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Ding Z, Wang Y, Kang N, Hai Y, Zhou L. A posterior trans-intervertebral osteotomy with anterior support for kyphosis deformity secondary to ankylosing spondylitis: a technical note. BMC Musculoskelet Disord 2025; 26:2. [PMID: 39743521 DOI: 10.1186/s12891-024-08260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/26/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND This study aimed to assess the efficacy of a novel spinal osteotomy technique, the posterior trans-intervertebral osteotomy with anterior support, in individuals diagnosed with ankylosing spondylitis. This study utilized computer software to simulate the osteotomy procedure, predict orthopedic outcomes, and assist in preoperative planning. METHODS Four patients with ankylosing spondylitis underwent posterior trans-intervertebral osteotomy with anterior support that post-operative follow-up of more than 1 year. Osteotomy was performed using the intervertebral space approach with the cage placed anteriorly in the intervertebral space to improve the correction. Perioperative clinical symptoms, imaging data, and surgical factors were also documented. RESULTS Patients who underwent posterior trans-intervertebral osteotomy with anterior support achieved good clinical results with favorable correction rates and minimal estimated blood loss. The average preoperative, postoperative and follow-up Cobb angles were 90.5° (range: 86-96°), 43.5° (range: 34-52°) and 46.25°(range: 37-55°), respectively. The average estimated blood loss was 500 mL (range: 300-800 mL). Patients with preoperative deficits improved their neurological status, and no complications were observed throughout the postoperative period. Pain, self-image, and mental health in the SRS-22 demonstrated significant improvement at the final follow-up compared to preoperative values. The satisfaction with management score was 3.25 ± 0.65. CONCLUSIONS Posterior trans-intervertebral osteotomy with an anterior support procedure was performed through the intervertebral space and subsequent implantation of a cage within the transpedicular space, effectively addressing the constraints associated with the conventional trans-intervertebral osteotomy method. Our preliminary findings indicate that posterior trans-intervertebral osteotomy with anterior support is potentially more secure than the conventional method for correcting ankylosing spondylitis kyphosis.
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Affiliation(s)
- Zihao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yunsheng Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research & Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, 100000, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, 100000, China.
- Clinical Center for Spinal Deformity, Capital Medical University of China, Beijing, 100000, China.
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
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Quinonez AJ, Carroll AH, Mo F. L4 Pedicle Subtraction Osteotomy in a Patient With Multiple Previous Revisions: A Case Report. Cureus 2024; 16:e73534. [PMID: 39669871 PMCID: PMC11636669 DOI: 10.7759/cureus.73534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2024] [Indexed: 12/14/2024] Open
Abstract
Pedicle subtraction osteotomy (PSO) is a technically complex procedure that is effective at improving the sagittal profile in spinal deformity surgery. This case report describes a 64-year-old man with a history of ten previous spinal surgeries, including failed T10-pelvis posterior spinal fusion, undergoing revision with L4 PSO. The patient regained approximately 30° of lumbar lordosis. The procedure was complicated by an uneventful intraoperative durotomy and delayed postoperative surgical site infection requiring two surgical debridements and a prolonged course of antibiotics. At the 14-month follow-up, the patient was ambulating 3 miles per day and had significantly decreased pain with no sign of recurrent infection. PSOs performed in revision cases are more challenging procedures but can achieve similar degrees of correction even in patients with multiple previous revisions.
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Affiliation(s)
- Alejandro J Quinonez
- Orthopedic Surgery, Georgetown University School of Medicine, Washington DC, USA
| | - Austin H Carroll
- Orthopedic Surgery, MedStar Georgetown University Hospital, Washington DC, USA
| | - Fred Mo
- Orthopedic Surgery, MedStar Georgetown University Hospital, Washington DC, USA
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Baker SC, Lucasti C, Graham BC, Scott MM, Vallee EK, Kowalski D, Patel DV, Hamill CL. Predicting Complications in 153 Lumbar Pedicle Subtraction Osteotomies by a Single Surgeon Over a 6-Year Period. J Am Acad Orthop Surg 2024; 32:e930-e939. [PMID: 38787893 DOI: 10.5435/jaaos-d-23-01263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Pedicle subtraction osteotomy (PSO) is a complex surgical procedure that provides correction of moderate sagittal imbalance. Surgical complications have adverse effects on patient outcomes and healthcare costs, making it imperative for clinical researchers to focus on minimizing complications. However, when it comes to risk modeling of PSO surgery, there is currently no consensus on which patient characteristics or measures should be used. This study aimed to describe complications and compare the performance of various sociodemographic characteristics, surgical variables, and established risk indices in predicting postoperative complications, infections, and readmissions after lumbar PSO surgeries. METHODS A review was conducted on 191 patients who underwent PSO surgery at a single institution by a single fellowship-trained orthopaedic spine surgeon between January 1, 2018, and December 31, 2021. Demographic, intraoperative, and postoperative data within 30 days, 1 year, and 2 years of the index procedure were evaluated. Descriptive statistics, t -test, chi-squared analysis, and logistic regression models were used. RESULTS Intraoperative complications were significantly associated with coronary artery disease (odds ratios [OR] 3.95, P = 0.03) and operating room time (OR 1.01, P = 0.006). 30-day complications were significantly cardiovascular disease (OR 2.68, P = 0.04) and levels fused (OR 1.10, P = 0.04). 2-year complications were significantly associated with cardiovascular disease (OR 2.85, P = 0.02). 30-day readmissions were significantly associated with sex (4.47, 0.04) and length of hospital stay (χ 2 = 0.07, P = 0.04). 2-year readmissions were significantly associated with age (χ 2 = 0.50, P = 0.03), hypertension (χ 2 = 4.64, P = 0.03), revision surgeries (χ 2 = 5.46, P = 0.02), and length of hospital stay (χ 2 = 0.07, P = 0.03). DISCUSSION This study found that patients with coronary vascular disease and longer fusions were at higher risk of postoperative complications and patients with notable intraoperative blood loss were at higher risk of postoperative infections. In addition, physicians should closely follow patients with extended postoperative hospital stays, with advanced age, and undergoing revision surgery because these patients were more likely to be readmitted to the hospital.
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Affiliation(s)
- Seth C Baker
- From the Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (Baker, Graham, Scott, and Vallee), and the UBMD Orthopaedics and Sports Medicine Doctors, Buffalo, NY (Lucasti, Kowalski, Patel, and Hamill)
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Lee KY, Lee JH, Kang KC, Jung CH. Effects of Minimally Invasive Lateral Lumbar Interbody Fusion with Accessory Rod Technique on Rod Fracture in Adult Spinal Deformity Surgery: Analysis of 239 Patients. Spine (Phila Pa 1976) 2024; 49:E291-E299. [PMID: 38212931 PMCID: PMC11346710 DOI: 10.1097/brs.0000000000004920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2024]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To analyze factors associated with rod fracture (RF) in adult spinal deformity (ASD), and to assess whether the accessory rod (AR) technique can reduce RF occurrence in deformity correction in the setting of minimally invasive lateral lumbar interbody fusion (LLIF). SUMMARY OF BACKGROUND DATA Instrumentation failure is the most common reason for revision surgery in ASD. Several RF reduction methods have been introduced. However, there are insufficient studies on postoperative RF after deformity correction using minimally invasive LLIF. MATERIALS AND METHODS This study included 239 patients (average age 71.4 y and a minimum 2-year follow-up) with ASD who underwent long-segment fusion from T10 to sacrum with sacropelvic fixation. Patients were classified into the non-RF group and the RF group. After logistic regression analysis of the risk factors for RF, subgroup analyses were performed: pedicle subtraction osteotomy (PSO) with two-rod (P2 group) versus PSO with two-rod and AR (P4 group), and LLIF with two-rod (L2 group) versus LLIF with two-rod and AR (L4 group). RESULTS RF occurred in 50 patients (21%) at an average of 25 months. RF occurred more frequently in patients who underwent PSO than in those who underwent LLIF ( P =0.002), and the use of the AR technique was significantly higher in the non-RF group ( P <0.05).Following logistic regression analysis, preoperative PI-LL mismatch, PSO, and the AR technique were associated with RF. In subgroup analyses, RF incidence was 65% (24/37 cases) of the P2 group, 8% (4/51 cases) of the P4 group, and 21% (22/105 cases) of the L2 group. In the L4 group, there was no RF. CONCLUSION Minimally invasive multilevel LLIF with the AR technique is capable of as much LL correction as conventional PSO and appears to be an effective method for reducing RF.
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Singh M, Balmaceno-Criss M, Daher M, Lafage R, Hamilton DK, Smith JS, Eastlack RK, Fessler RG, Gum JL, Gupta MC, Hostin R, Kebaish KM, Klineberg EO, Lewis SJ, Line BG, Nunley PD, Mundis GM, Passias PG, Protopsaltis TS, Buell T, Ames CP, Mullin JP, Soroceanu A, Scheer JK, Lenke LG, Bess S, Shaffrey CI, Schwab FJ, Lafage V, Burton DC, Diebo BG, Daniels AH. Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile. World Neurosurg 2024; 189:e219-e229. [PMID: 38866236 DOI: 10.1016/j.wneu.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data are limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients. METHODS Severe adult spinal deformity patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and PROMs at baseline and 6-week postoperative visit were included. Patients were grouped into ALIF (1-2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1-2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs. RESULTS Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores, and radiographic spinopelvic parameters (P > 0.05). However, PSO was performed more often in revision cases (P < 0.001). Following surgery, L4-S1 lordosis correction (P = 0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (P = 0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (P < 0.001) and motor deficits (P = 0.049), and in-hospital ICU admission (P = 0.022) and blood products given (P = 0.004), but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and 6-week PROMs were comparable as well. CONCLUSIONS ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intraoperative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
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Affiliation(s)
- Manjot Singh
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | | | - Mohammad Daher
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, New York, New York, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Richard G Fessler
- Department of Neurological Surgery, Rush University Medical School, Chicago, Illinois, USA
| | | | - Munish C Gupta
- Washington University in St Louis, St. Louis, Missouri, USA
| | - Richard Hostin
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Dallas, Texas, USA
| | - Khaled M Kebaish
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of Texas Health, Houston, Texas, USA
| | - Stephen J Lewis
- Division of Orthopedics, Toronto Western Hospital, Toronto, Canada
| | - Breton G Line
- Denver International Spine Center, Denver, Colorado, USA
| | | | | | - Peter G Passias
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA
| | | | - Thomas Buell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, University of Buffalo, New York, New York, USA
| | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Calgary, Canada
| | - Justin K Scheer
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, New York, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, New York, USA
| | - Shay Bess
- Denver International Spine Center, Denver, Colorado, USA
| | | | - Frank J Schwab
- Department of Orthopedic Surgery, New York, New York, USA
| | | | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA.
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Bourghli A, Boissiere L, Obeid I. Lumbar pedicle subtraction osteotomy: techniques and outcomes. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100516. [PMID: 39188669 PMCID: PMC11345922 DOI: 10.1016/j.xnsj.2024.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024]
Abstract
Pedicle subtraction osteotomy has been thoroughly described and studied over the past 2 decades, being applied mainly in the lumbar spine, followed by the thoracic spine. Our better understanding of alignment biomechanics, and the progressive refinements of the surgical technique over time made it a very efficient procedure for the management of fixed sagittal malalignment. However, a long learning curve is mandatory to mitigate the associated risks particularly neurological deficits and achieve satisfactory clinical and radiological outcomes with an acceptable rate of complications.
