On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab’s spinal osteotomy classification

Bourghli, Anouar; Boissière, Louis; Konbaz, Faisal; Aleissa, Sami; Al‐Habib, Amro; Qian, Bangping; Qiu, Yong; Hayashi, Kazunori; Pizones, Javier; Ames, Christopher P.; Vital, Jean-Marc; Obeid, Ibrahim

doi:10.1007/s43390-020-00247-6

Cited by 12 publications

(9 citation statements)

References 27 publications

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“…Some scholars advise that these procedures should be named “trans-discal” osteotomies, while this name fails to contain the meaning that facet joints are a part of the intervertebral structure, which is not a “discal” portion. Because the widely used Schwab-SRS osteotomy classification rarely covers all these techniques ( Ramey et al., 2021 ; ZÁrate-KalfÓpulos et al., 2020 ), Bourghli et al proposed a complementary part to the SRS-Schwab osteotomy classification to subdivide the existing SRS-Schwab grade 3 and 4 osteotomies ( Bourghli et al., 2021 ) . While the present TIO classification generalized the essence of the above techniques and emphasized the intervertebral space in improving correction.…”

Section: Discussionmentioning

confidence: 99%

Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space

Wang¹,

Huang²,

Zheng³

et al. 2023

Brain and Spine

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Section: Discussionmentioning

confidence: 99%

Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space

Wang¹,

Huang²,

Zheng³

et al. 2023

Brain and Spine

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“…Several variations in performing a PSO exist that range from a traditional to an extended PSO. 2,6,21,31 The SE-PSO technique represents a modification of the extended PSO with two adjacent interbody grafts, leaving intervening bone sandwiched between two titanium interbody spacers, which optimizes the surface area of contact between fusion surfaces to support arthrodesis. The addition of interbody cages also provides anterior column support, serving as a fulcrum for the production of lordosis; its use with multirod constructs increases the overall rigidity across the PSO site.…”

Section: Discussionmentioning

confidence: 99%

The “Sandwich” Extended Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Malalignment: Technical Description, Case Series, and Early Results With 2-Year Outcomes

Bakhsheshian,

Hassan,

Greisberg

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Adult spinal deformity (ASD) with fixed sagittal malalignment (FSM) may require a pedicle subtraction osteotomy (PSO) for greater focal lordosis and restoration of global alignment. Despite growing trends in minimizing PSOs given their associated high risks, a considerable portion of patients with ASD still require a lumbar PSO most commonly because of iatrogenic flat back deformity. The purpose of this article is to describe a modified extended PSO technique with additional anterior column support coined the “sandwich” extended PSO (SE-PSO) to promote arthrodesis and report the outcomes in a consecutive case series. METHODS: Patients with ASD treated with a lumbar SE-PSO at a single institution from 2015 to 2020 were analyzed. Complications, radiographic data, and patient-reported outcomes were compared preoperatively, at immediate postoperative follow-up, and at a 2-year postoperative follow-up (FU). RESULTS: Fourteen patients who underwent revision operations for FSM were included. Improvements in segmental lordosis across the PSO site (14.8 ± 6.8 vs 39.9 ± 7.1, P < .0001), overall lumbar lordosis (14.6 ± 15.4 vs 44.6 ± 12.1, P < .0001), sacral slope (21.0 ± 10.5 31.1 ± 10.7, P = .0150), C7 sagittal vertical axis (140.1 ± 59.0 mm vs 35.9 ± 28.5, P < .0001), and spinopelvic mismatch (52.5 ± 21.3 vs 18.6 ± 14.1, P = .0001) were obtained in all patients. Eight patients experienced perioperative complications, with intraoperative durotomy being the most common (n = 7). Eight patients had a 2-year FU and demonstrated improvements in their segmental lordosis across the PSO site (14.3 ± 7.0 vs 41.3 ± 7.3, P = .0003), overall lumbar lordosis (8.7 ± 17.8 vs 46.1 ± 14.2, P = .0014), sacral slope (19.1 ± 12.8 vs 32.3 ± 12.5, P = .0479), C7 sagittal vertical axis (173.6 ± 54.4 mm vs 35.8 ± 30.0, P < .0001), and spinopelvic mismatch (63.0 ± 19.7 vs 21.1 ± 18.3, P < .0001), all of which were maintained at final FU (P > .05). At 2 years, a significant increase in Scoliosis Research Society-22r total score (2.5 ± 0.8 vs 3.6 ± 0.7, P = .0023 was reported. There were no reports of symptomatic pseudarthrosis or mechanical complications. CONCLUSION: SE-PSO is an effective technique to correct FSM and is associated with low complications, improved patient-reported outcomes, and spinopelvic parameters that are maintained at 2 years.

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“…In posttraumatic thoracolumbar kyphosis Gao et al 19 reached a mean correction of 34 degrees comparable to a standard PSO. More recently, Bourghli et al 20 have modified the Schwab classification describing a partial osteotomy in L4. They recommend to only preserve the lower third of the pedicle and the disk above.…”

Section: Discussionmentioning

confidence: 99%

L5 Partial Pedicle Subtraction Osteotomy in High Pelvic Incidence Patients: A New Way to Manage Lordosis

Grobost¹,

Chevillotte²,

Schlösser

et al. 2021

Techniques in Orthopaedics

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Introduction: Numerous corrective osteotomy techniques have been reported in lumbar area. Owing to mechanical difficulties and reputation of higher neurological risk, L5 pedicle subtraction osteotomy (PSO) has been poorly used and described. Until now, there was no reported specific method of PSO in L5 to manage the shape of the lordosis with respect of local anatomy. The objective of this study was to describe a new partial PSO technique in L5 to manage the lower arc of lordosis in high pelvic incidence patients with fixed sagittal imbalance. Materials and Methods: We describe, here, the surgical technique for a partial PSO at L5 level and the associated technique of instrumentation and correction of lordosis. Results: Two different cases were reviewed retrospectively to illustrate this new technique to manage lordosis. The described technique is feasible either in first intention or in a revision surgery. Radiologic results on lordosis and sagittal balance are exposed. Conclusion: A partial resection of the pedicles at L5 is often sufficient to create enough lordosis, maybe more effective than complete L3 and L4 PSO for restoration of sagittal balance and less aggressive than complete L5 PSO.

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On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab’s spinal osteotomy classification

Cited by 12 publications

References 27 publications

Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space

Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space

The “Sandwich” Extended Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Malalignment: Technical Description, Case Series, and Early Results With 2-Year Outcomes

L5 Partial Pedicle Subtraction Osteotomy in High Pelvic Incidence Patients: A New Way to Manage Lordosis

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