The Comprehensive Anatomical Spinal Osteotomy Classification

Schwab, Frank J.; Blondel, Benjamin; Chay, Edward; Demakakos, Jason; Lenke, Lawrence G.; Tropiano, Patrick; Ames, Christopher P.; Smith, Justin S.; Shaffrey, Christopher I.; Glassman, Steven D.; Farcy, Jean-Pierre; Lafage, Virginie

doi:10.1227/neu.0000000000000182

Cited by 83 publications

(118 citation statements)

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“…29,34,35 Effective deformity correction can often be achieved without ALIF and the associated risks, leading many authors to question its routine use in ASD. 11,20 PSO (Schwab 27 Grade 3 of 4) provides excellent sagittal correction for severe ASD, with up to 35° LL restoration and 10-cm posterior trunk translation. 32 Even in experienced hands, PSO carries significant surgical risks, both immediate (neurological deficit, durotomy) and delayed (infection, pseudarthrosis).…”

Section: Discussionmentioning

confidence: 99%

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Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

Strom¹,

Bae

Mizutani

et al. 2016

SPI

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OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy (29° ± 10°, p = 0.045). CONCLUSIONS LIF+OP is an effective strategy for ASD of moderate severity. Compared with the authors' OP-only operations, LIF+OP was associated with faster recovery, fewer complications, and greater relief of pain and disability.

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Section: Discussionmentioning

confidence: 99%

“…Interspinous ligament resection and Schwab 27 Grade 1 facet osteotomies were performed from L-1 to S-1. Additional bone resection (Grade 2 Ponte osteotomy or Grade 3-4 PSO) was performed as necessary.…”

Section: Surgical Techniquementioning

confidence: 99%

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

Strom¹,

Bae

Mizutani

et al. 2016

SPI

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“…PVCRtype osteotomies performed at multiple levels are classified as grade 6, according to the classification of Frank Schwab et al, and should be used as the last resort in the correction of severe rigid deformities. 16 In their study of 147 patients with spinal deformity, submitted to surgical treatment with PVCR, Lenke et al reported a complication rate of 59%. 17 In our study, two of the four patients with middle term follow-up presented intraoperative motor-evoked potential alterations, and of these, one patient remained with an ASIA D neurological examination in the lower limbs after 6 months.…”

Section: Discussionmentioning

confidence: 99%

Correction of Severe Dystrophic Scoliosis in Neurofibromatosis 1 With Posterior Vertebral Column Resection in Multiple Levels

et al. 2019

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Objective To evaluate the results after multiple posterior vertebral column resection (PVCR) in patients with severe kyphoscoliosis secondary to neurofibromatosis type 1 (NF-1). Methods Retrospective study of 4 adult male patients, mean age of 26.5 years, with severe rigid deformity, mean kyphosis of 122º and scoliosis of 88º, through clinical analysis and complementary exams. Results The mean postoperative follow-up was 27 months. Three vertebrae were resected on average. Interbody consolidation of arthrodesis was confirmed by CT in all cases. The correction rates of sagittal and coronal deformities were 54.09% and 70.45%, respectively. Prior to surgery, all patients were neurologically intact and as a post-surgical complication one patient had motor deficit (ASIA D) and pneumothorax also occurred in two patients. Conclusions The correction of severe kyphoscoliosis in adult patients with NF-1 is technically demanding and is not free of major complications. However, in view of the limited possibility of correction of these deformities, multiple-level PVCR has proved to be a safe and effective technique. Level of evidence IV; Case Series.

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“…Всем пациентам оперативное лечение осуществляли из заднего оперативного доступа. Выполняли первичную или ревизионную транспедикулярную фиксацию (ТПФ) и варианты вертебротомий [10,11]. В ряде случаев на уровне консолидированного тела позвонка выполняли дополнительный опорный передний спондилодез кейджем.…”

Section: результатыunclassified

Post-traumatic deformities of the spine: relevance, problems, and revision surgery

Прудникова

Хомченков

2019

Hir. pozvonoč.

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Objective. To analyze tactical approaches and types of surgical interventions for post-traumatic deformity of the spine. Material and Methods. Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods. Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients-60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The follow-Цель исследования. Анализ тактических подходов и видов оперативных вмешательств при посттравматических деформациях позвоночника. Материал и методы. Дизайн исследования: ретроспективная моноцентровая когорта. В исследование включено 116 пациентов: 1-я группа-50 больных с первичными посттравматическими деформациями, 2-я группа-66 больных со вторичными деформациями на фоне ранее выполненных декомпрессивно-стабилизирующих операций, госпитализированных для ревизионных вмеша

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The Comprehensive Anatomical Spinal Osteotomy Classification

Cited by 83 publications

References 0 publications

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

Correction of Severe Dystrophic Scoliosis in Neurofibromatosis 1 With Posterior Vertebral Column Resection in Multiple Levels

Post-traumatic deformities of the spine: relevance, problems, and revision surgery

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