Outcome of Pedicle Subtraction Osteotomies for Fixed Sagittal Imbalance of Multiple Etiologies

Abstract

Based on the results of this study, PSO is considered a reliable and relatively safe procedure for the correction of fixed sagittal imbalance with multiple etiologies.

Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis

“…This type of osteotomy is carried through all three columns of the spine, obviating the need for anterior exposure and its associated complications. With its indications growing, PSO has been modified to treat some fixed sagittal plane deformities for a variety of disease states including tuberculosis, trauma, and postsurgical conditions [12,20,21]. In general, the mean correction of a standard lumbar PSO is about 35° [5].…”

“…Although VCR could obtain enough correction, it is not fully suitable for the treatment of global sagittal imbalance. Thus, some authors recommended two-level PSO to complement the correction insufficiency [5,11,12]. Yet still, these articles did not talk about surgical strategies of two-level PSO for severe AS kyphosis in detail.…”

“…And PSO, a V-shaped wedge resection of the vertebral body, involving bilateral pedicles and posterior elements, was first introduced to correct AS kyphosis by Thomasen in 1985 [10]. This type of osteotomy, typically performed at L2 or L3, which is the normal apex of lumbar lordosis, can obtain a correction of 30-40°at one osteotomized segment [3][4][5][11][12][13][14]. While VCR is a formidable last resort technique reserved for the most tenacious spinal deformities which are not amenable to other osteotomy techniques such as the SPO or the PSO, it has been suggested for the treatment of spinal tumor, congenital kyphoscoliosis as well as for hemivertebrae excision [15].…”

Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature

“…Orthopedic efficiency of PSO is approximately tripled comparing with SPO per segment [6]. However, as the extensive application and risk of potential hazards of mass blood loss, neurological deficits, pseudarthrosis, and dural tears increase [7,8], the rigid, severe spinal deformities can reach good correction via VCR. Unfortunately, with resection of the whole vertebral body, the incidence of major complications significantly increases [9,10].…”

Perioperative complications of pedicle subtraction osteotomy

“…Additional rod fixation (i.e., two additional rods across the PSO) was added at the surgeon's discretion but not routinely used in this series of patients. The PSOs were performed at T12 (2), L1 (2), L2 (17), L3 (33), L4 (9), and L5 (2). All patients who underwent a PSO at our institution were included in the study, and none were excluded.…”