The Nuances of Pedicle Subtraction Osteotomies

Gupta, Sachin; Gupta, Munish C.

doi:10.1016/j.nec.2018.03.001

Cited by 14 publications

(7 citation statements)

References 24 publications

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“…Three-column PSO has been selected as the technique of choice when there is a rigid spine, the need to correct more than 25º and an SVA larger than 10 cm. 12 PSO technique has a high number of major complications (29.4%) such as dural tears (5.9%), neurologic deficit (3.8%), wound infection (3.8%), wound or epidural hematoma (3%), and pseudoarthrosis or implant failure (1.7%) 13 . In patients with a rigid spine, vertebral subluxations have been described as an immediate complication.…”

Section: Discussionmentioning

confidence: 99%

Sagittal Deformity Correction in a Patient Suffering From Diffuse Idiopathic Skeletal Hyperostosis Who Previously Underwent a Total Hip and Bilateral Knee Replacement

García-Martín

Verdejo-González

Ruiz-Picazo

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Physiological aging frequently leads to degenerative changes and spinal deformity. In patients with hypolordotic fusions or ankylosing illnesses such as diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis, compensation mechanisms can be altered causing severe pain and disability. In addition, if a total hip replacement and/or knee replacement is performed, both pelvic and lower limbs compensation mechanisms could be damaged and prosthetic dislocation or impingement syndrome could be present. Pedicle subtraction osteotomy has proven to be the optimal correction technique for spinal deformation in patients suffering from a rigid spine. Case Presentation: A 70-year-old male patient with diffuse idiopathic skeletal hyperostosis criteria and a rigid lumbar kyphosis, who previously underwent a total hip and knee replacement, had severe disability. We then performed corrective surgery by doing a pedicle subtraction osteotomy. The procedure and outcomes are presented here. Conclusion: In symptomatic patients with sagittal imbalance and a rigid spine, pedicle subtraction osteotomy can indeed correct spinal deformity and re-establish sagittal balance.

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Section: Discussionmentioning

confidence: 99%

Sagittal Deformity Correction in a Patient Suffering From Diffuse Idiopathic Skeletal Hyperostosis Who Previously Underwent a Total Hip and Bilateral Knee Replacement

García-Martín

Verdejo-González

Ruiz-Picazo

et al. 2021

Geriatr Orthop Surg Rehabil

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“…Analyzing 82 consecutive 3COs performed in 66 patients without the use of adjuvant graft material, biologics, or anterior column support, Lewis et al 46 reported the achievement of a 95% fusion rate via direct bone-to-bone closure of the osteotomy. Moreover, the closure technique itself, such as the cantilever technique, compression of the osteotomy site, and use of a table that bends the torso in extension, might influence the results 11 . Both biomechanical 47,48 and clinical studies 11 have pointed toward the fact that the construct composition, namely the number of rods and position of additional rods as well as the use of cross-connectors might influence the results.…”

Section: Technical Considerationsmentioning

confidence: 99%

“…Both biomechanical 47,48 and clinical studies 11 have pointed toward the fact that the construct composition, namely the number of rods and position of additional rods as well as the use of cross-connectors might influence the results. Using satellite rods 11 or a central hook-rod construct 49 might result in a more controlled and effective correction while adding overall fixation strength. Strain over the bone and implants can be further reduced by the addition of interbody spacers at the upper and lower levels adjacent to the PSO site 50 .…”

Section: Three-column Osteotomiesmentioning

confidence: 99%

Osteotomies for the Treatment of Adult Spinal Deformities

et al. 2022

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Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications. » The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions. » Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques.» There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.

