Pedicle Subtraction Osteotomy: Surgical Technique

Abstract BACKGROUND Thoracic hyperkyphosis can display pathological deterioration, resulting in either hyperlordotic cervical compensation or sagittal malalignment. Various techniques have been described to treat fixed malalignment. Pedicle subtraction osteotomy (PSO) is commonly used in the lumbar spine and frequently limited to the distal thoracic spine. This series focuses on the surgical specificities of proximal thoracic PSO, with clinical and radiological outcomes. OBJECTIVE To report the surgical specificities and assess the clinical and radiological outcomes of proximal thoracic osteotomies for correction of rigid kyphotic deformities. METHODS This is a retrospective review of 10 consecutive patients who underwent single level proximal thoracic PSO (T2-T5). Preoperative and postoperative full-body EOSTM radiographs, perioperative data, and complications were recorded. The surgical technique and its nuances were described in detail. RESULTS Patients had mean age of 41.8 yr and 50% were female. The technique provided correction of segmental and global kyphosis, 26.6° and 29.5°, respectively. Patients reported reciprocal reduction in C2-C7 cervical lordosis (37.6°-18.6°, P < .001), significantly correlating with the reduction of thoracic hyperkyphosis (R = 0.840, P = .002). Mean operative time was 291 min, blood loss 1650 mL, and mean hospital stay was 13.8 d. Three patients reported complications that were resolved, including 1 patient who was revised because of a painful cross link. There were no neurological complications, pseudarthroses, instrumentation breakage, or wound infections at a minimum of 2-yr follow-up. CONCLUSION Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.

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Asymmetric C7 pedicle subtraction osteotomy for correction of rigid cervical coronal imbalance secondary to post-traumatic heterotopic ossification: a case report, description of a novel surgical technique, and literature review

European Spine Journal ◽

10.1007/s00586-016-4931-4 ◽

2016 ◽

Vol 26 (S1) ◽

pp. 141-145 ◽

Cited By ~ 4

Author(s):

Alexander A. Theologis ◽

Kate D. Bellevue ◽

Erion Qamirani ◽

Christopher P. Ames ◽

Vedat Deviren

Keyword(s):

Case Report ◽

Surgical Technique ◽

Literature Review ◽

Heterotopic Ossification ◽

Pedicle Subtraction Osteotomy ◽

Coronal Imbalance ◽

Post Traumatic

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Mini-Open Pedicle Subtraction Osteotomy: Surgical Technique

World Neurosurgery ◽

10.1016/j.wneu.2012.10.002 ◽

2014 ◽

Vol 81 (5-6) ◽

pp. 843.e11-843.e14 ◽

Cited By ~ 11

Author(s):

Michael Y. Wang ◽

Karthik Madhavan

Keyword(s):

Surgical Technique ◽

Pedicle Subtraction Osteotomy ◽

Mini Open

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Mini-open pedicle subtraction osteotomy as a treatment for severe adult spinal deformities: case series with initial clinical and radiographic outcomes

Journal of Neurosurgery Spine ◽

10.3171/2015.7.spine15188 ◽

2016 ◽

Vol 24 (5) ◽

pp. 769-776 ◽

Cited By ~ 22

Author(s):

Michael Y. Wang ◽

Gerd Bordon

Keyword(s):

