S1 Pedicle Subtraction Osteotomy in Sagittal Balance Correction. A Feasibility Study on Human Cadaveric Specimens

Vanaclocha, Vicente; Vanaclocha, Leyre; Rivera-Paz, Marlon; Atienza-Vicente, Carlos; Ortiz-Criado, José María; Belloch, Vicente; Santabárbara-Gómez, José Manuel; Gómez, A Beamud

doi:10.1016/j.wneu.2018.11.052

Cited by 4 publications

(9 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a cadaveric study of specimens with a normal baseline PI, S1 PSO produced a mean reduction of PI of 16°. 24 Bodin and Roussouly reported a mean reduction of 27.6° in a population of patients with a significantly elevated preoperative PI (from a mean 97.2° preoperatively to 69.6° postoperatively). 16 Case reports by Hsieh et al and Ozturk et al reported reduction of PI of 23° and 15°, respectively.…”

Section: Discussionmentioning

confidence: 94%

“…In addition to directly reducing PI and correcting PI-LL mismatch, S1 PSO offers very powerful sagittal deformity correction as a result of being performed at a lower level than traditional lumbar 3CO. 24 As a result, sacral PSO can produce a significant reduction in SVA and corresponding improvements in health-related quality-of-life metrics. 11,12 The S1 PSO is technically challenging and the surgical technique is fairly different from preforming a traditional lumbar PSO.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Complication profile associated with S1 pedicle subtraction osteotomy compared with 3-column osteotomies at other thoracolumbar levels for adult spinal deformity: series of 405 patients with 9 S1 osteotomies

Lau¹,

Haddad²,

Deviren

et al. 2020

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEThere is an increased recognition of disproportional lumbar lordosis (LL) and artificially high pelvic incidence (PI) as a cause for positive sagittal imbalance and spinal pelvic mismatch. For such cases, a sacral pedicle subtraction osteotomy (PSO) may be indicated, although its morbidity is not well described. In this study, the authors evaluate the specific complication risks associated with S1 PSO.METHODSA retrospective review of all adult spinal deformity patients who underwent a 3-column osteotomy (3CO) for thoracolumbar deformity from 2006 to 2019 was performed. Demographic, clinical baseline, and radiographic parameters were recorded. The primary outcome of interest was perioperative complications (surgical, neurological, and medical). Secondary outcomes of interest included case length, blood loss, and length of stay. Multivariate analysis was used to assess the risk of S1 PSO compared with 3CO at other levels.RESULTSA total of 405 patients underwent 3CO in the following locations: thoracic (n = 55), L1 (n = 25), L2 (n = 29), L3 (n = 141), L4 (n = 129), L5 (n = 17), and S1 (n = 9). After S1 PSO, there were significant improvements in the sagittal vertical axis (14.8 cm vs 6.7 cm, p = 0.004) and PI-LL mismatch (31.7° vs 9.6°, p = 0.025) due to decreased PI (80.3° vs 65.9°, p = 0.006). LL remained unchanged (48.7° vs 57.8°, p = 0.360). The overall complication rate was 27.4%; the surgical, neurological, and medical complication rates were 7.7%, 6.2%, and 20.0%, respectively. S1 PSO was associated with significantly higher rates of overall complications: thoracic (29.1%), L1 (32.0%), L2 (31.0%), L3 (19.9%), L4 (32.6%), L5 (11.8%), and S1 (66.7%) (p = 0.018). Similarly, an S1 PSO was associated with significantly higher rates of surgical (thoracic [9.1%], L1 [4.0%], L2 [6.9%], L3 [5.7%], L4 [10.9%], L5 [5.9%], and S1 [44.4%], p = 0.006) and neurological (thoracic [9.1%], L1 [0.0%], L2 [6.9%], L3 [2.8%], L4 [7.0%], L5 [5.9%], and S1 [44.4%], p < 0.001) complications. On multivariate analysis, S1 PSO was independently associated with higher odds of overall (OR 7.93, p = 0.013), surgical (OR 20.66, p = 0.010), and neurological (OR 14.75, p = 0.007) complications.CONCLUSIONSS1 PSO is a powerful technique for correction of rigid sagittal imbalance due to an artificially elevated PI in patients with rigid high-grade spondylolisthesis and chronic sacral fractures. However, the technique and intraoperative corrective maneuvers are challenging and associated with high surgical and neurological complications. Additional investigations into the learning curve associated with S1 PSO and complication prevention are needed.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Complication profile associated with S1 pedicle subtraction osteotomy compared with 3-column osteotomies at other thoracolumbar levels for adult spinal deformity: series of 405 patients with 9 S1 osteotomies

