

✓The authors describe the use of sacral pedicle subtraction osteotomy (PSO) with multiple sacral alar osteotomies for the correction of sacral kyphosis and pelvic incidence and for achieving sagittal balance correction in cases of fixed sagittal deformity after a sacral fracture. In this paper, the authors report on a novel technique using a series of sacral osteotomies and a sacral PSO to correct a fixed sagittal deformity in a patient with a sacral fracture that had healed in a kyphotic position. The patient sustained this fracture after a previous surgery for multilevel instrumented fusion. Preoperative and postoperative radiographic studies are reviewed and the clinical course and outcome are presented. Experts agree that the pelvic incidence is a fixed parameter that dictates the morphological characteristics of the pelvis and affects spinopelvic orientation and sagittal spinal alignment. An increased pelvic incidence is associated with a higher degree of spondylolisthesis in the lumbosacral junction, and increased shear forces across this junction. The authors demonstrate that the pelvic incidence can be altered and corrected with a series of sacral osteotomies to improve sacral kyphosis, compensatory lumbar hyperlordosis, and sagittal balance.

Comprehensive Evaluation of Accessory Rod Position, Rod Material and Diameter, Use of Cross-Connectors, and Anterior Column Support in a Pedicle Subtraction Osteotomy Model, Part I

Spine ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Daniel E. Gelb ◽  
Jarid Tareen ◽  
Ehsan Jazini ◽  
Steven C. Ludwig ◽  
Jonathan A. Harris ◽  
...  
Keyword(s):  
Comprehensive Evaluation ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Anterior Column Support

Comprehensive In Silico Evaluation of Accessory Rod Position, Rod Material and Diameter, Use of Cross-Connectors, and Anterior Column Support in a Pedicle Subtraction Osteotomy Model, Part II

Spine ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ehsan Jazini ◽  
Daniel E. Gelb ◽  
Jarid Tareen ◽  
Steven C. Ludwig ◽  
Jonathan A. Harris ◽  
...  
Keyword(s):  
In Silico ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Anterior Column Support

P68. Thoracic Pedicle Subtraction Osteotomy for Fixed Sagittal Deformity: Clinical and Radiographic Outcomes

2007 ◽  
Vol 7 (5) ◽  
pp. 114S
Author(s):  
O'Shaughnessy Brian ◽  
Tim Kuklo ◽  
Benson Yang ◽  
Tyler Koski ◽  
Stephen Ondra
Keyword(s):  
Pedicle Subtraction Osteotomy ◽  
Radiographic Outcomes ◽  
Sagittal Deformity

scholarly journals A Comparative Biomechanical Analysis of Various Rod Configurations Following Anterior Column Realignment and Pedicle Subtraction Osteotomy

Neurospine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 587-596
Author(s):  
Muzammil Mumtaz ◽  
Justin Mendoza ◽  
Ardalan Seyed Vosoughi ◽  
Anthony S. Unger ◽  
Vijay K. Goel
Keyword(s):  
Stress Reduction ◽  
Factor Of Safety ◽  
Maximum Stress ◽  
Element Model ◽  
Pedicle Subtraction Osteotomy ◽  
Biomechanical Analysis ◽  
Anterior Column ◽  
Von Mises Stress ◽  
Correction Technique ◽  
Von Mises

Objective: The objective of this study was to compare the biomechanical differences of different rod configurations following anterior column realignment (ACR) and pedicle subtraction osteotomy (PSO) for an optimal correction technique and rod configuration that would minimize the risk of rod failure.Methods: A validated spinopelvic (L1-pelvis) finite element model was used to simulate ACR at the L3–4 level. The ACR procedure was followed by dual-rod fixation, and for 4-rod constructs, either medial/lateral accessory rods (connected to primary rods) or satellite rods (directly connected to ACR level screws). The range of motion (ROM), maximum von Mises stress on the rods, and factor of safety (FOS) were calculated for the ACR models and compared to the existing literature of different PSO rod configurations.Results: All of the 4-rod ACR constructs showed a reduction in ROM and maximum von Mises stress compared to the dual-rod ACR construct. Additionally, all of the 4-rod ACR constructs showed greater percentage reduction in ROM and maximum von Mises stress compared to the PSO 4-rod configurations. The ACR satellite rod construct had the maximum stress reduction i.e., 47.3% compared to dual-rod construct and showed the highest FOS (4.76). These findings are consistent with existing literature that supports the use of satellite rods to reduce the occurrence of rod fracture.Conclusion: Our findings suggest that the ACR satellite rod construct may be the most beneficial in reducing the risk of rod failure compared to all other PSO and ACR constructs.

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.

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.

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