Surgical Technique ◽

Lumbar Lordosis ◽

Visual Analog Scale Score ◽

Pedicle Subtraction Osteotomy ◽

Summary Score ◽

Spinal Deformities ◽

Analog Scale ◽

Radiographic Outcomes ◽

Sf 36 ◽

Mini Open

OBJECTIVE Pedicle subtraction osteotomy (PSO) is a powerful but high-risk surgical technique for destabilizing the spine for deformity correction in both the sagittal and coronal planes. Numerous reports have demonstrated the benefits of this technique for realigning the spine in a physiological posture; however, the open surgical technique is associated with a high complication rate. In this report the authors review data obtained in a series of patients who underwent PSO through a less invasive approach. METHODS Sixteen patients with severe coronal- and/or sagittal-plane deformities were treated in this series. Conservative measures had failed in all cases and patients had undergone a single-level PSO or extended PSO at L-2 or L-3. Fixation was accomplished using percutaneous instrumentation and interbody or facet joint fusions were used at the remaining levels. None of the procedures were aborted or converted to a traditional open procedure. Standard clinical and radiographic measures were used to assess patient outcomes. RESULTS Mean age was 68.8 years and mean follow-up duration was 17.7 months. An average of 7.6 levels were fused, and 50% of the patients had bilateral iliac screw fixation, with all constructs crossing both the thoracolumbar and lumbosacral junctions. Operative time averaged 356 ± 50 minutes and there was a mean blood loss of 843 ± 339 ml. The leg visual analog scale score improved from a mean of 5.7 ± 2.7 to one of 1.3 ± 1.6, and the back visual analog scale score improved from a mean of 8.6 ± 1.3 to one of 2.4 ± 2.1. The Oswestry Disability Index score improved from a mean of 50.1 ± 14.4 to 16.4 ± 12.7, representing a mean reduction of 36.0 ± 16.9 points. The SF-36 physical component summary score changed from a mean of 43.4 ± 2.6 to one of 47.0 ± 4.3, and the SF-36 mental component summary score changed from a mean of 46.7 ± 3.6 to 46.30 ± 3.0. Coronal alignment improved from a mean of 27.9 ± 43.6 mm to 16.0 ± 17.2 mm. The lumbar Cobb angle improved from a mean of 41.2° ± 18.4° to 15.4° ± 9.6°, and lumbar lordosis improved from 23.1° ± 15.9° to 48.6° ± 11.7°. Pelvic tilt improved from a mean of 33.7° ± 8.6° to 24.4° ± 6.5°, and the sagittal vertical axis improved from 102.4 ± 73.4 mm to 42.2 ± 39.9 mm. The final lumbar lordosis–pelvic incidence difference averaged 8.4° ± 12.1°. There were 4 patients who failed to achieve less than or equal to a 10° mismatch on this parameter. Ten of the 16 patients underwent delayed postoperative CT, and 8 of these had developed a solid arthrodesis at all levels treated. A total of 6 complications occurred in this series. There were no cases of symptomatic proximal junction kyphosis. CONCLUSIONS Advancements in minimally invasive technique have resulted in the ability to manage increasingly complex deformities with hybrid approaches. In this limited series, the authors describe the results of utilizing a tissue-sparing mini-open PSO to correct severe spinal deformities. This method was technically feasible in all cases with acceptable radiographic outcomes similar to open surgery. However, high complication rates associated with these deformity corrections remain problematic.

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Closure of L3 pedicle subtraction osteotomy via an open-bottom hinged table in 3D video

Neurosurgical Focus: Video ◽

10.3171/2020.1.focusvid.19718 ◽

2020 ◽

Vol 2 (1) ◽

pp. V6

Author(s):

Chih-Chang Chang ◽

Praveen V. Mummaneni ◽

Joshua Rivera ◽

Rory Mayer ◽

Dean Chou

Keyword(s):

Surgical Technique ◽

Spinal Column ◽

Pedicle Screws ◽

Pedicle Subtraction Osteotomy ◽

3D Video ◽

Link Type ◽

Flat Back

Iatrogenic flat back deformity generally can be treated with a pedicle subtraction osteotomy (PSO) (Chan et al., 2018; Lu and Chou, 2007). One of the difficulties with PSO is that a controlled closure can sometimes be problematic in that there may be translation of the spine, manual pushing of the spine, and significant stress on the pedicle screws, which may risk loosening. The authors present a video of their surgical technique for PSO closed by passive closure using an open-bottom hinged table. This allows the osteotomy to be closed without any force on the screws and without significant manual forces on the spinal column.The video can be found here: https://youtu.be/pUECEjKdmSk.

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