Neurologic Complications of Lumbar Pedicle Subtraction Osteotomy

Buchowski, Jacob M.; Bridwell, Keith H.; Lenke, Lawrence G.; Kuhns, Craig A.; Lehman, Ronald A.; Kim, Youngjung J.; Stewart, David A.; Baldus, Chris

doi:10.1097/brs.0b013e31814b2d52

Cited by 264 publications

(141 citation statements)

References 34 publications

Supporting

Mentioning

126

Contrasting

Unclassified

Order By: Relevance

“…27 Buchowski et al retrospectively evaluated 108 patients who had undergone lumbar PSO and found the incidence of neurological complications, defined as the loss of bowel or bladder control only, to be 11.1%. 5 The rate of neurological complications is higher in the present study, probably because of our more comprehensive definition of neurological complications. Variation in the follow-up could also lead to differences in the rates of neurological complications between the studies.…”

Section: Discussionmentioning

confidence: 51%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 51%

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

View full text Add to dashboard Cite

show abstract

“…However, there is a paucity of current peer-reviewed literature addressing the premise that adult spinal deformity patients benefit from surgical treatment [2][3][4]. Yadla et al [8] in a recent systematic review analysed 49 articles reporting data in 3,299 patients, and found only four articles reporting on all specified outcome measures (change in ODI scores before and after surgery, change in SRS scores, curve reduction, complications, and pseudoarthrosis) [9][10][11][12]. The articles analysed reported a huge number of complications, with a pooled incidence of 41.2 % [8].…”

Section: Discussionmentioning

confidence: 99%

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

et al. 2013

View full text Add to dashboard Cite

Purpose The surgical approach to adult spine deformities is complex and presents a high incidence of complications. Methods We report here a prospective consecutive case series analysis of 20 patients submitted to posterior correction and instrumented fusion for adult degenerative scoliosis. Clinical outcomes were assessed by self-reported measures. Pre-operative and post-operative complications were analysed during a mean 30-month follow-up period. Results Eleven patients (55 %) presented pre-operative or post-operative complications. Fifteen different complications occurred, six in the early pre-operative period and nine during follow-up period: ten of these complications occurred in patients who underwent a previous surgery for spine disease. Conclusions The clinical improvement at the final follow-up resulted as statistically significant only for the group of patients exposed to posterior fusion without interbody fusion. The observations reported here have to be considered for a shared decision-making in the management of adult scoliosis.

show abstract

“…They believed that PSO may achieve a larger correction, with shorter operative time and less blood loss compared with anteriorposterior surgery. Buchowski et al, 3 showed an intraoperative or post-operative neurological deficit rate of 11.1 % (12 of 108 patients), but only 2.8 % of deficits were permanent over a 10-year period. Deficits were always unilateral and were not detected by neuromonitoring.…”

Section: Discussionmentioning

confidence: 99%

Modified Pedicle Subtraction Osteotomy for Posttraumatic Kyphosis: Long Term Follow-Up

Sleem

2017

Egyptian Spine Journal

View full text Add to dashboard Cite

Background Data: Post traumatic kyphosis (PTK) of the thoracolumbar spine is a severe complication of spine fractures and its management can be quite challenging. Pedicle subtraction osteotomy includes posteriorly based wedge resection of the posterior column and both pedicles, with the hinge located at the anterior cortex of the vertebral body. It has been developed to achieve significant deformity correction. It does not involve the adjacent disc which is usually affected and represents a cause of pain, neurological compression and progression of deformity. Modified pedicle subtraction osteotomy (MPSO) including resection of posteriorly based wedge of posterior column and both pedicles together with the damaged disc to achieve correction and solid fusion between the affected vertebra and the adjacent one. It seems to be more suitable for the management of PTK. Purpose: The purpose of this prospective study is to review our experience with modified Pedicle subtraction osteotomy (MPSO) technique for the management of thoracolumbar posttraumatic kyphosis (PTK). Study Design: Prospective cohort clinical case study. Patients and Methods: From February 2010 to July 2014, 14 consecutive patients with PTK were managed by MPSO. The patients were followed clinically and radiologically. Back pain VAS, Denis work scale and regional kyphotic angle (RKA) were recorded and analyzed preoperatively, postoperative and at the latest follow up. Results: The study included 14 patients with an average age of 38. 43±6.63 (26 -48) years. The follow up period was 46.29±15.45 months. The average operative time was 286.43±12.74 minutes and per-operative blood loss

show abstract

Neurologic Complications of Lumbar Pedicle Subtraction Osteotomy

Abstract: Intraoperative or postoperative neurologic deficits are relatively common following a PSO; however, in a majority of cases, deficits are not likely to be permanent.

Cited by 264 publications

References 34 publications

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

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

Do benefits overcome the risks related to surgery for adult scoliosis? A detailed analysis of a consecutive case series

Modified Pedicle Subtraction Osteotomy for Posttraumatic Kyphosis: Long Term Follow-Up

Contact Info

Product

Resources

About