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Affiliation(s)
- Anouar Bourghli
- Spine surgery department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Louis Boissiere
- Spine surgery department, Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Ibrahim Obeid
- Spine surgery department, Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
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Bartlett AM, Dibble CF, Sykes DAW, Drossopoulos PN, Wang TY, Crutcher CL, Than KD, Bhomwick DA, Shaffrey CI, Abd-El-Barr MM. Early Experience with Prone Lateral Interbody Fusion in Deformity Correction: A Single-Institution Experience. J Clin Med 2024; 13:2279. [PMID: 38673552 PMCID: PMC11051569 DOI: 10.3390/jcm13082279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Lateral spine surgery offers effective minimally invasive deformity correction, but traditional approaches often involve separate anterior, lateral, and posterior procedures. The prone lateral technique streamlines this process by allowing single-position access for lateral and posterior surgery, potentially benefiting from the lordosing effect of prone positioning. While previous studies have compared prone lateral to direct lateral for adult degenerative diseases, this retrospective review focuses on the outcomes of adult deformity patients undergoing prone lateral interbody fusion. Methods: Ten adult patients underwent single-position prone lateral surgery for spine deformity correction, with a mean follow-up of 18 months. Results: Results showed significant improvements: sagittal vertical axis decreased by 2.4 cm, lumbar lordosis increased by 9.1°, pelvic tilt improved by 3.3°, segmental lordosis across the fusion construct increased by 12.2°, and coronal Cobb angle improved by 6.3°. These benefits remained consistent over the follow-up period. Correlational analysis showed a positive association between improvements in PROs and SVA and SL. When compared to hybrid approaches, prone lateral yielded greater improvements in SVA. Conclusions: Prone lateral surgery demonstrated favorable outcomes with reasonable perioperative risks. However, further research comparing this technique with standard minimally invasive lateral approaches, hybrid, and open approaches is warranted for a comprehensive evaluation.
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Affiliation(s)
- Alyssa M. Bartlett
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.M.B.)
| | - Christopher F. Dibble
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - David A. W. Sykes
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.M.B.)
| | | | - Timothy Y. Wang
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.M.B.)
| | | | - Khoi D. Than
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.M.B.)
| | - Deb A. Bhomwick
- Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.M.B.)
| | | | - Muhammad M. Abd-El-Barr
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Yu C, Owens RK, Crawford CH, Djurasovic M, Gum JL, Brown M, Carreon LY. Cost-Effectiveness of Intraoperative Electromyography to Determine Adequate Screw Position. Global Spine J 2024; 14:407-410. [PMID: 35950238 PMCID: PMC10802540 DOI: 10.1177/21925682221107652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Prospective observational cohort. OBJECTIVES To examine the cost-effectiveness of IntraOperative ElectroMyeloGraphy (IO-EMG) by evaluating how often an abnormal IO-EMG signal changed the surgeon's surgical plan, or replaced a pedicle screw either intra-operatively or as a second unplanned surgery. METHODS Patients undergoing instrumented posterolateral lumbar fusion were monitored with intraoperative triggered EMG's. Pedicle screws were placed freehand from L1 to S1 by attending physicians and fellows. Concern for pedicle breach was a screw stimulation<10 mA. RESULTS There were 145 cases with a total of 725 pedicle screws placed. Mean age was 57.8 ± 14.2 yrs, OR time was 238 ± 95 minutes, EBL was 426.8 ± 354.3cc. Mean number of surgical levels fused was 2.7 ± 1.1. 686 (95%) screws stimulated at >10 mA and 39 (5%) screws stimulated at <10 mA. All 39 screws were removed and pedicles re-examined. Intraoperative screw repositioning was necessary in 8 of 145 cases (6%). No patient required a return to the OR for screw repositioning. As a worst case cost analysis, assuming the 8 patients requiring intraoperative screw positioning would have returned to the OR at a cost of $11,798 per readmission, the per patient cost is $651 which is less than the ION per patient cost of $750. CONCLUSIONS Only 1% of the 725 lumbar pedicle screws placed in 8 of 145 cases required repositioning. Due to the infrequency of pedicle wall breaches and the cost of ION, the utility of this modality in straightforward lumbar fusions should be critically evaluated.
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Affiliation(s)
- Charles Yu
- Norton Leatherman Spine Center, Louisville, KY, USA
| | | | | | | | | | - Morgan Brown
- Norton Leatherman Spine Center, Louisville, KY, USA
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Oktavia D, Airlangga PA, Hidayat AR, Satmoko BA. Long-term outcome evaluation in ankylosing spondylitis with high-angle thoracolumbar kyphotic deformity corrected by one-stage single-level pedicle subtraction osteotomy augmented with Ponte osteotomy: A case series. Int J Surg Case Rep 2024; 114:109088. [PMID: 38056166 PMCID: PMC10746497 DOI: 10.1016/j.ijscr.2023.109088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A high-angle thoracolumbar kyphotic deformity (TLKD) may complicate surgical rectification of AS patients since one-stage two-level pedicle subtraction osteotomy (PSO), which provides high-angular correction, leads to excessive blood loss, neurological deficits and fixation failures. This case series presents the long-term results of one-stage single level PSO with Ponte osteotomy (PO) in the treatment of AS patients with high-angle TLKD. CASE PRESENTATION This case series presents two AS patients with high kyphotic angles (KAs) of 86.1o. We collected data retrospectively from our institution's database between 2019 and 2023. A sagittal axis imbalance was the only complaint initially, no neurological deficits or other problems. A PSO augmented by PO was performed with a decompression laminectomy. Intraoperative monitoring (IOM) during reduction was used to observe neurological deficits. Blood loss at the highest rate was 1000 cc. It corrected 57.8o of KA postoperatively without neurological deficits. We found consistent results over 36 months. CLINICAL DISCUSSION A thorough analytical approach may help diagnose AS. One-stage single-level PSO may correct high-angle TLKD in AS patients effectively. To achieve greater angular correction, PO, a less risky osteotomy, must be added. Decompression laminectomy is vital before osteotomy and IOM is crucial during reduction to prevent nerve injury. Even with two osteotomies, there was less blood loss than previously reported. These impressive long-term results call for further research. CONCLUSION Combined PSO and PO with IOM efficiently magnifies the angular correction without postoperative neurological deficits or excessive blood loss in AS patients with high-angle TLKD.
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Affiliation(s)
- Dwiyanto Oktavia
- Orthopedic and Traumatology Department, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Surabaya, Indonesia.
| | - Primadenny Ariesa Airlangga
- Orthopedic and Traumatology Department, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Surabaya, Indonesia.
| | - Aries Rakhmat Hidayat
- Orthopedic and Traumatology Department, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Surabaya, Indonesia.
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Bakhsheshian J, Hassan FM, Greisberg G, Platt A, Zuckerman SL, Lenke LG. The "Sandwich" Extended Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Malalignment: Technical Description, Case Series, and Early Results With 2-Year Outcomes. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00987. [PMID: 38047642 DOI: 10.1227/ons.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
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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Affiliation(s)
- Joshua Bakhsheshian
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, The Och Spine Hospital at New York-Presbyterian, New York, New York, USA
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Gabriella Greisberg
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Andrew Platt
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, The Och Spine Hospital at New York-Presbyterian, New York, New York, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, The Och Spine Hospital at New York-Presbyterian, New York, New York, USA
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Homer CJ, Haselhuhn JJ, Ellingson AM, Bechtold JE, Polly DW. Development of a sacral fracture model to demonstrate effects on sagittal alignment. Spine Deform 2023; 11:1325-1333. [PMID: 37382877 DOI: 10.1007/s43390-023-00721-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To develop a modeling framework to predict the secondary consequences on spinal alignment following correction and to demonstrate the impact of pedicle subtraction osteotomy (PSO) location on sagittal alignment. METHODS Six patients were included, and pelvic incidence (PI) was measured. Full-length standing radiographs were uploaded into PowerPoint and manipulated to model S1-S2 joint line sacral fractures at 15°, 20°, 25°, and 30°. PSO corrections with hinge points at the anterior superior corner and vertical midpoint of the L3-5 vertebral bodies were modeled. Anterior translation (AT) and vertical shortening (VS) were calculated for the six PSO locations in the four fracture angle (FA) models. RESULTS PI had a strong effect in the mixed AT and VS models (P < 0.001). Both AT and VS were significantly different from zero at all FA (p < 0.001), and pairwise comparisons revealed all FA were different from each other with respect to both AT and VS after adjusting for PSO location (p < 0.001), increasing as FA increased. Varying PSO location resulted in significant differences in AT when comparing all locations (p < 0.001). AT was greatest for all FA in all patients when the PSO correction was performed at the L3-AS (p < 0.001). There were significant differences in VS when comparing the L5-Mid PSO location to the L3-AS, L3-Mid, L4-AS, and L4-Mid PSO locations (p < 0.034). CONCLUSION PSO correction superior to a sacral fracture resulted in AT and VS of the spine. It is crucial that these changes in spinal measures be predicted and accounted for to optimize patient sagittal alignment and outcomes.
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Affiliation(s)
- Cole J Homer
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Jason J Haselhuhn
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
| | - Arin M Ellingson
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
- The Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joan E Bechtold
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
- The Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David W Polly
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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12
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Linzey JR, Lillard J, LaBagnara M, Park P. Complications and Avoidance in Adult Spinal Deformity Surgery. Neurosurg Clin N Am 2023; 34:665-675. [PMID: 37718113 DOI: 10.1016/j.nec.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Adult spinal deformity (ASD) is a complex disease that can result in significant disability. Although surgical treatment has been shown to be of benefit, the complication rate in the perioperative and postoperative periods can be as high as 70%. Some of the most common complications of ASD surgery include intraoperative cerebrospinal fluid leak, high blood loss, new neurologic deficit, hardware failure, proximal junctional kyphosis/failure, pseudarthrosis, surgical site infection, and medical complications. For each of these complications, one or more strategies can be utilized to avoid and/or minimize the consequences.
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Affiliation(s)
- Joseph R Linzey
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jock Lillard
- University of Tennessee & Semmes-Murphey Clinic, Memphis, TN 38120, USA
| | - Michael LaBagnara
- University of Tennessee & Semmes-Murphey Clinic, Memphis, TN 38120, USA
| | - Paul Park
- University of Tennessee & Semmes-Murphey Clinic, Memphis, TN 38120, USA.
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13
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Joiner EF, Mummaneni PV, Shaffrey CI, Chan AK. Posterior-based Osteotomies for Deformity Correction. Neurosurg Clin N Am 2023; 34:555-566. [PMID: 37718102 DOI: 10.1016/j.nec.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused anterior column and non-focal sagittal deformity requiring modest correction in lordosis. When performed on multiple levels, posterior-column osteotomy may provide significant harmonious correction in patients who require more extensive correction. Pedicle subtraction osteotomy and vertebral column resection are appropriate for patients with a fused anterior column and more severe deformity, particularly focal and/or multiplanar deformity. The power of pedicle subtraction osteotomy and vertebral column resection to provide greater correction and to address multiplanar deformity comes at the cost of higher complication rates than posterior-column osteotomy.
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Affiliation(s)
- Evan F Joiner
- Department of Neurological Surgery, Columbia University-NewYork Presbyterian Hospital, 710 West 168th Street, 4th Floor, New York, NY 10032, USA. https://twitter.com/efjoiner
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA; Department of Orthopaedic Surgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Och Spine Hospital, 5141 Broadway, 3FW, New York, NY, USA.
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14
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McNeill IT, Neifert SN, Deutsch BC, Martini ML, Shuman WH, Chapman E, Price G, Hwang S, Steinberger J, Caridi JM. Comparative Analysis of Early Outcomes and Complications of PSO Among Neurosurgeons and Orthopedic Surgeons. Clin Spine Surg 2023; 36:E174-E179. [PMID: 36201848 DOI: 10.1097/bsd.0000000000001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/02/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective comparative cohort study using the National Surgical Quality Improvement Program. OBJECTIVE The aim of this study was to evaluate trends in the annual number of PSOs performed, describe the patient populations associated with each cohort, and compare outcomes between specialties.Summary of Background Data:Pedicle subtraction osteotomies (PSO) are complex and advanced spine deformity surgical procedures performed by neurosurgeons and orthopedic surgeons. Though both sets of surgeons can be equally qualified and credentialed to perform a PSO, it is possible that differences in training and exposure could translate into differences in patient management and outcomes. METHODS Patients that underwent lumbar PSO from 2005 to 2014 in the American College of Surgeons-National Surgical Quality Improvement Program registry were identified. Relevant demographic, preoperative comorbidity, and postoperative 30-day complications were queried and analyzed. The data was divided into 2 cohorts consisting of those patients who were treated by neurosurgeons versus orthopedic surgeons. Additional data from the Scoliosis Research Society Morbidity and Mortality database was queried and analyzed for comparison. RESULTS Demographic and comorbidity factors were similar between the neurosurgery and orthopedic surgery cohorts, except there were higher rates of hypertension among orthopedic surgeon-performed PSOs (65.66% vs. 48.67%, P =0.004). Except for 2012, in every year queried, orthopedic surgeons reported more PSOs than neurosurgeons. In patients who underwent lumbar fusion surgery, there was a higher rate of PSOs if the surgery was performed by an orthopedic surgeon (OR 1.7824, 95% CI: 1.4017-2.2665). The incidence of deep vein thrombosis after PSOs was higher for neurosurgery compared with orthopedic surgery (8.85% vs. 1.20%, P =0.004). However, besides deep vein thrombosis, there were no salient differences in surgical complication rates between neurosurgeon-performed PSOs and orthopedic surgeon-performed PSOs. CONCLUSIONS The number of PSO procedures performed by neurosurgeons and orthopedic surgeons has increased annually. Differences in outcomes between neurosurgeons and orthopedic surgeons suggest an opportunity for wider assessment and alignment of adult spinal deformity surgery exposure and training across specialties.
