Corrective Osteotomies in Spine Surgery

Gill, J. Brian; Levin, Andrew; Burd, Tim; Longley, Michael

doi:10.2106/jbjs.h.00081

Cited by 164 publications

(89 citation statements)

References 26 publications

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“…30 Subsequently, these techniques have been adapted to treat fixed sagittal imbalance with excellent results. [6][7][8]15 These publications have elucidated the power of the PSO and SPO to affect regional and global parameters and have provided valuable guidance in operative planning. 6,15 The anticipated rate of lumbar lordosis and sagittal vertebral axis correction for the PSO is 30°-40° and 5.5-13.5 cm per level, respectively.…”

Section: Traditional Approach Versus Mi-lif With Acrmentioning

confidence: 99%

Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

Manwaring¹,

Bach²,

Ahmadian³

et al. 2014

SPI

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Object Minimally invasive (MI) fusion and instrumentation techniques are playing a new role in the treatment of adult spinal deformity. The open pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) are proven segmental methods for improving regional lordosis and global sagittal parameters. Recently the MI anterior column release (ACR) was introduced as a segmental method for treating sagittal imbalance. There is a paucity of data in the literature evaluating the alternatives to PSO and SPO for sagittal balance correction. Thus, the authors conducted a preliminary retrospective radiographic review of prospectively collected data from 2009 to 2012 at a single institution. The objectives of this study were to: 1) investigate the radiographic effect of MI-ACR on spinopelvic parameters, 2) compare the radiographic effect of MI-ACR with PSO and SPO for treatment of adult spinal deformity, and 3) investigate the radiographic effect of percutaneous posterior spinal instrumentation on spinopelvic parameters when combined with MI transpsoas lateral interbody fusion (LIF) for adult spinal deformity. Methods: Patient demographics and radiographic data were collected for 36 patients (9 patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR). Patients included in the study were those who had undergone at least a 2-level MI-LIF procedure; adequate preoperative and postoperative 36-inch radiographs of the scoliotic curvature; a separate second-stage procedure for the placement of posterior spinal instrumentation; and a diagnosis of degenerative scoliosis (coronal Cobb angle > 10° and/or sagittal vertebral axis > 5 cm). Statistical analysis was performed for normality and significance testing. Results Percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved coronal Cobb angle by 16°, and the fractional curve significantly improved in a subgroup treated with L5–S1 transforaminal lumbar interbody fusion. Fifteen ACRs were performed in 9 patients and resulted in significant coronal Cobb angle correction, lumbar lordosis correction of 16.5°, and sagittal vertebral axis correction of 4.8 cm per patient. Segmental analysis revealed a 12° gain in segmental lumbar lordosis and a 3.1-cm correction of the sagittal vertebral axis per ACR level treated. Conclusions The lateral MI-LIF with ACR has the ability to powerfully restore lumbar lordosis and correct sagittal imbalance. This segmental MI surgical technique boasts equivalence to SPO correction of these global radiographic parameters while simultaneously creating additional disc height and correcting coronal imbalance. Addition of posterior percutaneous instrumentation without in situ manipulation or overcorrection does not alter radiographic parameters when combined with the lateral MI-LIF.

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Section: Traditional Approach Versus Mi-lif With Acrmentioning

confidence: 99%

Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

Manwaring¹,

Bach²,

Ahmadian³

et al. 2014

SPI

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“…Despite variations in techniques, 3COs are effective procedures that allow for the correction of spinal deformity and the restoration of global alignment. 2,4,9,10,26,27 While 3CO procedures are powerful tools in the surgeon's armamentarium for the treatment of spinal deformity, the complexity of these procedures can result in major complications. Analysis of the Scoliosis Research Society morbidity and mortality database showed that patients who underwent osteotomies had higher rates of complications than those who underwent other surgical approaches, and more aggressive osteotomies were associated with higher complication rates.…”

mentioning

confidence: 99%

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Bianco

Norton

Schwab

et al. 2014

FOC

112

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Object Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL.

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“…Sagittal balance restoration is more important as it facilitates decreased energy requirements on walking, improving cosmesis and patient satisfaction. It also limits pain, fatigue and complications associated with new or untreated deformities (5) There are several recognized techniques which describe correction of a fixed sagittal imbalance (6)(7)(8). These include posterior only or anterior/posterior combined approaches, osteotomies such as the Smith-Peterson osteotomy (SPO), …”

Section: Discussionmentioning

confidence: 99%

Simultaneous anterior vertebral column resection-distraction and posterior rod contouring for restoration of sagittal balance: report of a technique

Bhagat

Durst

2016

J. Spine Surg.

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With an increasingly aging population, adult spinal deformity is becoming more common. This can be associated with increased morbidity. Results from multicentre studies of deformity surgery correction confirm complication rates as high as 40 percent. Most often a bad result is associated with inadequate restoration of the sagittal balance. Posterior vertebral body resection has been described as a method to correct significant deformity, but this is a complicated procedure. It is possible to do this in the thoracic spine where nerve roots can be sacrificed, but it is difficult in the lumbar spine due to the significant role of the lumbar nerve roots. We describe a safer technique for correction of deformity using a three stage process.This appears to be a good technique for revision surgery.

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Corrective Osteotomies in Spine Surgery

Cited by 164 publications

References 26 publications

Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Simultaneous anterior vertebral column resection-distraction and posterior rod contouring for restoration of sagittal balance: report of a technique

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