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“…Применение корригирующих остеотомий позвоночника для коррекции сагиттального баланса в течение последних двух десятилетий приобрело широкое распространение. В зависимости от ригидности и степени деформации позвоночника в сагиттальной плоскости применяются остеотомии задней колонны (остеотомии по Ponte и Smith-Petersen) и трехколонные остеотомии -педикулярная субтракционная остеотомия (pedicle subtraction osteotomy -PSO) и резекция позвоночного столба (vertebral column resection -VCR) [1][2][3][4][5][6][7].…”

Section: Introductionunclassified

“…Помимо возможности выраженной коррекции за счет од-ного сегмента, преимущества данной методики заключаются в формировании в зоне остеотомии большой площади поверхности губчатой костной ткани, что обеспечивает оптимальные условия для костного сращения и минимальный риск повреждения сосудов и органов, расположенных кпереди от позвоночного столба [7,10]. В связи с вышеперечисленными преимуществами методика в течение последних двух десятилетий получает все более широкое распространение, обеспечивая хорошие клинические результаты [5,[11][12][13]. В то же время, по данным литературы, трехколонные остеотомии, и PSO в частности, связаны с повышенным риском развития осложнений, что обусловлено их радикальностью [12,[14][15][16][17][18][19][20].…”

Section: Introductionunclassified

Еffectiveness of Four-Rod Fixation for Pedicle Subtraction Spinal Osteotomy

Пантелеев

Mironov

Bukhtin

et al. 2018

Traumatology and Orthopedics of Russia

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Introduction.Pedicle subtraction osteotomy (PSO) provides for significant segmental correction of the sagittalbalance of the spine. At the same time, the technique is associated with a high risk of complications, with rod fracture at the osteotomy site being the most common. The purposeof this study — to assess the effectiveness of four-rod fixation compared to literature data on standardtwo-rod fixation in patients undergoing PSO. Materials and Methods.The study is a retrospective analysis of 47 consecutive patients with rigid spinaldeformities, who underwent pedicle subtraction osteotomy at the lumbar level. The average age of the patients (33 females and 14 males) was 59.7 years. In all cases spinal fixation carried out using a four-rod construct with additional short rods at the osteotomy site. The minimal postoperative follow-up was 2 years. A detailed analysis of the radiographic data was carried out with calculation of the global sagittal balance and spinopelvic parameters. A detailed assessment of complications in the early and late postoperative periods was also performed. After an exhaustive review of literature, a comparative analysis was made of the four-rod fixation technique with current literature data on the frequency of complications (in particular, rod fractures in the osteotomy zone) after two-rod fixation. Results.In all cases the osteotomy was performed at one level, most often at L3 (49%). The average length offixation was 9.8 segments. The average angle of segmental correction was 27.1°. In most cases, it was possible to achieve adequate correction of spinopelvic parameters. Among complications, bone resorption around screws was most prevalent (23.4% of cases). Proximal junctional kyphosis occurred in 12.8% of cases, neurologic deficit — in 14.9% of cases, infectious complications — in 10.6% cases. Asymptomatic pseudarthrosis, confirmed by CT data, was observed in 12.8% of patients. Rod fracture at the PSO site and adjacent segments was not observed in any of the cases. Rod fractures of other localization were observed in 10.6% of patients. Conclusion. According to the literature, the frequency of rod fractures at the osteotomy site is the most frequentcomplication of PSO. The results of this study showed that four-rod fixation in PSO significantly reduces the incidence of pseudarthrosis and rod fracture rate in the long-term follow-up and provides greater control over the process of osteotomy closure.

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The Nuances of Pedicle Subtraction Osteotomies

Cited by 14 publications

References 24 publications

Sagittal Deformity Correction in a Patient Suffering From Diffuse Idiopathic Skeletal Hyperostosis Who Previously Underwent a Total Hip and Bilateral Knee Replacement

Sagittal Deformity Correction in a Patient Suffering From Diffuse Idiopathic Skeletal Hyperostosis Who Previously Underwent a Total Hip and Bilateral Knee Replacement

Osteotomies for the Treatment of Adult Spinal Deformities

Еffectiveness of Four-Rod Fixation for Pedicle Subtraction Spinal Osteotomy

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