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Affiliation(s)
- Ian T McNeill
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, CT
| | - Sean N Neifert
- Department of Neurosurgery, New York University Langone Medical Center
| | - Brian C Deutsch
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - William H Shuman
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA
| | - Emily Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gabrielle Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Songhon Hwang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeremy Steinberger
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, CT
| | - John M Caridi
- UTHealth Neurosciences Spine Center, Department of Neurosurgery, Houston
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15
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Tanaka M, Sonawane S, Meena U, Lu Z, Fujiwara Y, Taoka T, Uotani K, Oda Y, Sakaguchi T, Arataki S. Comparison of C-Arm-Free Oblique Lumbar Interbody Fusion L5-S1 (OLIF51) with Transforaminal Lumbar Interbody Fusion L5-S1 (TLIF51) for Adult Spinal Deformity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050838. [PMID: 37241070 DOI: 10.3390/medicina59050838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Adult spinal deformity (ASD) surgery, L5-S1 lordosis is very important factor. The main objective of the research is to retrospectively compare symptomatic presentation and radiological presentation in the sequelae of oblique lumbar inter-body spinal fusion at L5-S1 (OLIF51) and transforaminal lumbar interbody fusion (TLIF) for ASD. Materials and Methods: We retrospectively evaluated 54 patients who underwent corrective spinal fusion for ASD between October 2019 and January 2021. Thirteen patients underwent OLIF51 (average 74.6 years old, group O) and 41 patients underwent TLIF51 (average 70.5 years old, group T). Mean follow-up period was 23.9 months for group O and 28.9 months for group T, ranging from 12 to 43 months. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). Radiographic evaluation was also collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time in group O was less than that in group T (356 min vs. 492 min, p = 0.003). However, intraoperative blood loss of both groups were not significantly different (1016 mL vs. 1252 mL, p = 0.274). Changes in VAS and ODI were similar in both groups. L5-S1 angle gain and L5-S1 height gain in group O were significantly better than those of group T (9.4° vs. 1.6°, p = 0.0001, 4.2 mm vs. 0.8 mm, p = 0.0002). Conclusions: Clinical outcomes were not significantly different in both groups, but surgical time in OLIF51 was significantly less than that in TLIF51. The radiographic outcomes showed that OLIF51 created more L5-S1 lordosis and L5-S1 disc height compared with TLIF 51.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Sumeet Sonawane
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Umesh Meena
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Zhichao Lu
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Takuya Taoka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Shinya Arataki
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
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16
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Lainé G, Le Huec JC, Blondel B, Fuentes S, Fiere V, Parent H, Lucas F, Roussouly P, Tassa O, Bravant E, Berthiller J, Barrey CY. Factors influencing complications after 3-columns spinal osteotomies for fixed sagittal imbalance from multiple etiologies: a multicentric cohort study about 286 cases in 273 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3673-3686. [PMID: 36192454 DOI: 10.1007/s00586-022-07410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/14/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Spinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies. METHODS The study consisted of a blinded retrospective analysis of prospectively collected data from a large multicenter cohort of patients who underwent 3-columns (3C) spinal osteotomy, between January 2010 and January 2017. Clinical and radiological data were compared pre- and post-operatively. Complications and their risk factors were analyzed. RESULTS Two hundred eighty-six 3C osteotomies were performed in 273 patients. At 1 year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p < 0.001). A total of 164 patients (59.2%) experienced at least 1 complication (277 complications). Complications-free survival rates were only 30% at 5 years. Most of those were mechanical (35.2%), followed by general (17.6%), surgical site infection (17.2%) and neurological (10.9%). Pre-operative neurological status [RR = 2.3 (1.32-4.00)], operative time (+ 19% of risk each additional hour) and combined surgery [RR = 1.76 (1.08-2.04)] were assessed as risk factors for overall complication (p < 0.05). The use of patient-specific rods appeared to be significantly associated with less overall complications [RR = 0.5 (0.29-0.89)] (p = 0.02). CONCLUSION Spinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication.
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Affiliation(s)
- G Lainé
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
| | - J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux University, Bordeaux, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - V Fiere
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - H Parent
- Clinique Saint Léonard, Trélazé, France
| | - F Lucas
- Hopital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | - P Roussouly
- Centre Médico-Chirurgical Des Massues, Croix Rouge, Lyon, France
| | - O Tassa
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - E Bravant
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
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17
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The Relationship Among Surgeon Experience, Complications, and Radiographic Outcomes in Spine Deformity Surgery: The Experience of a Junior Surgeon. World Neurosurg 2022; 168:e399-e407. [DOI: 10.1016/j.wneu.2022.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
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18
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The Reliability of Computer-Assisted Three-Dimensional Surgical Simulation of Posterior Osteotomies in Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis Patients. Mediators Inflamm 2022; 2022:8134242. [PMID: 36072573 PMCID: PMC9444461 DOI: 10.1155/2022/8134242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives. The study was aimed at investigating the reliability of computer-assisted three-dimensional surgical simulation (CA3DSS) of posterior osteotomies in thoracolumbar kyphosis secondary to ankylosing spondylitis (TLKAS) patients. Methods. Eligible TLKAS patients who underwent posterior correction surgery with posterior osteotomies were consecutively included. Simulated posterior osteotomies were performed in Mimics and 3-Matic Medical software. Coronal and sagittal angle and alignment parameters were measured in preoperative full-length X-ray, preoperative original 3D spine (Pre-OS), simulated 3D spine (SS), and postoperative original 3D spine (Post-OS). Reliability was tested by both intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Results. A total of 30 TLKAS patients were included. Excellent consistency of radiological parameters was shown between preoperative X-ray and Pre-OS model. In SS and Post-OS models, excellent reliabilities were shown in global kyphosis (ICC 0.832, 95% CI 0.677-0.916), thoracic kyphosis (ICC 0.773, 95% CI 0.577-0.885), and lumbar lordosis (ICC 0.896, 95% CI 0.794-0.949) and good reliabilities were exhibited in the main curve (ICC 0.680, 95% CI 0.428-0.834) and sagittal vertical axis (ICC 0.619, 95% CI 0.338-0.798). ICCs of correction angle achieved by pedicle subtraction osteotomy (PSO) was 0.754 (95% CI 0.487-0.892), and that of posterior column osteotomies (PCO) was 0.703 (95% CI 0.511-0.829). Bland-Altman analysis also showed good agreement for both Cobb angle and distance measurements in Pre-OS and SS models, and good reliabilities were shown in PCO and PSO in real spine and SS models. Conclusions. CA3DSS can provide an accurate measurement, and it is a reliable and effective method to conduct proper simulation for correction surgery with posterior osteotomies in TLKAS patients. This trial is registered with Chinese Clinical Trial Registry ChiCTR2100053808.
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19
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Safaee MM, Scheer JK, Lau D, Fury M, Deviren V, Ames CP. Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature. Oper Neurosurg (Hagerstown) 2022; 23:e84-e90. [PMID: 35838456 DOI: 10.1227/ons.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/24/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Lumbosacral deformities are caused by high-grade spondylolisthesis, fractures, iatrogenic flat back, and other etiologies. The S1 pedicle subtraction osteotomy (PSO) can facilitate reduction of spondylolisthesis and lower the pelvic incidence. There are limited reports on the indications and outcomes of this technique. OBJECTIVE To present a technical description and literature review of the S1 PSO with video summary. METHODS This was a retrospective review of a single case to highlight the use of S1 PSO for the treatment of high-grade spondylolisthesis. A literature review was performed in accordance with STROBE guidelines. RESULTS A 47-year-old woman presented with back and right leg pain related to grade 4 spondylolisthesis at L5-S1 with sagittal imbalance and lumbosacral kyphosis. She was taken for an L2-pelvis instrumented fusion with S1 PSO. Three days later, she was taken for an L4-5 and L5-S1 anterior lumbar interbody fusion with the L5-S1 segmental plate. Her postoperative course was notable for right foot drop that resolved in 6 weeks. Postoperative x-rays showed successful reduction of spondylolisthesis with normal alignment and sagittal balance. Based on 6 studies involving 22 true sacral PSOs in the literature, the procedure carries a 27% risk of neurological deficit, typically in the form of L5 palsy. CONCLUSION The S1 PSO is a technically challenging operation that has a unique role in the treatment of high-grade spondylolisthesis. It carries a significant risk of L5 palsy and should be reserved for surgeons with experience performing complex 3-column osteotomies.
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Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Darryl Lau
- Department of Neurological Surgery, New York University, New York, New York, USA
| | - Marissa Fury
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA.,Department of Orthopedic Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
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20
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Kalidindi KKV, Sath S, Sharma JK, Vishwakarma G, Chhabra HS. Incidence and Risk Factors for Neurological Deterioration in Posterior Corrective Surgeries for Severe Angular Kyphotic Deformities: A 10-Year Institutional Retrospective Study. Global Spine J 2022; 12:1199-1207. [PMID: 33375870 PMCID: PMC9210251 DOI: 10.1177/2192568220979122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE Neurological deficit is one of the dreaded complications of kyphotic deformity correction procedures. There is inconsistency in the reports of neurological outcomes following such procedures and only a few studies have analyzed the risk factors for neurological deficits. We aimed to analyze the factors associated with neurological deterioration in severe kyphotic deformity correction surgeries. METHODS We performed a retrospective study of 121 consecutive surgically treated severe kyphotic deformity cases (49 males, 56 females) at a single institute (May 1st 2008 to May 31st 2018) and analyzed the risk factors for neurological deterioration. The demographic, surgical and clinical details of the patients were obtained by reviewing the medical records. RESULTS 105 included patients were divided into 2 groups: Group A (without neurological deficit) with 92 patients (42 males, 50 females) and Group B (with neurological deficit) with 13 patients (7 males, 6 females) (12.4%). Statistically significant difference between the 2 groups was observed in the preoperative sagittal Cobbs angle (p < 0.0001), operative time (p = 0.003) and the presence of myelopathic signs on neurological examination (p = 0.048) and location of the apex of deformity (p = 0.010) but not in other factors. CONCLUSIONS Preoperative Sagittal Cobbs angle, presence of signs of myelopathy, operative time and location of apex in the distal thoracic region were significantly higher in patients with neurological deterioration as compared to those without neurological deterioration during kyphotic deformity correction surgery. Distal thoracic curve was found to have 4 times more risk of neurological deterioration compared to others.
