New method for correction of lumbo-sacral kyphosis deformity in patient with high pelvic incidence

Czyż, Marcin; Forster, Stephen; Holton, James R.; Shariati, Babak; Clarkson, David J; Boszczyk, Bronek M.

doi:10.1007/s00586-017-5205-5

Cited by 8 publications

(2 citation statements)

References 10 publications

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“…The technique involved longitudinal osteotomies through the sacral ala and derotation of the sacrum to achieve the desired pelvic incidence. At one year after surgery, the patient reportedly maintained a balanced sagittal alignment [14].…”

Section: Discussionmentioning

confidence: 99%

Predicting the Effect of Bilateral Pelvic Osteotomy on Sagittal Alignment Correction and Surrounding Muscles: A Mathematical Model

Zarei

Yson

Bechtold

et al. 2019

Advances in Orthopedics

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Study Design. Mathematical Model. Objectives. To investigate the relationship between pelvic osteotomy opening angle (OA) and its effect on spinopelvic sagittal parameters as well as the resting length of surrounding muscles. Methods. Predictive equations correlating OA with spinopelvic parameters were derived using geometric relationships. A geometric model calculated spinopelvic parameters (SVA, pelvic incidence [PI], PT, and T1 pelvic angle [TPA]) produced by progressively increasing the OA. These values were compared to optimal balance criteria in the literature. Four muscles crossing the osteotomy site were evaluated: Gluteus Medius (GMED), Gluteus Maximus (GMAX), Piriformis (P), and Tensor Fascia Lata (TFL). Insertion points were obtained from an OpenSim software model. GMAX and GMED were subdivided into 3 (anterior, middle, and posterior). Results. OA correlated negatively with PI, TPA, and SVA and positively with PT. From baseline SVA of 22 cm, OA 21° reduced SVA to 5cm. OA 23° reduced TPA to 14°. OA 30° increased PT to 20°. OA 26° decreased PI-LL to 10°. OA range of 26°-30° resulted in optimal sagittal deformity correction. OA correlated with SR positively for TFL and anterior GMED and negatively for the rest of muscles. For this OA, the SR approximately decreased 6%, 5%, 6%, 8%, and 5% for posterior GMED, anterior GMAX, middle GMAX, posterior GMAX, and P, respectively. It increased 8% and 4% for anterior GMED and TFL, respectively. Conclusion. Predictive relationships between osteotomy OA and spinopelvic parameters were shown, providing proof of concept that sagittal balance may be achieved via pelvic osteotomy.

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Section: Discussionmentioning

confidence: 99%

Predicting the Effect of Bilateral Pelvic Osteotomy on Sagittal Alignment Correction and Surrounding Muscles: A Mathematical Model

Zarei

Yson

Bechtold

et al. 2019

Advances in Orthopedics

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“…An additional 7 studies were identified involving sacral dome osteotomies or osteotomies with transitional lumbar anatomy. 4,[18][19][20][21][22][23] When including these data, the rate of L5-related neurological deficit was 23% (12 of 52 patients), with most resolving over time. The results are summarized in Table.…”

Section: Literature Reviewmentioning

confidence: 99%

Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature

Safaee

Lau

Fury

et al. 2022

Operative Neurosurgery

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BACKGROUND:Lumbosacral deformities are caused by high-grade spondylolisthesis, fractures, iatrogenic flat back, and other etiologies. The S1 pedicle subtraction osteotomy (PSO) can facilitate reduction of spondylolisthesis and lower the pelvic incidence. There are limited reports on the indications and outcomes of this technique.OBJECTIVE:To present a technical description and literature review of the S1 PSO with video summary.METHODS:This was a retrospective review of a single case to highlight the use of S1 PSO for the treatment of high-grade spondylolisthesis. A literature review was performed in accordance with STROBE guidelines.RESULTS:A 47-year-old woman presented with back and right leg pain related to grade 4 spondylolisthesis at L5-S1 with sagittal imbalance and lumbosacral kyphosis. She was taken for an L2-pelvis instrumented fusion with S1 PSO. Three days later, she was taken for an L4-5 and L5-S1 anterior lumbar interbody fusion with the L5-S1 segmental plate. Her postoperative course was notable for right foot drop that resolved in 6 weeks. Postoperative x-rays showed successful reduction of spondylolisthesis with normal alignment and sagittal balance. Based on 6 studies involving 22 true sacral PSOs in the literature, the procedure carries a 27% risk of neurological deficit, typically in the form of L5 palsy.CONCLUSION:The S1 PSO is a technically challenging operation that has a unique role in the treatment of high-grade spondylolisthesis. It carries a significant risk of L5 palsy and should be reserved for surgeons with experience performing complex 3-column osteotomies.

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Dual iliac screws in spinopelvic fixation: a systematic review

2019

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New method for correction of lumbo-sacral kyphosis deformity in patient with high pelvic incidence

Abstract: Bilateral longitudinal sacral osteotomy appears to be a safe and efficient way of correcting the sagittal imbalance caused by an extremely high PI. Although technically demanding, it achieves good radiological and functional outcomes and avoids entering the spinal canal.

Cited by 8 publications

References 10 publications

Predicting the Effect of Bilateral Pelvic Osteotomy on Sagittal Alignment Correction and Surrounding Muscles: A Mathematical Model

Predicting the Effect of Bilateral Pelvic Osteotomy on Sagittal Alignment Correction and Surrounding Muscles: A Mathematical Model

Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature

Dual iliac screws in spinopelvic fixation: a systematic review

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