Single Level Proximal Thoracic Pedicle Subtraction Osteotomy for Fixed Hyperkyphotic Deformity: Surgical Technique and Patient Series

Obeid, Ibrahim; Diebo, Bassel G.; Boissière, Louis; Bourghli, Anouar; Cawley, Derek; Larrieu, Daniel; Pointillart, Vincent; Challier, Vincent; Vital, J. M.; Lafage, Virginie

doi:10.1093/ons/opx158

Cited by 11 publications

(16 citation statements)

References 17 publications

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“…The trunk is also shifted to the right (concave) side. Lateral bending films showed good flexibility of the main curve of the stiffness and the magnitude of the major thoracic curve [10,12]. An experimented team may perform these techniques safely.…”

Section: B Type 1b: Concave CM With Main Thoracic or Cervicothoracmentioning

confidence: 94%

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Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

et al. 2018

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Introduction In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction.Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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Section: B Type 1b: Concave CM With Main Thoracic or Cervicothoracmentioning

confidence: 94%

“…Surgical correction of sagittal and coronal malalignment needs biplanar maneuvers, which may be challenging and may need different kinds of osteotomies [9,10].…”

Section: Introductionmentioning

confidence: 99%

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

et al. 2018

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“…Proximal upper thoracic PSO performed for upper thoracic kyphosis and compensatory cervical deformity has been reported to achieve good correction in the sagittal plane. In a series reported by Obeid et al, 11 segmental kyphosis and thoracic kyphosis both significantly decreased by 26.6° and 29.5°, respectively, which induced a reduction of the C1-7 cervical lordosis and the C7 slope by 20° each. A significant correlation was found between the reduction of thoracic kyphosis and the reduction of C1-7 lordosis.…”

Section: Resultsmentioning

confidence: 82%

“…12 Three column osteotomy or pedicle subtraction osteotomy is a technically demanding technique, but nevertheless considered safer than the previously aforementioned vertebral column resection (VCR), it enables correction of the rigid deformity in both sagittal and coronal planes and has been advocated as an ideal technique for the upper thoracic area. 11,13,14 The following paragraph will describe in details the different steps of performing an upper thoracic PSO (between T1 and T5).…”

Section: Preoperative Considerationsmentioning

confidence: 99%

“…In this category, the problem will need to be dealt with outside the cervical spine in the adjacent upper thoracic area. 10,11 In this article, we will focus on the latter situation when cervical deformity arises from outside the cervical spine, managing it by performing a pedicle subtraction osteotomy (PSO) in the upper thoracic area. Restauration of proper sagittal and coronal alignment will indirectly correct the cervical deformity to a properly aligned cervical spine.…”

Section: Introductionmentioning

confidence: 99%

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Cervical Deformity Arising From Upper Thoracic Malalignment

Obeid¹,

Boissière²,

Bourghli

2020

Neurospine

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This study aims to describe the surgical management of cervical deformity arising from outside the cervical spine because of upper thoracic malalignment, using pedicle subtraction osteotomy (PSO). Cervical spine deformity is a complex topic and it can be generally divided into 2 categories, the first category is when the primary deformity is inside the cervical spine and the treatment will focus on the cervical spine itself, whereas the second category is when the primary deformity is outside the cervical spine usually in the adjacent upper thoracic area, the cervical deformity is a compensation for the adjacent malalignment, and thus in this situation, the management will occur in the upper thoracic area. Description of a single surgeon's technique for performing PSO to treat rigid upper thoracic deformity. PSO in the upper thoracic spine is a safe and effective procedure and can result in satisfying clinical and radiological outcome with indirect correction of the compensatory cervical deformity. Cervical deformity arising from upper thoracic malalignment should be dealt with by treating the problem at its origin outside the cervical spine by performing a PSO in the upper thoracic spine.

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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

Bourghli

Boissière²,

Konbaz

et al. 2020

Spine Deform

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Single Level Proximal Thoracic Pedicle Subtraction Osteotomy for Fixed Hyperkyphotic Deformity: Surgical Technique and Patient Series

Abstract: Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.

Cited by 11 publications

References 17 publications

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

Cervical Deformity Arising From Upper Thoracic Malalignment

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

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