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Affiliation(s)
- Kalyan Kumar Varma Kalidindi
- Department of Spine Service, Indian Spinal Injuries Center, New Delhi, India,Kalyan Kumar Varma Kalidindi, Indian Spinal Injuries Center, Vasant Kunj, New Delhi 110070, India.
| | - Sulaiman Sath
- Department of Spine Service, Indian Spinal Injuries Center, New Delhi, India
| | - Jeevan Kumar Sharma
- Department of Spine Service, Indian Spinal Injuries Center, New Delhi, India
| | - Gayatri Vishwakarma
- Department of Biostatistics, Indian Spinal Injuries Center, New Delhi, India
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21
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Yilgor C, Kindan P, Yucekul A, Zulemyan T, Alanay A. Osteotomies for the Treatment of Adult Spinal Deformities: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202205000-00010. [PMID: 35613311 DOI: 10.2106/jbjs.rvw.21.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» 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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Affiliation(s)
- Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Peri Kindan
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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22
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Zhu L, Wang JW, Zhang L, Feng XM. Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:142-154. [PMID: 33438462 PMCID: PMC8965311 DOI: 10.1177/2192568220979145] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES To evaluate clinical and radiographic outcomes, and perioperative complications of oblique lateral interbody fusion (OLIF) for adult spinal deformity (ASD). METHODS We performed a systematic review and meta-analysis of related studies reporting outcomes of OLIF for ASD. The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry Disability Index (ODI). The radiographic parameters were evaluated by sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL), Cobb angle and fusion rate. A random effects model and 95% confidence intervals (CI) were performed to investigate the results. RESULTS A total of 16 studies involving 519 patients were included in the present study. The mean difference of VAS-back score, VAS-leg score and ODI score before and after surgery was 5.1, 5.0 and 32.3 respectively. The mean correction of LL was 20.6°, with an average of 6.9° per level and the mean correction of Cobb was 16.4°, with an average of 4.7° per level. The mean correction of SVA, PT, SS, TK and PI-LL was 59.3 mm, 11.7°, 6.9°, 9.4° and 20.6° respectively. The mean fusion rate was 94.1%. The incidence of intraoperative and postoperative complications was 4.9% and 29.6% respectively. CONCLUSIONS OLIF is an effective and safe surgery method in the treatment of mild or moderate ASD and it has advantages in less intraoperative blood loss and lower perioperative complications.
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Affiliation(s)
- Lei Zhu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jun-Wu Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China,Xin-Min Feng and Liang Zhang, Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou 225001, China. Emails: ;
| | - Xin-Min Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China,Xin-Min Feng and Liang Zhang, Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou 225001, China. Emails: ;
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Chen Y, Luo C, Wang J, Liu L, Huang B, Li CQ, Zhou Y, Feng C. Roles of multimodal intra-operative neurophysiological monitoring (IONM) in percutaneous endoscopic transforaminal lumbar interbody fusion: a case series of 113 patients. BMC Musculoskelet Disord 2021; 22:989. [PMID: 34836537 PMCID: PMC8627103 DOI: 10.1186/s12891-021-04824-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite the wide use of intraoperative neurophysiological monitoring (IONM) in spinal surgeries, the efficacy of IONM during percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgery in detecting postoperative neurological deficits has not been well characterized. Methods MIONM data from 113 consecutive patients who underwent PE-TLIF surgeries between June 2018 and April 2020 were retrospectively reviewed. Postoperative neurological deficits were documented and analyzed, and the efficacy and specificity of various IONM techniques were compared. Results Of the 113 consecutive patients, 12 (10.6%) with IONM alerts were identified. The MIONM sensitivity and specificity were 100 and 96.2%, respectively. The frequency of neurological complications, including minor deficits, was 6.2% (n = 7); all of the neurological complications were temporary. The ability of single IONM modalities to detect neurological complications varied between 25.0 and 66.6%, whereas that of all modalities was 100%. Conclusions MIONM is more effective and accurate than unimodal monitoring in assessing nerve root function during PE-TLIF surgeries, reducing both neurological complications and false-negative findings. We recommend MIONM in PE-TLIF surgeries.
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Affiliation(s)
- Yu Chen
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Chunmei Luo
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Juan Wang
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Libangxi Liu
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Bo Huang
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Chang-Qing Li
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Chencheng Feng
- Department of Orthopaedics, Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China.
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Koller H, Ansorge A, Hostettler IC, Koller J, Hitzl W, Hempfing A, Jeszenszky D. Center of rotation analysis for thoracic and lumbar 3-column osteotomies in patients with sagittal plane spinal deformity: insights in geometrical changes can improve understanding of correction mechanics. J Neurosurg Spine 2021:1-12. [PMID: 34653992 DOI: 10.3171/2021.4.spine21118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Three-column osteotomy (3CO) is used for severe spinal deformities. Associated complications include sagittal translation (ST), which can lead to neurological symptoms. Mismatch between the surgical center of rotation (COR) and the concept of the ideal COR is a potential cause of ST. Matching surgical with conceptual COR is difficult with pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). This mismatch influences correction geometry, which can prevent maximum possible correction. The authors' objective was to examine the sagittal correction geometry and surgical COR of thoracic and lumbar 3CO. METHODS In a retrospective study of patients with PSO or VCR for severe sagittal plane deformity, analysis of surgical COR was performed using pre- and postoperative CT scans in the PSO group and digital radiographs in the VCR group. Radiographic analysis included standard deformity measurements and regional kyphosis angle (RKA). All patients had 2-year follow-up, including neurological outcome. Preoperative CT scans were studied for rigid osteotomy sites versus mobile osteotomy sites. Additional radiographic analysis of surgical COR was based on established techniques superimposing pre- and postoperative images. Position of the COR was defined in a rectangular net layered onto the osteotomy vertebrae (OVs). RESULTS The study included 34 patients undergoing PSO and 35 undergoing VCR, with mean ages of 57 and 29 years and mean RKA corrections of 31° and 49°, respectively. In the PSO group, COR was mainly in the anterior column, and surgical and conceptual COR matched in 22 patients (65%). Smaller RKA correction (27° vs 32°, p = 0.09) was seen in patients with anterior eccentric COR. Patients with rigid osteotomy sites were more likely to have an anterior eccentric COR (41% vs 11%, p = 0.05). In the VCR group, 20 patients (57%) had single-level VCR and 15 (43%) had multilevel VCR. COR was mainly located in the anterior or middle column. Mismatch between surgical and conceptual COR occurred in 24 (69%) patients. Larger RKA correction (63° vs 45°, p = 0.03) was seen in patients with anterior column COR. Patients with any posterior COR had a smaller RKA correction compared to the rest of the patients (42° vs 61°, p = 0.007). CONCLUSIONS Matching the surgical with the conceptual COR is difficult and in this study failed in one- to two-thirds of all patients. In order to avoid ST during correction of severe deformities, temporary rods, tracking rods, or special instruments should be used for correction maneuvers.
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Affiliation(s)
- Heiko Koller
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Alexandre Ansorge
- 2Department for Spine Surgery, Schulthess Clinic Zurich, Switzerland
| | - Isabel C Hostettler
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,3Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland
| | - Juliane Koller
- 4Department for Orthopedic Surgery, Schoen Clinic Vogtareuth, Germany
| | - Wolfgang Hitzl
- 5Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria.,6Research Office (biostatistics), Paracelsus Medical University Salzburg, Austria; and
| | - Axel Hempfing
- 7Spine Center, Werner-Wicker Clinic, Bad Wildungen, Germany
| | - Dezsoe Jeszenszky
- 2Department for Spine Surgery, Schulthess Clinic Zurich, Switzerland
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Lau D, Guo L, Deviren V, Ames CP. Utility of intraoperative neuromonitoring and outcomes of neurological complication in lower cervical and upper thoracic posterior-based three-column osteotomies for cervical deformity. J Neurosurg Spine 2021:1-9. [PMID: 34624840 DOI: 10.3171/2021.5.spine202057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For severe and rigid adult cervical deformity, posterior-based three-column osteotomies (3COs) are warranted, but neurological complications are relatively high with such procedures. The performance measures of intraoperative neuromonitoring (IONM) during cervicothoracic 3CO have yet to be studied, and there remains a paucity of literature regarding the topic. Therefore, the authors of this study examined the performance of IONM in predicting new neurological weakness following lower cervical and upper thoracic 3CO. In addition, they report the 6-month, 1-year, and 2-year outcomes of patients who experienced new postoperative weakness. METHODS The authors performed a retrospective review of a single surgeon's experience from 2011 to 2018 with all patients who had undergone posterior-based 3CO in the lower cervical (C7) or upper thoracic (T1-4) spine. Medical and neuromonitoring records were independently reviewed. RESULTS A total of 56 patients were included in the analysis, 38 of whom had undergone pedicle subtraction osteotomy and 18 of whom had undergone vertebral column resection. The mean age was 61.6 years, and 41.1% of the patients were male. Among the study cohort, 66.1% were myelopathic and 33.9% had preoperative weakness. Mean blood loss was 1565.0 ml, and length of surgery was 315.9 minutes. Preoperative and postoperative measures assessed were cervical sagittal vertical axis (6.5 and 3.8 cm, respectively; p < 0.001), cervical lordosis (2.3° and -6.7°, p = 0.042), and T1 slope (48.6° and 35.8°, p < 0.001). The complication rate was 49.0%, and the new neurological deficit rate was 17.9%. When stratifying by osteotomy level, there were significantly higher rates of neurological deficits at C7 and T1: C7 (37.5%), T1 (44.4%), T2 (16.7%), T3 (14.3%), and T4 (0.0%; p = 0.042). Most new neurological weakness was the nerve root pattern rather than the spinal cord pattern. Overall, there were 16 IONM changes at any threshold: 14 at 50%, 8 at 75%, and 13 if only counting patients who did not return to baseline (RTB). Performance measures for the various thresholds were accuracy (73.2% to 77.8%), positive predictive value (25.0% to 46.2%), negative predictive value (81.3% to 88.1%), sensitivity (18.2% to 54.5%), and specificity (77.8% to 86.7%). Sensitivity to detect a spinal cord pattern of weakness was 100% and 28.6% for a nerve root pattern of weakness. In patients with a new postoperative deficit, 22.2% were unchanged, 44.4% improved, and 33.3% had a RTB at the 2-year follow-up. CONCLUSIONS Complication rates are high following posterior 3CO for cervical deformity. 3CO at C7 and T1 has the highest rates of neurological deficit. Current IONM modalities have modest performance in predicting postoperative deficits, especially for nerve root neuropraxia. A large prospective multicenter study is warranted.
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Affiliation(s)
- Darryl Lau
- 1Department of Neurosurgery, New York University, New York, New York
| | - Lanjun Guo
- 2Department of Neurophysiology, University of California, San Francisco
| | - Vedat Deviren
- 3Department of Orthopaedic Surgery, University of California, San Francisco; and
| | - Christopher P Ames
- 4Department of Neurological Surgery, University of California, San Francisco, California
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Ha AS, Cerpa M, Mathew J, Park P, Lombardi JM, Luzzi AJ, Lee NJ, Dyrszka MD, Sardar ZM, Lehman RA, Lenke LG. Femoral head to lower lumbar neural foramen distance as a novel radiographic parameter to predict postoperative stretch neuropraxia. J Neurosurg Spine 2021; 36:23-31. [PMID: 34479196 DOI: 10.3171/2021.1.spine201989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbosacral fractional curves in adult spinal deformity (ASD) patients often have sharp coronal curves resulting in significant pain and imbalance. Postoperative stretch neuropraxia after fractional curve correction can lead to discomfort and unsatisfactory outcomes. The goal of this study was to use radiographic measures to increase understanding of the relationship between postoperative stretch neuropraxia and fractional curve correction. METHODS In 62 ASD patients treated from 2015 to 2018, radiographic review was performed, including measurement of the distance between the lower lumbar neural foramen (L4 and L5) in the concavity and convexity of the lumbosacral fractional curve and the ipsilateral femoral heads (FHs; L4-FH and L5-FH) in pre- and postoperative anteroposterior spine radiographs. The largest absolute preoperative to postoperative change in distance between the lower lumbar neural foramen and the ipsilateral FH (ΔL4/L5-FH) was used for analysis. Chi-square analyses, independent and paired t-tests, and logistic regression were performed to study the relationship between L4/L5-FH and stretch neuropraxia for categorical and continuous variables, respectively. RESULTS Of the 62 patients, 13 (21.0%) had postoperative stretch neuropraxia. Patients without postoperative stretch neuropraxia had an average ΔL4-FH distance of 16.2 mm compared to patients with stretch neuropraxia, who had an average ΔL4-FH distance of 31.5 mm (p < 0.01). Patients without postoperative neuropraxia had an average ΔL5-FH distance of 11.1 mm compared to those with stretch neuropraxia, who had an average ΔL5-FH distance of 23.0 mm (p < 0.01). Chi-square analysis showed that patients had a 4.78-fold risk of developing stretch neuropraxia with ΔL4-FH > 20 mm (95% CI 1.3-17.3) and a 5.17-fold risk of developing stretch neuropraxia with ΔL5-FH > 15 mm (95% CI 1.4-18.7). Logistic regression analysis indicated that the odds of developing stretch neuropraxia were 15:1 with a ΔL4-FH > 20 mm (95% CI 3-78) and 21:1 with a ΔL5-FH > 15 mm (95% CI 4-113). CONCLUSIONS The novel ΔL4/L5-FH distances are strongly associated with postoperative stretch neuropraxia in ASD patients. A ΔL4-FH > 20 mm and ΔL5-FH > 15 mm significantly increase the odds for patients to develop postoperative stretch neuropraxia.
