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.

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.

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.  

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

P26. Pre-Operative Pelvic Parameters Must be Considered to Achieve Adequate Sagittal Balance after Lumbar Osteotomy

2009 ◽  
Vol 9 (10) ◽  
pp. 129S ◽  
Author(s):  
Frank Schwab ◽  
Virginie Lafage ◽  
Christopher Shaffrey ◽  
Jean-Pierre Farcy ◽  
Oheneba Boachie-Adjei ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Pelvic Parameters ◽  
Lumbar Osteotomy

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.

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.

Spinal Balance/Alignment—Clinical Relevance and Biomechanics

2019 ◽  
Vol 141 (7) ◽  
Author(s):  
Anoli Shah ◽  
Justin V. C. Lemans ◽  
Joseph Zavatsky ◽  
Aakash Agarwal ◽  
Moyo C. Kruyt ◽  
...  
Keyword(s):  
Social Interaction ◽  
Sagittal Balance ◽  
Sagittal Plane ◽  
The Body ◽  
Optimal Configuration ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Compensatory Mechanisms ◽  
Spinal Balance ◽  
Spinal Imbalance

In the anatomy of a normal spine, due to the curvatures in various regions, the C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvic-ball and socket hip and ankle joints. A failure to recognize malalignment in the sagittal plane can affect the patient's activity as well as social interaction due to deficient forward gaze. The sagittal balance configuration leads to the body undertaking the least muscular activities as possible necessary to maintain spinal balance. Global sagittal imbalance is energy consuming and often results in painful compensatory mechanisms that in turn negatively influence the patient's quality of life, self-image, and social interaction due to inability to maintain a horizontal gaze. Deformity, scoliosis, kyphosis, trauma, and/or surgery are some ways that this optimal configuration can be disturbed, thus requiring higher muscular activity to maintain posture and balance. Several parameters such as the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and hip and leg positions influence the sagittal balance and thus the optimal configuration of spinal alignment. This review examines the clinical and biomechanical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by deformities—ankylosing spondylitis (AS), scoliosis and kyphosis; surgical corrections—pedicle subtraction osteotomies (PSO), long segment stabilizations, and consequent postural complications like proximal and distal junctional kyphosis. The study of the biomechanics involved in spinal imbalance is relatively new and thus the literature is rather sparse. This review suggests several potential research topics in the area of spinal biomechanics.

scholarly journals Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

2021 ◽  
pp. 219256822110325
Author(s):  
Athan G. Zavras ◽  
T. Barrett Sullivan ◽  
Navya Dandu ◽  
Howard S. An ◽  
Christopher J. DeWald ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Pedicle Subtraction Osteotomy ◽  
Current Evidence ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lumbar Level ◽  
Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

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 Secondary thoracolumbar deformity and sagittal imbalance due to osteoporosis in a young man with Cushing’s disease: A case report

2020 ◽  
Vol 76 ◽  
pp. 134-138
Author(s):  
José Ramírez-Villaescusa ◽  
David Ruiz-Picazo ◽  
Cristina Lamas Oliveira ◽  
Carlos Morillas-Ariño
Keyword(s):  
Case Report ◽  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Sagittal Imbalance
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