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Objective: To compare the clinical and radiological results of Smith-Petersen osteotomy (SPO), Pedicle Subtraction Osteotomy (PSO) and Vertebral Column Resection (VCR) on sagittal imbalance. Methods: Retrospective cohort study. We compared 42 patients submitted to 3 SPO (n=14), 1 PSO (n=16) and 1 VCR (n=12) for fixed sagittal imbalance in the period 2003 to 2011. The sample consisted of 71.4% males, and the mean age was 43 years (17-74). The mean follow-up was 5 years. The complications, results of the SRS-22 questionnaire, sagittal Cobb angle and sagittal vertical axis (SVA) prior to surgery and 2 years after surgery were recorded. Results: Mean operating time (min) was lower in SPO vs PSO and VCR (420 ± 347 vs. 578 ± 459 vs. 533 ± 435) (p<0.00). Average blood loss (cc) was lower in SPO vs PSO and VCR (1341 ± 804 vs. 2364 ± 1.459 vs. 2134 ± 1335) (p<0.03). The overall rate of complications was 38%. There were no differences in the mean segmental kyphosis correction achieved, but in the correction of SVA differences were observed, with SPO being lower. In SRS-22, the three groups showed significant differences in all areas, compared with the preoperative results, where there were no differences between the groups. Conclusions: there were no differences in complications, although these were more severe in PSO and VCR. No differences were found in correction of segmental kyphosis, but PSO and VSR achieved better results in terms of modifying the SVA. There was no difference in quality of life.Keywords: Osteotomy; Spine; Spinal curvature; Quality of life. RESUMO Objetivo: Comparar os resultados clínicos e radiológicos de pacientes submetidos a osteotomias de Smith-Petersen (SPO), de subtração pedicular (PSO) e vertebrectomias (VCR RESUMENObjetivo: Comparar los resultados clínicos y radiológicos de pacientes sometidos a osteotomías de Smith-Petersen (SPO), de sustracción pedicular (PSO) y vertebrectomías (VCR) en pacientes con desequilibrio sagital. Métodos: Estudio observacional y retrospectivo. Se compararon 42 pacientes sometidos a 3 SPO (n=14), 1 PSO (n=16) y 1 VCR (n=12) por desequilibrio sagital fijo en el periodo de 2003-2011. La muestra constó de 71,4% de hombres y la edad promedio fue 43 años (17-74). El tiempo de seguimiento promedio fue 5 años. Se registraron las complicaciones, los resultados del cuestionario SRS-22, el ángulo de cifosis y eje sagital vertical (SVA) en el preoperatorio y a los 2 años postoperatorios. Resultados: El tiempo quirúrgico (min.) fue menor en SPO respecto a PSO y VCR (420±347 vs. 578±459 vs. 533±435) (p<0,00). El sangrado intraoperatorio (cc) fue menor en SPO respecto a PSO y VCR (1341±804 vs. 2364±1459 vs, 2134±1335) (p<0,03). Del total, 38% presentaron complicaciones. No se observaron diferencias en el promedio de corrección en la cifosis segmentaria, pero sí en la corrección del SVA, siendo menor SPO. En el SRS-22, en los tres grupos se presentaron cambios significativos en todos los dominios respecto al preoperatorio, sin diferencias significativas entre grupos. Co...

Purpose Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. Methods This was a retrospective study of a series of patients. Those with pathological fractures, using anticoagulant or antiplatelet therapy, with severe anemia (hemoglobin [Hb] <9 g/dL), who had received a transfusion before surgery, or with hematological disorders were excluded. A descriptive analysis of recorded variables was performed, and total blood volume (TBV), total bleeding (TB), HBL, and Hb drop were calculated. This was followed by a comparative analysis between HBL and the variables of hospital stay and postoperative evolution. Results A total of 40 patients were included, eight men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5 mL. HBL greater than 500 mL was related to a higher probability of torpid postoperative evolution (p = 0.045) and a longer hospital stay (p = 0.067). A higher HBL was observed in surgeries of greater technical complexity and longer surgical time. Conclusion Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.

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Purpose Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. Materials and methods This was a retrospective study of a series of patients. Those with pathological fractures, using anticoagulant or antiplatelet therapy, with severe anemia (hemoglobin [Hb] < 9 g/dL), who had received a transfusion before surgery, or with hematological disorders were excluded. A descriptive analysis of recorded variables was performed, and total blood volume (TBV), total bleeding (TB), HBL, and Hb drop were calculated. This was followed by a comparative analysis between HBL and the variables of hospital stay and postoperative evolution. Results A total of 40 patients were included, eight men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5 mL. HBL greater than 500 mL was related to a higher probability of torpid postoperative evolution (p = 0.045) and a longer hospital stay (p = 0.067). A higher HBL was observed in surgeries of greater technical complexity and longer surgical time. Conclusion Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.