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Godzik J, de Andrada Pereira B, Sawa AGU, Lehrman JN, Mundis GM, Hlubek RJ, Uribe JS, Kelly BP, Turner JD. Biomechanics of open versus minimally invasive deformity correction: comparison of stability and rod strain between pedicle subtraction osteotomy and anterior column realignment. J Neurosurg Spine 2021; 35:347-355. [PMID: 34214986 DOI: 10.3171/2020.12.spine201306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior column realignment (ACR) is a new minimally invasive approach for deformity correction that achieves a degree of lordosis similar to that obtained with pedicle subtraction osteotomy (PSO). This study compared the biomechanical profiles of ACR with PSO using range of motion (ROM) and posterior rod strain (RS) to gain insight into the ACR technique and the necessary surgical strategies to optimize longevity and stability. METHODS An in vitro biomechanical study using standard flexibility testing (7.5 Nm) was performed on 14 human cadaveric specimens, separated into 2 groups similar in age, sex, bone mineral density, and intact ROM. For group 1 (n = 7, instrumented L1-S1), a 30° ACR was performed at L3-4. For group 2 (n = 7, instrumented T12-S1), a 30° L3 PSO was performed. Specimens were subjected to nondestructive loads in flexion, extension, axial rotation, lateral bending, and compression. Conditions tested were 1) intact, 2) pedicle screw with 2 rods (PSR), 3) ACR or PSO with 2 rods (+2R), and 4) ACR or PSO with 4 rods (+4R). Primary outcome measures of interest were ROM stability and posterior RS at L3-4. RESULTS No difference was observed between groups in lumbar lordosis (p = 0.83) or focal angular lordosis at L3-4 (p = 0.75). No differences in stability were observed between ACR+2R and PSO+2R (p ≥ 0.06); however, ACR+2R was significantly less stable than PSR in flexion and extension (p ≤ 0.02), whereas PSO+2R was less stable than PSR only in extension (p = 0.04). ACR+4R was more stable than ACR+2R in flexion, extension, left axial rotation, and compression (p ≤ 0.02). PSO+4R was more stable than PSO+2R only in extension (p = 0.04). Both ACR+2R and PSO+2R resulted in significant increases in RS in flexion and extension compared with PSR (p ≤ 0.032). RS in flexion and extension decreased significantly for ACR+4R versus ACR+2R and for PSO+4R versus PSO+2R (p ≤ 0.047). PSO+2R yielded lower RS than ACR+2R in compression (p = 0.03). No differences existed in RS between ACR+4R and PSO+4R (p ≥ 0.05). CONCLUSIONS Although ACR appeared to be slightly more destabilizing than PSO using traditional 2R fixation, both techniques resulted in significant increases in posterior RS. The 4R technique increased stability in ACR and decreased RS in both ACR and PSO but may be more beneficial in ACR. Longer-term clinical studies are needed to appropriately identify the durability of the ACR technique in deformity correction.
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Affiliation(s)
| | - Bernardo de Andrada Pereira
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Anna G U Sawa
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Jennifer N Lehrman
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Gregory M Mundis
- 3San Diego Spine Foundation, Scripps Clinic Division of Orthopedic Surgery, La Jolla, California
| | | | | | - Brian P Kelly
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Adult spinal deformity surgery: posterior three-column osteotomies vs anterior lordotic cages with posterior fusion. Complications, clinical and radiological results. A systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3150-3161. [PMID: 34415448 DOI: 10.1007/s00586-021-06925-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of our study is to analyse mid- to long-term severe adult spinal deformity (ASD) surgery outcomes by comparing three-column osteotomies (3CO) and multiple anterior interbody fusion cages (AC). MATERIALS AND METHODS The PRISMA flowchart was used to systematically review the literature. Only articles with a minimum 24-month follow-up were examined, and 11 articles were included. The following radiological parameters were observed: pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), Cobb angle and T1-sacrum plumbline. Clinical outcome was assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores. The main complications were analysed, and the two groups were compared. RESULTS Except for age, the two populations were homogeneous. Both techniques had the same number of posterior instrumented levels (7.4 ± 1.7). The AC group had a mean 3 ± 1.4 interbody fusions per patient. In the PSO group, all patients had 1 3CO and 89.8% of the osteotomies were performed at L2 or L3 vertebrae. No difference was observed between the two groups in terms of clinical outcomes. Both techniques were effective in sagittal parameters restoration with a final PI-LL mismatch = 4.4°. The PSO group had a statistically higher rate of intraoperative blood loss (p = 0.036), major complications, pseudoarthrosis and dural tears (p < 0.001). CONCLUSION Both PSO and multiple AC are effective in treating ASD. Multiple AC seems more suitable when treating older patients because of a lower intraoperative blood loss, lower rate of major complications and fewer number of revision surgeries.
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Wu N, Shao J, Zhang Z, Wang S, Li Z, Zhao S, Yang Y, Liu L, Yu C, Liu S, Zhao Z, Du Y, Zhang Y, Wang L, Zhao Y, Yu K, Zhao H, Shen J, Qiu G, Wu Z, Zhang TJ. Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis. BMC Musculoskelet Disord 2021; 22:483. [PMID: 34034738 PMCID: PMC8152117 DOI: 10.1186/s12891-021-04361-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied. Methods We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis. Results One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003). Conclusions Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.
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Affiliation(s)
- Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.
| | - Jiashen Shao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Zhen Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ziquan Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Sen Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lian Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Chenxi Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Sen Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhengye Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Yuanqiang Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China.,Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Lianlei Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China.,Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yu Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Keyi Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hong Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianxiong Shen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
| | | | - Zhihong Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.,Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Terry Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.
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Girod PP, Kögl N, Molliqaj G, Lener S, Hartmann S, Thomé C. Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients. Neurosurg Rev 2021; 45:517-524. [PMID: 33963469 DOI: 10.1007/s10143-021-01559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
Three-column osteotomy (3-CO) is a powerful technique in adult deformity surgery, and pedicle subtraction osteotomy (PSO) is the workhorse to correct severe kyphotic spinal deformities. Aging of the population, increasing cases of iatrogenic flat back deformities and understanding the importance of sagittal balance have led to a dramatic increase of this surgical technique. Surgery, however, is demanding and associated with high complication rates so that every step of the procedure requires meticulous technique. Particularly, osteotomy closure is associated with risks like secondary fracture, translation, or iatrogenic stenosis. This step is traditionally performed by compression or a cantilever maneuver with sometimes excessive forces on the screws or instrumentation. Implant loosening or abrupt subluxation resulting in construct failure and/or neurological deficits can result. The aim of this prospective registry study was to assess the efficacy and safety of our surgical PSO technique as well as the osteotomy closure by flexing a hinge-powered OR table. In a series of 84 consecutive lumbosacral 3-CO, a standardized surgical technique with special focus on closure of the osteotomy was prospectively evaluated. The surgical steps with the patients positioned prone on a soft frame are detailed. Osteotomy closure was achieved by remote controlled bending of a standard OR table without compressive or cantilever forces in all 84 cases. This technique carries a number of advantages, particularly the reversibility and the slow speed of closure with minimum force. There was not a single mechanical intraoperative complication such as vertebral body fracture, subluxation, or adjacent implant loosening during osteotomy closure, compared to external cohorts using the cantilever technique (p = 0.130). The feasibility of controlled 3-CO closure by flexing a standard OR table is demonstrated. This technique enables a safe, gentle closure of the osteotomy site with minimal risk of implant failure or accidental neurological injury.
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Affiliation(s)
- Pierre-Pascal Girod
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria.
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Granit Molliqaj
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
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31
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Olivares OB, Carrasco MV, Pinto GI, Tonda FN, Riera Martínez JA, González AS. Preoperative and Postoperative Sagittal Alignment and Compensatory Mechanisms in Patients With Posttraumatic Thoracolumbar Deformities Who Undergo Corrective Surgeries. Int J Spine Surg 2021; 15:585-590. [PMID: 33963023 DOI: 10.14444/8079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Secondary posttraumatic spinal kyphosis is a fixed deformity that has an asymptomatic presentation in most patients, but in some, persistent pain and disability can develop refractory to conservative treatment, which may result in the need for corrective surgery. Our aim was to analyze the modification of sagittal alignment and the variation in compensation mechanisms of spinal-pelvic segments before and after surgical correction in a group of patients with symptomatic posttraumatic kyphosis. METHODS A retrospective cohort study of 16 consecutive patients from the beginning of 2007 until the beginning of 2017 who underwent surgery due to thoracolumbar sagittal deformities was performed. Regional kyphosis (RK), thoracic kyphosis (TK), lumbar lordosis (LL), lower lumbar lordosis (LLL), lumbar lordosis under the deformity (LLUD), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL were measured in preoperative and postoperative lateral full spine x rays. Statistical analysis was performed with the nonparametric Wilcoxon test to compare preoperative and postoperative radiologic variables. RESULTS Sixteen patients were included with a median age of 47.5 years (32-62 years), the median time elapsed from the accident until corrective surgery was 7 months (2-33 months), the median follow-up time was 16.5 months (6-80 months), and the most used corrective strategy was pedicle subtraction osteotomy (11/16 patients). Statistically and radiologically significant improvements were observed in RK (33.5° versus 12°, P < .001) and LLUD (68.5° versus 61°, P = .017), with a noticeable decrease in PI-LL (15° versus 9.5°, P = .233). There were no statistically significant results regarding TK, LL, LLL, PI, PT, or SVA. CONCLUSIONS Osteotomies are an effective tool to correct angular deformities at a local level after spine trauma. Posttraumatic kyphosis results in the compensation of sagittal imbalance through modification of segmental alignment of the mobile spine under the deformity. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE This work shows the compensation mechanisms after post-traumatic kyphosis in patients with previously healthy spines.
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Affiliation(s)
| | - Manuel Valencia Carrasco
- Mutual de Seguridad, Spine Surgical Unit, Santiago, Chile.,Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | | | - Felipe Novoa Tonda
- Mutual de Seguridad, Spine Surgical Unit, Santiago, Chile.,Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
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32
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Saigal R, Lau D, Berven SH, Carreon L, Dekutoski MB, Kebaish KM, Qiu Y, Matsuyama Y, Kelly M, Dahl BT, Mehdian H, Pellisé F, Lewis SJ, Cheung KM, Shaffrey CI, Fehlings MG, Lenke LG, Ames CP. Impact of New Motor Deficit on HRQOL After Adult Spinal Deformity Surgery: Subanalysis From Scoli Risk 1 Prospective Study. Spine (Phila Pa 1976) 2021; 46:E450-E457. [PMID: 33290376 PMCID: PMC8677606 DOI: 10.1097/brs.0000000000003852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/15/2020] [Accepted: 09/16/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN International, multicenter, prospective, longitudinal observational cohort. OBJECTIVE To assess how new motor deficits affect patient reported quality of life scores after adult deformity surgery. SUMMARY OF BACKGROUND DATA Adult spinal deformity surgery is associated with high morbidity, including risk of new postoperative motor deficit. It is unclear what effect new motor deficit has on Health-related Quality of Life scores (HRQOL) scores. METHODS Adult spinal deformity patients were enrolled prospectively at 15 sites worldwide. Other inclusion criteria included major Cobb more than 80°, C7-L2 curve apex, and any patient undergoing three column osteotomy. American Spinal Injury Association (ASIA) scores and standard HRQOL scores were recorded pre-op, 6 weeks, 6 months, and 2 years. RESULTS Two hundred seventy two complex adult spinal deformity (ASD) patients enrolled. HRQOL scores were worse for patients with lower extremity motor score (LEMS). Mean HRQOL changes at 6 weeks and 2 years compared with pre-op for patients with motor worsening were: ODI (+12.4 at 6 weeks and -4.7 at 2 years), SF-36v2 physical (-4.5 at 6 weeks and +2.3 at 2 years), SRS-22r (0.0 at 6 weeks and +0.4 at 2 years). Mean HRQOL changes for motor-neutral patients were: ODI (+0.6 at 6 weeks and -12.1 at 2 years), SF-36v2 physical (-1.6 at 6 weeks and +5.9 at 2 years), and SRS-22r (+0.4 at 6 weeks and +0.7 at 2 years). For patients with LEMS improvement, mean HRQOL changes were: ODI (-0.6 at 6 weeks and -16.3 at 2 years), SF-36v2 physical (+1.0 at 6 weeks and +7.0 at 2 years), and SRS-22r (+0.5 at 6 weeks and +0.9 at 2 years). CONCLUSION In the subgroup of deformity patients who developed a new motor deficit, total HRQOLs and HRQOL changes were negatively impacted. Patients with more than 2 points of LEMS worsening had the worst changes, but still showed overall HRQOL improvement at 6 months and 2 years compared with pre-op baseline.Level of Evidence: 3.
