Closing-Opening Wedge Osteotomy for the Treatment of Sagittal Imbalance

Chang, Kao-Wha; Cheng, Ching-Wei; Chen, Hung-Chang; Chang, Ku-I; Chen, Tsung-Chein

doi:10.1097/brs.0b013e3181753bcd

Cited by 103 publications

(71 citation statements)

References 17 publications

(19 reference statements)

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“…1,3,4,6,[13][14][15][16][17][19][20][21]23,[25][26][27]30,32,33,38,[44][45][46][47]50,51 Although development of rod fracture may have significant consequences for patients, including pain, loss of deformity correction, and the need for revision surgery, the literature regarding rod fracture remains relatively limited. 1,4,9,11,15,19,23,29,38,49,51,52 Previous reports discussing rod fracture have many limitations, including retrospective design, inclusion of patients from only a single surgeon's cases or from a single institution, or lack of details regarding the specific type or composition of instrumentation. In addition, most previous series lack sufficient numbers of patients to enable a meaningful analysis of the subset with rod fracture.…”

mentioning

confidence: 99%

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

Smith

Shaffrey

Klineberg

et al. 2014

SPI

213

174

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Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

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mentioning

confidence: 99%

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

Smith

Shaffrey

Klineberg

et al. 2014

SPI

213

174

View full text Add to dashboard Cite

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“…These include the Smith-Petersen osteotomy, 54 which involves wide resection of the posterior elements, including the lamina and bilateral facets, and, as initially described, was applied to multiple levels through previously fused facets in upper levels of the lumbar spine. 7,20 Osteotomies similar to the Smith-Petersen osteotomy but through unfused articular processes have been described, including the Chevron osteotomy 4 and the extension osteotomy. 30 Similarly, for polysegmental 44 and Ponte 12 osteotomies, bone is removed from the articular processes and the interlaminar space to achieve deformity correction.…”

Section: Grade 2: Complete Facet Joint Resection/ponte Osteotomymentioning

confidence: 99%

“…Primary among these is the development of an agreed-upon nomenclature in this process to allow direct outcome comparisons among clearly defined techniques. The primary techniques for correction of rigid CSDs are osteotomies, 1,3,7,9,12,14,20,31,32,34,35,39,40,51,56,59,61,62 which have many variations and lack a standardized nomenclature. As a first step toward the long-term goal of developing a cervical deformity classification system, our objective in the present study was to establish a standardized nomenclature for cervical spine osteotomies to provide a common language among spine surgeons.…”

mentioning

confidence: 99%

A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

Ames

Smith

Scheer

et al. 2013

SPI

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Object Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies. The authors' objective was to establish a universal nomenclature for cervical spine osteotomies to provide a common language among spine surgeons. Methods A proposed nomenclature with 7 anatomical grades of increasing extent of bone/soft tissue resection and destabilization was designed. The highest grade of resection is termed the major osteotomy, and an approach modifier is used to denote the surgical approach(es), including anterior (A), posterior (P), anterior-posterior (AP), posterior-anterior (PA), anterior-posterior-anterior (APA), and posterior-anterior-posterior (PAP). For cases in which multiple grades of osteotomies were performed, the highest grade is termed the major osteotomy, and lower-grade osteotomies are termed minor osteotomies. The nomenclature was evaluated by 11 reviewers through 25 different radiographic clinical cases. The review was performed twice, separated by a minimum 1-week interval. Reliability was assessed using Fleiss kappa coefficients. Results The average intrarater reliability was classified as “almost perfect agreement” for the major osteotomy (0.89 [range 0.60–1.00]) and approach modifier (0.99 [0.95–1.00]); it was classified as “moderate agreement” for the minor osteotomy (0.73 [range 0.41–1.00]). The average interrater reliability for the 2 readings was the following: major osteotomy, 0.87 (“almost perfect agreement”); approach modifier, 0.99 (“almost perfect agreement”); and minor osteotomy, 0.55 (“moderate agreement”). Analysis of only major osteotomy plus approach modifier yielded a classification that was “almost perfect” with an average intrarater reliability of 0.90 (0.63–1.00) and an interrater reliability of 0.88 and 0.86 for the two reviews. Conclusions The proposed cervical spine osteotomy nomenclature provides the surgeon with a simple, standard description of the various cervical osteotomies. The reliability analysis demonstrated that this system is consistent and directly applicable. Future work will evaluate the relationship between this system and health-related quality of life metrics.

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“…COWO (Chang KW et al,2008) (Figure 2) and Smith-Peterson osteotomy (SPO) (SmithPeterson MN et al,1969) were performed in this study to provide adequate release and flexibility for optimal correction. The apex of the lumbar kyphosis was usually between L2 and L4.…”

Section: Determine the Lumbosacral Curve That Can Bring The Promontormentioning

confidence: 99%

“…According to the blueprint, COWO (Chang KW et al, 2008) for three-column release was performed as close to the apical vertebra of the deformity as possible (either L2 or L3). Laminectomy and facetectomy at the level of osteotomy were performed.…”

Section: Surgerymentioning

confidence: 99%

Quality Control of Reconstructed Sagittal Balance for Sagittal Imbalance

Chang¹

2012

The Role of Osteotomy in the Correction of Congenital and Acquired Disorders of the Skeleton

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Closing-Opening Wedge Osteotomy for the Treatment of Sagittal Imbalance

Abstract: COWO is a useful procedure for patients with sagittal imbalance requiring more than 35 degrees lordotic correction through the osteotomy site. A worse clinical result is associated with increasing patient comorbidities, pseudarthrosis in lumbosacral fusion, and junctional kyphosis.

Cited by 103 publications

References 17 publications

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

Quality Control of Reconstructed Sagittal Balance for Sagittal Imbalance

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