Comparison of Smith-Petersen Osteotomy versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance

Cho, Kyu Jung; Park, Seung Rim; Kim, Myung Ku; Lee, Tong Joo; Choi, Sung Wook

doi:10.4184/jkss.2004.11.4.261

Cited by 73 publications

(131 citation statements)

References 18 publications

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“…In our series, the corrections of the segmental kyphotic angle were similar to those found in the study of Cho et al, 6 who compared patients submitted to three or more SPOs with those submitted to one PSO for sagittal imbalance. They found an angle of correction of segmental kyphosis of 33.0º ±9.2º and in the group subjected to SPO, this angle was 31.7º ±9.0º.…”

Section: Discussionsupporting

confidence: 76%

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Comparación de resultados de osteotomías de Smith-Petersen, osteotomías de sustracción pedicular y vertebrectomía en el tratamiento de desequilibrio sagital

et al. 2013

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Objective: To compare the clinical and radiological results of Smith-Petersen osteotomy (SPO), Pedicle Subtraction Osteotomy (PSO) and Vertebral Column Resection (VCR) on sagittal imbalance. Methods: Retrospective cohort study. We compared 42 patients submitted to 3 SPO (n=14), 1 PSO (n=16) and 1 VCR (n=12) for fixed sagittal imbalance in the period 2003 to 2011. The sample consisted of 71.4% males, and the mean age was 43 years (17-74). The mean follow-up was 5 years. The complications, results of the SRS-22 questionnaire, sagittal Cobb angle and sagittal vertical axis (SVA) prior to surgery and 2 years after surgery were recorded. Results: Mean operating time (min) was lower in SPO vs PSO and VCR (420 ± 347 vs. 578 ± 459 vs. 533 ± 435) (p<0.00). Average blood loss (cc) was lower in SPO vs PSO and VCR (1341 ± 804 vs. 2364 ± 1.459 vs. 2134 ± 1335) (p<0.03). The overall rate of complications was 38%. There were no differences in the mean segmental kyphosis correction achieved, but in the correction of SVA differences were observed, with SPO being lower. In SRS-22, the three groups showed significant differences in all areas, compared with the preoperative results, where there were no differences between the groups. Conclusions: there were no differences in complications, although these were more severe in PSO and VCR. No differences were found in correction of segmental kyphosis, but PSO and VSR achieved better results in terms of modifying the SVA. There was no difference in quality of life.Keywords: Osteotomy; Spine; Spinal curvature; Quality of life. RESUMO Objetivo: Comparar os resultados clínicos e radiológicos de pacientes submetidos a osteotomias de Smith-Petersen (SPO), de subtração pedicular (PSO) e vertebrectomias (VCR RESUMENObjetivo: Comparar los resultados clínicos y radiológicos de pacientes sometidos a osteotomías de Smith-Petersen (SPO), de sustracción pedicular (PSO) y vertebrectomías (VCR) en pacientes con desequilibrio sagital. Métodos: Estudio observacional y retrospectivo. Se compararon 42 pacientes sometidos a 3 SPO (n=14), 1 PSO (n=16) y 1 VCR (n=12) por desequilibrio sagital fijo en el periodo de 2003-2011. La muestra constó de 71,4% de hombres y la edad promedio fue 43 años (17-74). El tiempo de seguimiento promedio fue 5 años. Se registraron las complicaciones, los resultados del cuestionario SRS-22, el ángulo de cifosis y eje sagital vertical (SVA) en el preoperatorio y a los 2 años postoperatorios. Resultados: El tiempo quirúrgico (min.) fue menor en SPO respecto a PSO y VCR (420±347 vs. 578±459 vs. 533±435) (p<0,00). El sangrado intraoperatorio (cc) fue menor en SPO respecto a PSO y VCR (1341±804 vs. 2364±1459 vs, 2134±1335) (p<0,03). Del total, 38% presentaron complicaciones. No se observaron diferencias en el promedio de corrección en la cifosis segmentaria, pero sí en la corrección del SVA, siendo menor SPO. En el SRS-22, en los tres grupos se presentaron cambios significativos en todos los dominios respecto al preoperatorio, sin diferencias significativas entre grupos. Co...

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Section: Discussionsupporting

confidence: 76%

“…In VCR, the group of Suk et al 5 showed 17% neurological complications. A study by Cho et al 6 found 30 cases in patients subjected to more than 2 SPOs.…”

Section: Discussionmentioning

confidence: 99%

Comparación de resultados de osteotomías de Smith-Petersen, osteotomías de sustracción pedicular y vertebrectomía en el tratamiento de desequilibrio sagital

et al. 2013

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“…In a world where appearance and health become increasingly important for social acceptance and well-being, the inability to function at the level of one's peers due to pain or deformity can create a huge psychological burden. As the recognition, evaluation, and treatment of spinal deformity continues to progress, there are many emerging new methods for the treatment of kyphoscoliosis, including common VCR, SPO (SmithPetersen osteotomy), PSO (pedicle subtraction osteotomy), PVCR, and eggshell methods [5,8,28,33]. In general, for minor degree of imbalance and curve less than 70°and 50°i n coronal and sagittal planes, posterior soft tissue release with compression on the convex side should be sufficient to produce moderate correction and balance [11].…”