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Affiliation(s)
- Rajiv Saigal
- Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Darryl Lau
- Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Sigurd H. Berven
- Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | | | | | - Khaled M. Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Yong Qiu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Michael Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Benny T. Dahl
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hossein Mehdian
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Ferran Pellisé
- Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
| | - Stephen J. Lewis
- University of Toronto Spine Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kenneth M.C. Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Michael G. Fehlings
- University of Toronto Spine Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lawrence G. Lenke
- The Daniel and Jane Och Spine Hospital, Columbia University Department of Orthopaedic Surgery, New York, NY
| | - Christopher P. Ames
- Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
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33
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Sciubba D, Jain A, Kebaish KM, Neuman BJ, Daniels AH, Passias PG, Kim HJ, Protopsaltis TS, Scheer JK, Smith JS, Hamilton K, Bess S, Klineberg EO, Ames CP. Development of a Preoperative Adult Spinal Deformity Comorbidity Score That Correlates With Common Quality and Value Metrics: Length of Stay, Major Complications, and Patient-Reported Outcomes. Global Spine J 2021; 11:146-153. [PMID: 32875843 PMCID: PMC7882823 DOI: 10.1177/2192568219894951] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Retrospective review of a multicenter prospective registry. OBJECTIVES Our goal was to develop a method to risk-stratify adult spinal deformity (ASD) patients on the basis of their accumulated health deficits. We developed a novel comorbidity score (CS) specific to patients with ASD based on their preoperative health state and investigated whether it was associated with major complications, length of hospital stay (LOS), and self-reported outcomes after ASD surgery. METHODS We identified 273 operatively treated ASD patients with 2-year follow-up. We assessed associations between major complications and age, comorbidities, Charlson Comorbidity Index score, and Oswestry Disability Index score. Significant factors were used to construct the ASD-CS. Associations of ASD-CS with major complications, LOS, and patient-reported outcomes were analyzed. RESULTS Major complications increased significantly with ASD-CS (P < .01). Compared with patients with ASD-CS of 0, the odds of major complications were 2.8-fold higher (P = .068) in patients with ASD-CS of 1 through 3; 4.5-fold higher (P < .01) in patients with ASD-CS of 4 through 6; and 7.5-fold higher (P < .01) in patients with ASD-CS of 7 or 8. Patients with ASD-CS of 7 or 8 had the longest mean LOS (10.7 days) and worst mean Scoliosis Research Society-22r total score at baseline; however, they experienced the greatest mean improvement (0.98 points) over 2 years. CONCLUSIONS The ASD-CS is significantly associated with major complications, LOS, and patient-reported outcomes in operatively treated ASD patients.
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Affiliation(s)
| | - Amit Jain
- The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M. Kebaish
- The Johns Hopkins University, Baltimore, MD, USA,Khaled M Kebaish, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA.
| | | | - Alan H. Daniels
- The Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Han J. Kim
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Justin S. Smith
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kojo Hamilton
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shay Bess
- New York University, New York, NY, USA
| | - Eric O. Klineberg
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christopher P. Ames
- University of California San Francisco School of Medicine, San Francisco, CA, USA
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34
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Kwan KYH, Lenke LG, Shaffrey CI, Carreon LY, Dahl BT, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kebaish KM, Lewis SJ, Matsuyama Y, Mehdian H, Qiu Y, Schwab FJ, Cheung KMC. Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation. Clin Orthop Relat Res 2021; 479:312-320. [PMID: 33079774 PMCID: PMC7899533 DOI: 10.1097/corr.0000000000001521] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Global Alignment and Proportion (GAP) score, based on pelvic incidence-based proportional parameters, was recently developed to predict mechanical complications after surgery for spinal deformities in adults. However, this score has not been validated in an independent external dataset. QUESTIONS/PURPOSES After adult spinal deformity surgery, is a higher GAP score associated with (1) an increased risk of mechanical complications, defined as rod fractures, implant-related complications, proximal or distal junctional kyphosis or failure; (2) a higher likelihood of undergoing revision surgery to treat a mechanical complication; and (3) is a lower (more proportioned) GAP score category associated with better validated outcomes scores using the Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) and the Short Form-36 questionnaires? METHODS A total of 272 patients who had undergone corrective surgeries for complex spinal deformities were enrolled in the Scoli-RISK-1 prospective trial. Patients were included in this secondary analysis if they fulfilled the original inclusion criteria by Yilgor et al. From the original 272 patients, 14% (39) did not satisfy the radiographic inclusion criteria, the GAP score could not be calculated in 14% (37), and 24% (64) did not have radiographic assessment at postoperative 2 years, leaving 59% (159) for analysis in this review of data from the original trial. A total of 159 patients were included in this study,with a mean age of 58 ± 14 years at the time of surgery. Most patients were female (72%, 115 of 159), the mean number of levels involved in surgery was 12 ± 4, and three-column osteotomy was performed in 76% (120 of 159) of patients. The GAP score was calculated using parameters from early postoperative radiographs (between 3 and 12 weeks) including pelvic incidence, sacral slope, lumbar lordosis, lower arc lordosis and global tilt, which were independently obtained from a computer software based on centralized patient radiographs. The GAP score was categorized as proportional (scores of 0 to 2), moderately disproportional (scores of 3 to 6), or severely disproportional (scores higher than 7 to 13). Receiver operating characteristic area under curve (AUC) was used to assess associations between GAP score and risk of mechanical complications and risk of revision surgery. An AUC of 0.5 to 0.7 was classified as "no or low associative power", 0.7 to 0.9 as "moderate" and greater than 0.9 as "high". We analyzed differences in validated outcome scores between the GAP categories using Wilcoxon rank sum test. RESULTS At a minimum of 2 years' follow-up, a higher GAP score was not associated with increased risks of mechanical complications (AUC = 0.60 [95% CI 0.50 to 0.70]). A higher GAP score was not associated with a higher likelihood of undergoing a revision surgery to treat a mechanical complication (AUC = 0.66 [95% 0.53 to 0.78]). However, a moderately disproportioned GAP score category was associated with better SF-36 physical component summary score (36 ± 10 versus 40 ± 11; p = 0.047), better SF-36 mental component summary score (46 ± 13 versus 51 ± 12; p = 0.01), better SRS-22 total score (3.4 ± 0.8 versus 3.7 ± 0.7, p = 0.02) and better ODI score (35 ± 21 versus 25 ± 20; p = 0.003) than severely disproportioned GAP score category. CONCLUSION Based on the findings of this external validation study, we found that alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. Parameters not included in the original GAP score needed to be considered to reduce the likelihood of mechanical complications. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Kenny Yat Hong Kwan
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lawrence G Lenke
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Christopher I Shaffrey
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Leah Y Carreon
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Benny T Dahl
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Michael G Fehlings
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Christopher P Ames
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Oheneba Boachie-Adjei
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Mark B Dekutoski
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Khaled M Kebaish
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Stephen J Lewis
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yukihiro Matsuyama
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hossein Mehdian
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yong Qiu
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Frank J Schwab
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth Man Chee Cheung
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
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Medical optimization of modifiable risk factors before thoracolumbar three-column osteotomies: an analysis of 195 patients. Spine Deform 2020; 8:1039-1047. [PMID: 32323168 DOI: 10.1007/s43390-020-00114-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the rate of preoperative modifiable laboratory abnormalities (both major and minor) and the association with early postoperative medical and surgical complications. METHODS All patients undergoing thoracolumbar three-column osteotomy between 2013 and 2016 with preoperative laboratory data were identified. Potential preoperative modifiable laboratory abnormalities (major and minor) were assessed including hyponatremia (sodium < 130 and < 135 mEq/L), anemia (hematocrit < 25% and < 30%), renal insufficiency (creatinine ≥ 1.8 and ≥ 1.2 mg/dL), coagulopathy (INR ≥ 1.8 and ≥ 1.2), and hypoalbuminemia (albumin < 2.5 and < 3.5 g/dL). Multivariate logistic regression was used to determine associations with 30-day complications after controlling for possible confounding factors. RESULTS A total of 195 patients were identified. The rates of major and minor preoperative laboratory abnormalities were 7.7% and 31.3%, respectively. The rates of serious medical, minor medical, and surgical complications over 30-days were 6.7%, 21.5%, and 10.3%, respectively. In multivariate analysis the presence of major preoperative laboratory abnormalities had a significant association with serious medical complications (odds ratio [OR] 77.8, P < 0.001), and minor medical complications (OR 13.3, P < 0.001), but not surgical complications (P = 0.243). The presence of minor preoperative laboratory abnormalities had a significant association with serious medical complications (OR 10.4, P = 0.041) and minor medical complications (OR 2.4, P = 0.045), but not surgical complications (P = 0.490). CONCLUSIONS While major laboratory abnormalities had a strong association with complications, even minor modifiable laboratory abnormalities had a significant association with both serious and minor medical complications.
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Lee KH, Kim KT, Kim YC, Lee JW, Ha KY. Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis. J Neurosurg Spine 2020; 33:366-372. [PMID: 32413867 DOI: 10.3171/2020.3.spine191355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the rate of and the risk factors for surgery-related complications demonstrated on radiography after pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis in patients with ankylosing spondylitis (AS). METHODS The authors retrospectively reviewed the medical records of 230 consecutive patients with thoracolumbar kyphosis due to AS who had undergone 1-level PSO at a single institution in the period from 2010 to 2017. The causes of surgery-related complications were divided into two types: surgical/technical failure and mechanical failure. RESULTS The patients consisted of 20 women and 210 men, with an average age of 43.4 years. The average follow-up period was 39.0 months. The preoperative sagittal vertical axis was 18.5 ± 69.3 cm, which improved to 4.9 ± 4.6 cm after PSO. Of the 77 patients (33.5%) who experienced minor or major surgery-related complications, 56 had complications related to surgical/technical failure (overall incidence 24.3%) and 21 had complications related to mechanical failure (overall incidence 9.1%). Fourteen patients (6.1%) underwent reoperation. However, among the 77 patients with complications, the rate of revision surgery was 18.2%. The most common radiological complications were as follows: sagittal translation in 24 patients, coronal imbalance in 20, under-correction in 8, delayed union in 8, and distal junctional failure and kyphosis in 8. The most common causes of reoperation were coronal imbalance in 4 patients, symptomatic malposition of pedicle screws in 3, and distal junctional failure in 3. Delayed union was statistically correlated with posterior sagittal translation (p = 0.007). CONCLUSIONS PSO can provide acceptable radiographic outcomes for the correction of thoracolumbar kyphosis in patients with AS. However, a high incidence of surgery-related complications related to mechanical failure and surgical technique can develop. Thorough radiographic investigation before and during surgery is needed to determine whether complete ossification occurs along the anterior and posterior longitudinal ligaments of the spine.