Lau¹,

Haddad²,

Deviren

et al. 2020

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

show abstract

“…The sacroiliac joint was modeled using a soft contact with exponential behavior. The material properties were adapted from the literature and assigned to each component (Table 1 ) [ 24 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…The material properties were adapted from the literature and assigned to each component (Table 1 ) [ 24 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical evaluation of multi-rod constructs to stabilize an S1 pedicle subtraction osteotomy (PSO): a finite element analysis

Shekouhi,

Tripathi,

Goel

et al. 2023

Spine Deform

View full text Add to dashboard Cite

Purpose To develop and validate a finite element (FE) model of a sacral pedicle subtraction osteotomy (S1-PSO) and to compare biomechanical properties of various multi-rod configurations to stabilize S1-PSOs. Methods A previously validated FE spinopelvic model was used to develop a 30° PSO at the sacrum. Five multi-rod techniques spanning the S1-PSO were made using 4 iliac screws and a variety of primary rods (PR) and accessory rods (AR; lateral: Lat-AR or medial: Med-AR). All constructs, except one, utilized a horizontal rod (HR) connecting the iliac bolts to which PRs and Med-ARs were connected. Lat-ARs were connected to proximal iliac bolts. The simulation was performed in two steps with the acetabula fixed. For each model, PSO ROM and maximum stress on the PRs, ARs, and HRs were recorded and compared. The maximum stress on the L5–S1 disc and the PSO forces were captured and compared. Results Highest PSO ROMs were observed for 4-Rods (HR + 2 Med-AR). Constructs consisting of 5-Rods (HR + 2 Lat-ARs + 1 Med-AR) and 6-Rods (HR + 2 Lat-AR + 2 Med-AR) had the lowest PSO ROM. The least stress on the primary rods was seen with 6-Rods, followed by 5-Rods and 4-Rods (HR + 2 Lat-ARs). Lowest PSO forces and lowest L5–S1 disc stresses were observed for 4-Rod (Lat-AR), 5-Rod, and 6-Rod constructs, while 4-Rods (HR + Med-AR) had the highest. Conclusion In this first FE analysis of an S1-PSO, the 4-Rod construct (HR + Med-AR) created the least rigid environment and highest PSO forces anteriorly. While 5- and 6-Rods created the stiffest constructs and lowest stresses on the primary rods, it also jeopardized load transfer to the anterior column, which may not be favorable for healing anteriorly. A balance between the construct’s rigidity and anterior load sharing is essential.

show abstract

Ostéotomie sacrée pour changer les paramètres pelviens : technique chirurgicale et modélisation 3D

Khalifé

Khalife²,

Pascal‐Moussellard

2020

Revue de Chirurgie Orthopédique et Traumatologique

View full text Add to dashboard Cite

S1 Pedicle Subtraction Osteotomy in Sagittal Balance Correction. A Feasibility Study on Human Cadaveric Specimens

Cited by 4 publications

References 80 publications

Complication profile associated with S1 pedicle subtraction osteotomy compared with 3-column osteotomies at other thoracolumbar levels for adult spinal deformity: series of 405 patients with 9 S1 osteotomies

Complication profile associated with S1 pedicle subtraction osteotomy compared with 3-column osteotomies at other thoracolumbar levels for adult spinal deformity: series of 405 patients with 9 S1 osteotomies

Biomechanical evaluation of multi-rod constructs to stabilize an S1 pedicle subtraction osteotomy (PSO): a finite element analysis

Ostéotomie sacrée pour changer les paramètres pelviens : technique chirurgicale et modélisation 3D

Contact Info

Product

Resources

About