Section: Discussionmentioning

confidence: 99%

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

Wang

Zhang

et al. 2008

Eur Spine J

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We report a multilevel modified vertebral column resection (MVCR) through a single posterior approach and clinical outcomes for treatment of severe congenital rigid kyphoscoliosis in adults. Transpedicular eggshell osteotomies and vertebral column resection are two techniques for the surgical treatment of rigid severe spine deformities. The authors developed a new technique combining the two surgical methods as a MVCR, through a single posterior approach, for surgical treatment of severe congenital rigid kyphoscoliosis in adults. Thirteen adult patients with severe rigid congenital kyphoscoliosis deformity were treated by a single posterior approach using a MVCR technique. The surgery processes included a onestage posterior transpedicular eggshell technique first, and then expanded the eggshell technique to adjacent intervertebra space through abrasive reduction of the vertebral cortices from inside out. All posterior vertebral elements were removed including the cortical vertebral bone around the neural canal. Range of resection of the vertebral column at the apex of the deformity included apical vertebra and both cephalic and/or caudal adjacent wedged vertebrae. Totally, 32 vertebrae had been removed in 13 patients, with 2.42 vertebrae being removed on average in each case. The average fusion extent was 7.69 vertebrae. Mean operation time was 266 min with average blood loss of 2,411.54 ml during operation. Patients were followed up for an average duration of 2.54 years. Deformity correction was 59% in the coronal plane (from 79.7°to 32.4°) postoperatively and 33.7°(57% correction) at 2 years followup. In the sagittal plane, correction was from preoperative 85.9°to 27.5°immediately after operation, and 32.0°at 2 years follow-up. Postoperative pain was reduced from preoperative 1.77 to 0.54 at 2 years follow-up in visual analog scale. SRS-24 scale was from 38.2 preoperatively to 76.9 at 2 years follow-up postoperative. Complications were encountered in four patients (30.7%) with transient neurology that spontaneously improved without further treatment within 3 months. MVCR technique through a single posterior approach is an effective procedure for the surgical treatment of severe congenital rigid kyphoscoliosis in adults.

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“…87 percent of patients who had SPOs required anterior arthrodesis compared to 39 percent for patients with PSOs. 8 This is due to the fact that a PSO results in apposition of bone surfaces of the anterior and middle columns, unlike the SPO.…”

Section: Discussionmentioning

confidence: 99%

“…SPOs average only 10.7 degrees of sagittal correction per segment while PSOs average 33 degrees of correction per segment. 8 Second, follow-up anterior stabilization is required less often with PSOs. 87 percent of patients who had SPOs required anterior arthrodesis compared to 39 percent for patients with PSOs.…”

Section: Discussionmentioning

confidence: 99%

Pedicle Reduction Osteotomy in the Upper Cervical Spine: Technique, Case Report and Review of the Literature

et al. 2015

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ObjectiveTo present a case report of the correction of a degenerative cervical 45-degree kyphosis centered at C4 with a single stage PSO. Summary of Background DataCorrection of a fixed cervical kyphosis is a surgical challenge that is frequently managed with a combination of anterior and posterior surgical procedures. An alternative the three stage operation is a single stage pedicle subtraction osteotomy (PSO). A PSO releases the posterior, middle and anterior columns of the spine by resecting the facet joints, pedicles, and a portion of the vertebral body at the apex of a kyphosis through a posterior approach. MethodsThis was a case report of a patient who had degenerative cervical 45 degree kyphosis and was corrected with a single stage pedicle subtraction osteotomy. We did a literature review to provide information on current techniques to treat these patients. ResultsWith careful resection of the lateral mass and decompression of the vertebral artery by removal of the posterior margin of the foramen transversarium the upper cervical pedicles can be accessed and a PSO can be performed. The vertebral arteries were not obstructed or kinked with posterior reduction of the PSO in this case. ConclusionsA closing wedge PSO is a useful tool for correcting fixed kyphotic deformities in the upper cervical spine. Further studies are necessary to evaluate the long-term outcomes in these patients.keywords: pedicle reduction osteotomy, Cervical Spine, surgical technique Volume 9 Article 57

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Comparison of Smith-Petersen Osteotomy versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance

Cited by 73 publications

References 18 publications

Comparación de resultados de osteotomías de Smith-Petersen, osteotomías de sustracción pedicular y vertebrectomía en el tratamiento de desequilibrio sagital

Comparación de resultados de osteotomías de Smith-Petersen, osteotomías de sustracción pedicular y vertebrectomía en el tratamiento de desequilibrio sagital

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

Pedicle Reduction Osteotomy in the Upper Cervical Spine: Technique, Case Report and Review of the Literature

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