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Affiliation(s)
- Keun-Ho Lee
- 1Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul; and
| | - Ki-Tack Kim
- 2Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong-Chan Kim
- 2Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joong-Won Lee
- 2Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kee-Yong Ha
- 2Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Posterior Vertebral Column Resection Combined With Bone Cement Augmentation of Pedicle Screw Fixation for Treatment of Severe Vertebral Compression Fractures With Kyphotic Deformity: A Retrospective Case Series. Clin Spine Surg 2020; 33:E269-E275. [PMID: 31917719 DOI: 10.1097/bsd.0000000000000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE Severe osteoporotic vertebral compression fractures with kyphotic deformity are difficult to treat. The objective of this study was to investigate the clinical efficacy of posterior vertebral column resection (PVCR) combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity. SUMMARY OF BACKGROUND DATA The data of patients with a severe vertebral compression fracture and kyphotic deformity treated at our university between October 2013 and October 2017 were retrospectively reviewed. MATERIALS AND METHODS All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction. The operative time, intraoperative blood loss, postoperative complications, and screw stability at the last follow-up in all patients were documented. The clinical benefits were evaluated by the Visual Analog Scale (VAS) score, Oswestry Dysfunction Index (ODI), Japanese Orthopedic Association (JOA) scores, and Frankel classification. RESULTS The mean Cobb angle, sagittal vertical axis, VAS score, JOA score, and ODI were 48.5±6.9 degrees, 44.0±5.7, 6.5±1.5, 11.2±2.7, and 59.0±5.7 before surgery, respectively. The average follow-up period was 28.7±3.2 months. The Frankel grade in 5 patients with neurological impairment improved from D to E after surgery. The average Cobb angles for kyphotic deformity, sagittal vertical axis, VAS score, JOA score, and ODI were 9.5±3.8 degrees, 18.3±3.5, 2.6±1.2, 20.5±3.6, and 20.7±4.0, respectively, at the last follow-up (all P<0.05 compared with before surgery). CONCLUSIONS For patients with severe vertebral compression fractures and kyphotic deformity, PVCR combined with bone cement augmentation of pedicle screw fixation can restore the spine sequence to achieve good clinical efficacy. Clinical trials are necessary for confirmation.
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Wang H, Li W. Multilevel extended posterior column osteotomy plus unilateral cage strutting for degenerative lumbar kyphoscoliosis. INTERNATIONAL ORTHOPAEDICS 2020; 44:1375-1383. [PMID: 32440815 DOI: 10.1007/s00264-020-04632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the surgical outcome of patients with degenerative lumbar kyphoscoliosis who underwent multilevel extended posterior column osteotomy (PCO) plus unilateral cage strutting (UCS). METHODS From Jan 2012 to Aug 2017, 23 patients with degenerative lumbar kyphoscoliosis who underwent multilevel extended PCO plus UCS technique (study group) and 13 patients who underwent asymmetrical pedicle subtraction osteotomy (PSO) technique (control group) were retrospectively reviewed; the radiological features, including coronal/sagittal deformity, and clinical evaluation including Oswestry Disability Index (ODI), visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores-lumbar were assessed before surgery and at follow-up. RESULTS All patients underwent the operation successfully. There was no difference in fusion level, blood loss, and follow-up duration between the two groups; the operation time and length of hospital stay were shorter in study group than that in control group. All patients achieved significant correction of both scoliotic and kyphotic deformity and maintained the correction at minimum of two year follow-up, without any difference in deformity correction and correction loss between the two groups. All patients got back pain and leg pain alleviation and neurological function improvement at two year follow-up, without any difference between the two groups. The incidence of complications was lower in study group than that in control group. CONCLUSION Multilevel extended PCO plus UCS procedure could achieve significant correction of scoliosis and kyphosis in the treatment of degenerative lumbar kyphoscoliosis, presenting less surgery time, lower incidence of complication, and shorter hospital stay when compared with the asymmetric PSO technique.
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Affiliation(s)
- Hui Wang
- From the orthopedic of Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Weishi Li
- From the orthopedic of Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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Gupta MC, Gupta S, Kelly MP, Bridwell KH. Pedicle Subtraction Osteotomy. JBJS Essent Surg Tech 2020; 10:ST-D-19-00028. [PMID: 32368407 DOI: 10.2106/jbjs.st.19.00028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pedicle subtraction osteotomy (PSO) was originally performed in cases of ankylosing spondylitis. This procedure was invented because it was safer than trying to lengthen the anterior column via osteoclasis, which risked vascular injury and death1-4. PSO involves the removal of the posterior elements and the use of a vertebral body wedge to shorten the spine posteriorly and achieve sagittal-plane correction5,6. PSO has been used to correct sagittal-plane deformities not only in patients with ankylosing spondylitis but also in those with degenerative conditions or those who have previously undergone surgical procedures resulting in a loss of lumbar lordosis7,8. Description The fixation points are placed with pedicle screws above and below the planned osteotomy level. The posterior elements are decompressed at the level of the osteotomy and at 1 level proximally. In addition to the use of straight and angled curets, a high-speed burr is used to decancellate the vertebral body. Pedicle osteotomes are used to remove the pedicle. Temporary rods are placed. The posterior wall of the body is then impacted into the vertebral body, and the temporary rods are loosened. To close the osteotomy, the bed is extended or the spine is pushed manually, resulting in correction of the lordosis. The temporary rods are tightened. The main rods, independent of the short rods, are used to connect multiple segments several levels above and below the osteotomy site to provide final stabilization. Alternatives The alternatives to PSO depend on the surgical history of the patients, as well as the flexibility and alignment of the spine. In a spine with mobile disc spaces, Smith-Petersen osteotomies can be performed posteriorly to shorten the posterior column over multiple segments to gain lordosis. A formal anterior or lateral approach can be performed to release the disc spaces and restore the disc height. A posterior release through the facet joints with segmental compression can achieve desired lumbar lordosis. A vertebral column resection can also be performed to achieve lordosis. Rationale PSO is ideal for patients who have undergone multiple spinal fusions and who have a very rigid, flat lumbar spine. A single posterior approach can be used to provide adequate correction of the flat lumbar spine up to 40°. Asymmetric PSO can also be performed to allow for correction in the coronal plane. Recently, PSO has been performed more frequently because of the improved osteotomy instrumentation, exposure to resection techniques, and improved positioning tables that allow correction of the osteotomy.
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Affiliation(s)
- Munish C Gupta
- Washington University School of Medicine, Saint Louis, Missouri
| | - Sachin Gupta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Kelly
- Washington University School of Medicine, Saint Louis, Missouri
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Tsai SH, Liang CH, Chen KH, Pan CC, Lu WH, Lee CH. Novel, safe, and easy spinal osteotomy for regional kyphotic deformities. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:144-148. [PMID: 32254029 DOI: 10.5152/j.aott.2020.02.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to assess the efficacy and safety of a newly developed transpedicular, anterior open-wedge osteotomy procedure with lamina preservation to correct sagittal imbalance in regional kyphotic deformities following compression fractures. METHODS All seven patients [four females and three males; mean (range) age, 67 (56-78) years] included in this study underwent surgery between May 2005 and May 2016 for symptomatic, rigid kyphosis secondary to compression fractures. Transpedicular, anterior open-wedge osteotomy with lamina preservation was performed in all patients using an osteotome to create a transverse fracture in the vertebral body through bilateral pedicles and an anterior open-wedge space filled with compacted bone graft to correct kyphosis. Pre- and post-operative kyphotic Cobb angles were evaluated, and the volume of intra-operative blood loss was measured. RESULTS The pre- and post-operative kyphotic Cobb angle was 35.3° and 17.7°, respectively (p<0.01); mean angle correction was 17.6° (p<0.05). No patient developed any complication with neurologic injury. Mean blood loss was 771 mL. Callus formation viewed on plain film was evident in all patients and was accompanied by decreased thoracolumbar back pain. CONCLUSION Transpedicular, anterior open-wedge osteotomy with lamina preservation is an easy and safe spinal osteotomy procedure for the correction of regional, fixed kyphotic deformities. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Shang-Hsuan Tsai
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan;Department of Orthopedic Surgery, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Che-Han Liang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Hsien Lu
- Department of Orthopedic Surgery, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan;Department of Biotechnology, Hung-Kuang University, Taichung, Taiwan
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Jung JM, Hyun SJ, Kim KJ, Jahng TA. Rod fracture after multiple-rod constructs for adult spinal deformity. J Neurosurg Spine 2020; 32:407-414. [PMID: 31783347 DOI: 10.3171/2019.9.spine19913] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study investigated the incidence and risk factors of rod fracture (RF) after multiple-rod constructs (MRCs) for adult spinal deformity (ASD) surgery. METHODS A single-center, single-surgeon consecutive series of adult patients who underwent posterior thoracolumbar fusion at 4 or more levels using MRCs after osteotomy with at least 1 year of follow-up were retrospectively reviewed. Patient characteristics, radiological parameters, operative data, and clinical outcomes (on the Scoliosis Research Society-22r questionnaire) were analyzed at baseline and follow-up. RESULTS Seventy-six patients were enrolled in this study. RF occurred in 9 patients (11.8%), with all cases involving partial rod breakage. Seven patients (9.2%) underwent revision surgery. There were no significant differences in baseline demographic characteristics, radiological parameters, and surgical factors between the RF and non-RF groups. Multivariable analysis revealed that interbody fusion at the L5-S1 and L4-S1 levels could significantly reduce the occurrence of RF after MRCs for ASD (adjusted odds ratios 0.070 and 0.035, respectively). The RF group had significantly worse function score (mean 2.9 ± 0.8 vs 3.5 ± 0.7) and pain score (mean 2.8 ± 1.0 vs 3.5 ± 0.8) compared with the non-RF group at last visit. CONCLUSIONS RF occurred in 11.8% of patients with MRCs after ASD surgery. Most RFs occurred at the lumbosacral junction or adjacent level (77%). Interbody fusion at the lumbosacral junction (L5-S1 or L4-S1 level) could significantly prevent the occurrence of RF after MRCs for ASD.
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[Posttraumatic deformity of the thoracolumbar spine]. Unfallchirurg 2020; 123:143-154. [PMID: 32016493 DOI: 10.1007/s00113-019-00764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.
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Lau D, Deviren V, Ames CP. The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve. J Neurosurg Spine 2020; 32:207-220. [PMID: 31653817 DOI: 10.3171/2019.7.spine19656] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Posterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD. METHODS A retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss. RESULTS A total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss. CONCLUSIONS Surgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon's experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.
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Affiliation(s)
| | - Vedat Deviren
- 2Orthopedic Surgery, University of California, San Francisco, California
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Surgeon-specific risk stratification model for early complications after complex adult spinal deformity surgery. Spine Deform 2020; 8:97-104. [PMID: 31981147 DOI: 10.1007/s43390-020-00047-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 05/05/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Retrospective outcome analysis of a prospectively collected single-surgeon cases OBJECTIVES: Identify risk factors for complications in adult surgical spine deformity patients, develop a surgeon-specific risk stratification model, and predict the likelihood of 6-week postoperative complications based on prospectively collected preoperative measures. Adult spinal deformity surgery is challenging technically as well as economically. Although many risk factors are well known for spine surgery, complications after complex spine deformity surgery remain a significant problem worldwide. METHODS We reviewed 124 consecutive adult patients who have undergone instrumented spinal fusion with nine or more levels over a 21-month period in a single institution. We extracted data from patient medical records. Complications within the 6 weeks after surgery were identified. Univariate and logistic regression analyses (LRAs) were implemented. We generated a formula based on the LRA predictive algorithm-a numeric probabilistic likelihood statistic representing an individual patient's risk of developing a complication. RESULTS A total of 34 (27%) patients had complications that were categorized into either 21 (17%) medical or 17 (13.7%) surgical complications, including 3 (2.4%) proximal junctional kyphosis, 8 (6.4%) neurologic deficit, and 9 (6.5%) any wound issue. The predictive model was significant and calibrated using area under the receiver operating characteristics curve analysis. The model correctly classified 83.1% cases. Patients with a three-column osteotomy or history of deep vein thrombosis have 6 and 19 times higher overall complications, respectively, compared with patients without. Patients with a three-column osteotomy or body mass index > 30, respectively, are 24 and 11 times more likely to develop a wound complication. Patients with a three-column osteotomy have 10 times higher rates of surgical complication. CONCLUSIONS Complex spine deformity is often associated with complications. No single variable effectively predicts postoperative complications for such a complicated situation. However, when all risk factors are considered, patients with three-column osteotomy have a significantly higher chance to develop early complications. LEVEL OF EVIDENCE Level IV.
