Hypercomplex pedicle subtraction osteotomies: definition, early clinical and radiological results and complications

Berjano, Pedro; Zanirato, Andrea; Compagnone, Domenico; Redaelli, Andrea; Damilano, Marco; Lamartina, Claudio

doi:10.1007/s00586-018-5463-x

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Pedicle subtraction osteotomy (PSO) has been widely used to achieve significant alignment corrections in adult deformity, which may achieve a lordosis angle up to 30°-35° at one single level [1][2][3][4]. Rod fracture is one concerning complication related to PSO, which can cause loss of posterior fixation and correction, pain, and neurological impairment [5,6].…”

Section: Introductionmentioning

confidence: 99%

Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study

Berjano

Damilano

et al. 2019

Eur Spine J

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Purpose The biomechanical performance of conventional multi-rod configurations (satellite rods and accessory rods) in pedicle subtraction osteotomies has been previously studied in vitro and using finite element models (FEM). Delta and deltacross rods are innovative multi-rod configurations where the rod bends were placed only in its proximal and distal extremities in order to obtain a dorsal translation of the central part of the rod respect to the most angulated area of the main rods. However, the biomechanical properties of the delta and delta-cross rods have not been investigated. This study used FEM to analyze the effect of delta-rod configurations on the stiffness and primary rod stress reduction in multiple-rod constructs after pedicle subtraction osteotomy. Methods The global range of motion in the spine and the magnitude and distribution of the von Mises stress in the rods were studied using a spine finite element model described previously. A follower load of 400 N along with moments of 7.5 N in flexion/extension, lateral bending, and axial rotation were tested on the spine model. Initial breakage was created on the rod based on the maximum stress location. The post-breakage models were tested under flexion. Results Delta and delta-cross rods reduced more range of motion (up to 45% more reduction) and reduced more primary rod stress than other previously tested rod configurations (up to 48% more reduction). After initial rod fracture occurred, delta and delta-cross rods also had less range of motion (up to 23.6% less) and less rod von Mises stress (up to 81.2% less) than other rod configurations did. Conclusions Delta and delta-cross rods have better biomechanical performance than satellite rods and accessory rods in pedicle subtraction osteotomies in terms of construct stiffness and rod stress reduction. After the initial rod breakage occurred, the delta and delta-cross rods could minimize the loss of fixation, which have less rod stress and greater residual stiffness than other rod configurations do. Based on this FEA study, delta-rod configurations show more favorable biomechanical behavior than previously described multi-rod configurations.

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Section: Introductionmentioning

confidence: 99%

Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study

Berjano

Damilano

et al. 2019

Eur Spine J

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“…In case of high amount of sagittal correction needed three-column osteotomies (3-CO) such as standard pedicle subtraction osteotomies (PSO), hypercomplex PSO or corner osteotomies are widely described strategies in the literature [16,17]. Three-column osteotomies are technically demanding procedures that provide powerful deformity correction (ranging from 25° to 55°), but are associated with significant complications rate [5,9]. Spine osteotomy in revision surgery implies technical difficulties, major intraoperative blood loss, additional operative time and risk for intraoperative and postoperative complications due to removal of previous instrumentation and dissection of the spine, scarred dura, and neural elements.…”

Section: Discussionmentioning

confidence: 99%

“…Conventional strategies include posterior approach with removal of rods followed by osteotomies of the fusion mass such as Smith-Petersen or 3-column osteotomies followed by posterior interbody fusion in order to restore the target lordosis [5]. Nevertheless, this surgical strategy is technically demanding due to the frequent presence of peridural scar tissue or interbody implants and may have encompass an increased risk of neurological complications or even impossibility to achieve the alignment goals.…”

Section: Introductionmentioning

confidence: 99%

Anterior Lumbar Interbody Fusion (ALIF) L5-S1 with overpowering of posterior lumbosacral instrumentation and fusion mass: a reliable solution in revision spine surgery

et al. 2021

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Background and purposeIn cases of spine surgical revisions of patients affected by sagittal malalignment, the restoration of the ideal lumbar lordosis (LL) is mandatory. ALIF procedures represent a powerful and effective approach to improve the LL in case of hypolordosis. This study evaluates the feasibility of ALIF to overpower posterior lumbar instrumentation and fusion mass in revision spine surgery and secondarily to estimate complications, clinical and radiological outcomes. Methods This is a single-center retrospective analysis of prospectively collected data on the use of ALIF overpowering in cases of lumbosacral instrumentation and/or fusion. Demographic, comorbidity, corrective strategy adopted, surgical data, clinical and radiological results, and intraoperative and postoperative complications were recorded. Results Twelve patients (3 male; 9 female) underwent overpowering ALIF L5-S1 were included in the study with a mean FU of 34.0 ± 13.4 months. In 10 cases, a posterior titanium instrumentation and fusion mass were present; in 2 patients, only a fusion mass was present. Indicators of pain and disability improved in all patients (p < 0.01). Sagittal realignment with the restoration of ideal spinopelvic parameters was obtained in all cases. One peritoneal lesion requiring intraoperative suture without sequelae, two cases of postoperative radiculopathy, and one posterior wound infection requiring surgical debridement and antibiotic therapy were reported. Conclusions Anterior implant of lordotic and hyperlordotic cages with increasing segmental lordosis is possible in the presence of posterior instrumentation and/or solid fusion mass. The biomechanical strength of this corrective technique can overcome posterior instrumentation and bone fusion resistance, therefore allowing a single-staged surgery for sagittal realignment.

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ALIF in the correction of spinal sagittal misalignment. A systematic review of literature

et al. 2020

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Hypercomplex pedicle subtraction osteotomies: definition, early clinical and radiological results and complications

Cited by 6 publications

References 17 publications

Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study

Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study

Anterior Lumbar Interbody Fusion (ALIF) L5-S1 with overpowering of posterior lumbosacral instrumentation and fusion mass: a reliable solution in revision spine surgery

ALIF in the correction of spinal sagittal misalignment. A systematic review of literature

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