Pedicle Reduction Osteotomy in the Upper Cervical Spine: Technique, Case Report and Review of the Literature

Post, Nicholas H.; Naziri, Qais; Cooper, Christopher S.; Pivec, Robert; Paulino, Carl B.

doi:10.14444/2057

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…Fixed cervical deformities result in immobile posterior facets, which preclude the use of anterior-only surgery. 18 As such, fixed deformity has been described as a major contributing factor to surgical planning and has been utilized by Hann et al to develop a surgical planning algo- Major complications were defined as complications that required surgical intervention in order to be treated. Minor complications were considered complications that did not require surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes in rigid versus flexible cervical deformities

Protopsaltis

Stekas

Smith

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVECervical deformity (CD) patients have severe disability and poor health status. However, little is known about how patients with rigid CD compare with those with flexible CD. The main objectives of this study were to 1) assess whether patients with rigid CD have worse baseline alignment and therefore require more aggressive surgical corrections and 2) determine whether patients with rigid CD have similar postoperative outcomes as those with flexible CD.METHODSThis is a retrospective review of a prospective, multicenter CD database. Rigid CD was defined as cervical lordosis (CL) change < 10° between flexion and extension radiographs, and flexible CD was defined as a CL change ≥ 10°. Patients with rigid CD were compared with those with flexible CD in terms of cervical alignment and health-related quality of life (HRQOL) at baseline and at multiple postoperative time points. The patients were also compared in terms of surgical and intraoperative factors such as operative time, blood loss, and number of levels fused.RESULTSA total of 127 patients met inclusion criteria (32 with rigid and 95 with flexible CD, 63.4% of whom were females; mean age 60.8 years; mean BMI 27.4); 47.2% of cases were revisions. Rigid CD was associated with worse preoperative alignment in terms of T1 slope minus CL, T1 slope, C2–7 sagittal vertical axis (cSVA), and C2 slope (C2S; all p < 0.05). Postoperatively, patients with rigid CD had an increased mean C2S (29.1° vs 22.2°) at 3 months and increased cSVA (47.1 mm vs 37.5 mm) at 1 year (p < 0.05) compared with those with flexible CD. Patients with rigid CD had more posterior levels fused (9.5 vs 6.3), fewer anterior levels fused (1 vs 2.0), greater blood loss (1036.7 mL vs 698.5 mL), more 3-column osteotomies (40.6% vs 12.6%), greater total osteotomy grade (6.5 vs 4.5), and mean osteotomy grade per level (3.3 vs 2.1) (p < 0.05 for all). There were no significant differences in baseline HRQOL scores, the rate of distal junctional kyphosis, or major/minor complications between patients with rigid and flexible CD. Both rigid and flexible CD patients reported significant improvements from baseline to 1 year according to the numeric rating scale for the neck (−2.4 and −2.7, respectively), Neck Disability Index (−8.4 and −13.3, respectively), modified Japanese Orthopaedic Association score (0.1 and 0.6), and EQ-5D (0.01 and 0.05) (p < 0.05). However, HRQOL changes from baseline to 1 year did not differ between rigid and flexible CD patients.CONCLUSIONSPatients with rigid CD have worse baseline cervical malalignment compared with those with flexible CD but do not significantly differ in terms of baseline disability. Rigid CD was associated with more invasive surgery and more aggressive corrections, resulting in increased operative time and blood loss. Despite more extensive surgeries, rigid CD patients had equivalent improvements in HRQOL compared with flexible CD patients. This study quantifies the importance of analyzing flexion-extension images, creating a prognostic tool for surgeons planning CD correction, and counseling patients who are considering CD surgery.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes in rigid versus flexible cervical deformities

Protopsaltis

Stekas

Smith

et al. 2021

Journal of Neurosurgery: Spine

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“…Law then reported two similar extension osteotomies at the C3-4 level in 1959. 10 11 Simmons 12 was in fact the one to pioneer the PSO in the cervical spine. Tokala then described his own experience with the procedure in 2007, 13 and Deviren followed this with a report of 11 PSO cases at the cervicothoracic junction in 2011.…”

Section: Historymentioning

confidence: 99%

“…10 Subsequently, McMaster published 15 cases in 1997, Belanger published 26 cases, and Simmons published a large series of 114 cervical SPO cases in 2006. 11 Simmons 12 was in fact the one to pioneer the PSO in the cervical spine. Tokala then described his own experience with the procedure in 2007, 13 and Deviren followed this with a report of 11 PSO cases at the cervicothoracic junction in 2011.…”