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Clinical results and functional outcomes after three-column osteotomy at L5 or the sacrum in adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:821-830. [PMID: 31993787 DOI: 10.1007/s00586-019-06255-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 11/01/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Three-column osteotomies at L5 or the sacrum (LS3COs) are technically challenging, yet they may be needed to treat lumbosacral kyphotic deformities. We investigated radiographic and clinical outcomes after LS3CO. METHODS We analyzed 25 consecutive patients (mean age 56 years) who underwent LS3CO with minimum 2-year follow-up. Standing radiographs and health-related quality-of-life scores were evaluated. A new radiographic parameter ["lumbosacral angle" (LSA)] was introduced to evaluate sagittal alignment distal to the S1 segment. RESULTS From preoperatively to the final follow-up, significant improvements occurred in lumbar lordosis (from - 34° to - 49°), LSA (from 0.5° to 22°), and sagittal vertical axis (SVA) (from 18 to 7.3 cm) (all, p < .01). Mean Scoliosis Research Society (SRS)-22r scores in activity, pain, self-image, and satisfaction (p < .05), and Oswestry Disability Index scores (p < .01) also improved significantly. Patients with SVA ≥ 5 cm at the final follow-up experienced less improvement in SRS-22r satisfaction scores than those with SVA < 5 cm. Patients with LSA < 20° at the final follow-up had significantly lower SRS-22r activity scores than those with LSA ≥ 20° (p = .014). Two patients had transient neurologic deficits, and 11 patients underwent revision for proximal junctional kyphosis (5), pseudarthrosis (3), junctional stenosis (2), or neurologic deficit (1). CONCLUSIONS LS3CO produced radiographic and clinical improvements. However, patients who remained sagittally imbalanced had less improvement in SRS-22r satisfaction score than those whose sagittal imbalance was corrected, and patients who maintained kyphotic deformity in the lumbosacral spine had lower SRS-22r activity scores than those whose lumbosacral kyphosis was corrected. These slides can be retrieved under Electronic Supplementary Material.
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Sabou S, Carrasco R, Verma R, Siddique I, Mohammad S. The clinical and radiological outcomes of multilevel posterior lumbar interbody fusion in the treatment of degenerative scoliosis: a consecutive case series with minimum 2 years follow up. JOURNAL OF SPINE SURGERY 2019; 5:520-528. [PMID: 32043002 DOI: 10.21037/jss.2019.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical treatment for adult degenerative scoliosis (ADS) is a complex undertaking and is associated with a high complication rate. Our aim was to evaluate the clinical and radiological outcomes, mortality and morbidity of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment in ADS based on the experience of a single tertiary referral center for spinal surgery. Methods We performed a retrospective analysis of prospectively collected data of consecutive patients who had undergone multi-level posterior interbody fusion for degenerative scoliosis. We prospectively recorded patients' demographics, co-morbidities; coronal and sagittal plane deformity assessment and surgical details: number of instrumented levels, and intra-operative and postoperative complications. Functional outcomes and patient-reported complications were entered in our local spine surgery database (part of the Eurospine Spine Tango Registry) and used to collect data on functional scores and patient-reported complications preoperatively and at 6, 12 and 24 months' follow-up. Results Our study involved 13 males and 51 females with a mean age of 70.26 (range 49-90, SD 8.9). MPLIF was performed at five levels in one patient, four levels in 29 patients, three levels in 20 patients, and two levels in 14 patients. There were a total of 14 (21.87%) major, minor and mechanical complications. There were no procedure-related mortalities. The average COMI and Eq5d scores improved significantly post-surgery, and this improvement was maintained at a mean follow-up of up to two years. Conclusions Multilevel posterior interbody fusion is a safe procedure, and in selected cases can result in good clinical and radiological outcomes with improvement in patient quality of life.
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Affiliation(s)
- Silviu Sabou
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research & Primary Care, Manchester, UK.,Biology, Medicine and Health (BMH), The University of Manchester, Manchester, UK
| | - Rajat Verma
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
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Raad M, Puvanesarajah V, Harris A, El Dafrawy MH, Khashan M, Jain A, Hassanzadeh H, Kebaish KM. The learning curve for performing three-column osteotomies in adult spinal deformity patients: one surgeon's experience with 197 cases. Spine J 2019; 19:1926-1933. [PMID: 31310816 DOI: 10.1016/j.spinee.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/18/2019] [Accepted: 07/10/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Three-column osteotomy (3CO) is used to correct rigid adult spinal deformity. It presents risk of complications because it involves extensive osseous resection and spinal destabilization. PURPOSE Our purpose was to characterize the learning curve for performing 3CO in adult spinal deformity patients. DESIGN Retrospective review. PATIENT SAMPLE A surgical registry at a tertiary care center was used to identify 238 cases of 3CO for correction of adult spinal deformity by 1 surgeon between 2005 and 2014. Patients with at least 1 year of clinical and radiographic follow-up were included (n=197; mean duration of follow-up, 43 months; range, 12-121). OUTCOME MEASURES We quantified associations between surgeon experience and (1) estimated blood loss per vertebral level fused (EBL/VLF), (2) incidence of new neurologic deficits, (3) incidence of reoperation for instrumentation failure, (4) operative time in minutes, and (5) magnitude of correction at the level of the osteotomy. METHODS The learning curve for binary outcomes was demonstrated using a LOWESS smoother plot of the probability of occurrence. Change in risk was calculated using a generalized linear model with link identity and binomial family. The learning curve for continuous variables was demonstrated using a scatter plot and a line of best fit based on linear regression analysis. Alpha=0.05. RESULTS EBL/VLF decreased by a mean of 19.7 mL (95% confidence interval [CI]: 11.3-28.1) with each 10 cases (decrease of 388 mL/level fused by the end of the study period). The risk of a neurologic deficit declined by 7.98% (95% CI: 7.98%, 7.99%) with every 100 cases. The risk of reoperation declined by 1.99% (95% CI: 0.83%, 3.17%) with every 10 cases until the 100th case. After that point, there was no significant change in the probability of reoperation (p>.05). The magnitude of correction and operative time did not change with increasing surgeon experience (p>.05). CONCLUSION Incidence of reoperation for instrumentation failure, incidence of new neurologic deficits, and estimated blood loss improved with increasing surgeon experience at performing 3CO. Most outcomes, except the risk of reoperation, improved through the last case.
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Affiliation(s)
- Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Andrew Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | | | - Morsi Khashan
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
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Rathod TN, Shah KA. Vertebral column resection for post tuberculosis severe kyphotic deformity: Results of 5 year follow-up. J Orthop 2019; 19:122-127. [PMID: 32025118 DOI: 10.1016/j.jor.2019.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background Spinal TB is endemic in our study region and many patients present with severe kyphotic deformities and neurological deficit. We corrected such deformities with all posterior single stage surgeries. This study was undertaken to evaluate the results, efficacy and safety of this technique. Methods Deformity correction of 16 patients was done during January 2012 to December 2014. All patients underwent posterior only approach for vertebral column resection at peri-apical region, posterior instrumentation with pedicular screws and anterior reconstruction using mesh cage. Postoperative X-ray films were evaluated. All patients were followed up at six weeks, 12 weeks, 18 weeks, six months and yearly thereafter. At follow-up patients were evaluated neurologically and radio-graphically. Results Mean age of the patients was 19.43 years. (Range 3-37) An average 1.62 vertebrae were excised and 5.93 vertebral levels were instrumented. Mean blood loss was 1013 ml and the mean duration of surgery was 6.78 h. The decrease in mean kyphotic deformity from preoperative 90.08⁰ to postoperative 38.06⁰ was statistically significant. (P < 0.000) Mean percentage correction was 57.59%. No pseudoarthrosis was found on X-rays. The decrease in Oswestry's Disability Index was from 55.43 to 10.06 was statistically significant. (P < 0.000) Two patients had neurological complications and one patient had wound complication. Conclusion The safety and efficacy of Posterior VCR technique for post tuberculosis severe kyphotic deformity is favorable with no severe late stage complications. Excision of ribs, careful handling of cord and gradual correction of deformity with good hemostasis is important.
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Affiliation(s)
- Tushar Narayan Rathod
- Department of Orthopaedics, Seth G S Medical College & KEM Hospital, Parel, Mumbai, India
| | - Kunal Ajitkumar Shah
- Department of Orthopaedics, Seth G S Medical College & KEM Hospital, Parel, Mumbai, India
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Shao J, Lee MY, Louis S, Knusel K, Lee BS, Pelle DW, Savage J, Tanenbaum JE, Mroz TE, Steinmetz MP. The efficacy of intraoperative multimodal monitoring in pedicle subtraction osteotomies of the lumbar spine. J Neurosurg Spine 2019; 31:683-690. [PMID: 31349220 DOI: 10.3171/2019.5.spine19125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Iatrogenic spine injury remains one of the most dreaded complications of pedicle subtraction osteotomies (PSOs) and spine deformity surgeries. Thus, intraoperative multimodal monitoring (IOM), which has the potential to provide real-time feedback on spinal cord signal transmission, has become the gold standard in such operations. However, while the benefits of IOM are well established in PSOs of the thoracic spine and scoliosis surgery, its utility in PSOs of the lumbar spine has not been robustly documented. The authors' aim was to determine the impact of IOM on outcomes in patients undergoing PSO of the lumbar spine. METHODS All patients older than 18 years who underwent lumbar PSOs at the authors' institution from 2007 to 2017 were analyzed via retrospective chart review and categorized into one of two groups: those who had IOM guidance and those who did not. Perioperative complications were designated as the primary outcome measure and postoperative quality of life (QOL) scores, specifically the Parkinson's Disease Questionnaire-39 (PDQ-39) and Patient Health Questionnaire-9 (PHQ-9), were designated as secondary outcome measures. Data on patient demographics, surgical and monitoring parameters, and outcomes were gathered, and statistical analysis was performed to compare the development of perioperative complications and QOL scores between the two cohorts. In addition, the proportion of patients who reached minimal clinically important difference (MCID), defined as an increase of 4.72 points in the PDQ-39 score or a decrease of 5 points in the PHQ-9 score, in the two cohorts was also determined. RESULTS A total of 95 patients were included in the final analysis. IOM was not found to significantly impact the development of new postoperative deficits (p = 0.107). However, the presence of preoperative neurological comorbidities was found to significantly correlate with postoperative neurological complications (p = 0.009). Univariate analysis showed that age was positively correlated with MCID achievement 3 months after surgery (p = 0.018), but this significance disappeared at the 12-month postoperative time point (p = 0.858). IOM was not found to significantly impact MCID achievement at either the 3- or 12-month postoperative period as measured by PDQ-39 (p = 0.398 and p = 0.156, respectively). Similarly, IOM was not found to significantly impact MCID achievement at either the 3- or 12-month postoperative period, as measured by PHQ-9 (p = 0.230 and p = 0.542, respectively). Multivariate analysis showed that female sex was significantly correlated with MCID achievement (p = 0.024), but this significance disappeared at the 12-month postoperative time point (p = 0.064). IOM was not found to independently correlate with MCID achievement in PDQ-39 scores at either the 3- or 12-month postoperative time points (p = 0.220 and p = 0.097, respectively). CONCLUSIONS In this particular cohort, IOM did not lead to statistically significant improvement in outcomes in patients undergoing PSOs of the lumbar spine (p = 0.220). The existing clinical equipoise, however, indicates that future studies in this arena are necessary to achieve systematic guidelines on IOM usage in PSOs of the lumbar spine.
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Affiliation(s)
- Jianning Shao
- 1Cleveland Clinic Lerner College of Medicine and
- 4Case Western School of Medicine, Case Western Reserve University; and
| | - Maxwell Y Lee
- 1Cleveland Clinic Lerner College of Medicine and
- 4Case Western School of Medicine, Case Western Reserve University; and
| | - Shreya Louis
- 1Cleveland Clinic Lerner College of Medicine and
- 4Case Western School of Medicine, Case Western Reserve University; and
| | - Konrad Knusel
- 4Case Western School of Medicine, Case Western Reserve University; and
| | | | - Dominic W Pelle
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jason Savage
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Thomas E Mroz
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Steinmetz
- 2Department of Neurosurgery and
- 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data. J Korean Neurosurg Soc 2019; 63:99-107. [PMID: 31658806 PMCID: PMC6952730 DOI: 10.3340/jkns.2018.0170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/26/2019] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO.
Methods A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed.
Results The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to -50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively, -16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications.
Conclusion PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.
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Affiliation(s)
- Ho Yong Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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