Section: Historymentioning

confidence: 99%

A Review of Indications, Surgical Technique, and Outcomes for the Cervical Pedicle Subtraction Osteotomy

Sivaganesan

Kim

2022

J Am Acad Orthop Surg

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Cervical spine deformity is a debilitating condition that can be challenging to treat. For patients with fixed, focal, kyphotic deformities near the cervicothoracic junction, a pedicle subtraction osteotomy (PSO) can be considered. Classifying a given cervical spine deformity and quantifying the mismatch between current and desired alignment are critical steps in determining whether a PSO should be done. It is also important to understand the relative contraindications for a cervical PSO and the radiographic and patient-reported outcomes associated with the procedure. Here, we review these topics and the details of our surgical technique and postoperative considerations. Specific nuances of the setup, exposure/approach, osteotomy, closure, and postoperative protocol are highlighted. A surgical video is also included (Video 1). Our aim is to provide a conceptual framework for understanding when a cervical PSO should be considered, how it can be performed effectively, and the outcomes that can be expected. Cervical spine deformity (CSD) is a debilitating condition that can be challenging to treat. Pathologic kyphosis of the cervical spine can inhibit forward gaze and swallowing, while placing the paraspinal muscles under incredible strain that leads to fatigue and serious disability. This is corroborated by the fact that inadequate cervical lordosis (CL), high C2-C7 sagittal vertical axis (SVA), and an unfavorable T1 slope/CL mismatch have been correlated with high Neck Disability Index (NDI) scores. 1 Background InformationThe surgical management of cervical deformity includes an anterior cervical diskectomy and fusion, anterior cervical corpectomy and fusion, anterior osteotomy, posterior cervical fusion with/without decompression, posterior cervical Smith-Peterson osteotomy (SPO), cervical pedicle subtraction osteotomy (PSO), and some combination of the above techniques. For patients

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“…6,11 Only few reports were published regarding the application in more proximal levels to C7. 16,17 We present a modification of this technique to make PSO feasible in the upper cervical levels. Through the resection of the posterior part of the transverse foramen, we could release the vertebral arteries, thus reducing risk of kinking during the closing procedure of the osteotomy.…”

Section: Pedicle Subtraction Osteotomy In the Cervical Spinementioning

confidence: 99%

Pedicle Subtraction Osteotomy for Deformity Correction in the Upper Cervical Spine: A Technical Note

Barim

Müther

Schipmann

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Kyphosis is the most common deformity of the cervical spine leading to development of severe disabilities. In case of fused kyphosis, surgical treatment can be demanding and often requires multiple-step procedures for adequate correction. We present a technique of single-stage pedicle subtraction osteotomy (PSO) of C3 to treat a patient with fused kyphosis of C2 and C3 causing spinal stenosis with subsequent myelopathy. Methods A 53-year-old man presented with progressive myelopathy not able to walk with 6/18 points on the modified Japanese Orthopedic Association scale. Horizontal gaze was lost due to cervical kyphosis. Magnetic resonance imaging (MRI) revealed a cervical kyphosis causing stenosis, cord compression, and kinking; computed tomography (CT) showed substantial anterior and posterior fusion of C2 and C3. Results Surgery included decompression via laminectomy of C2 to C6 in combination with PSO of C3 and additional dorsal instrumentation of C2 to C6. Cervical spinal alignment was corrected, as the C2–C4 Cobb angle was reduced from 48.9 to 20.6 degrees. Horizontal gaze was restored. Postoperative MRI demonstrated full decompression of the cord without kinking of the vertebral arteries. No complications were noted. The patient recovered well with restoration of his ability to walk. Conclusion Single-stage pedicle subtraction closing wedge osteotomy in the upper cervical spine, although a demanding surgical procedure, is an alternative treatment option in selected cases of fused and severe cervical kyphosis. In contrast to multiple-step approaches, the single-stage procedure could reduce operating time and may thus decrease complications.

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Pedicle Reduction Osteotomy in the Upper Cervical Spine: Technique, Case Report and Review of the Literature

Cited by 6 publications

References 23 publications

Surgical outcomes in rigid versus flexible cervical deformities

Surgical outcomes in rigid versus flexible cervical deformities

A Review of Indications, Surgical Technique, and Outcomes for the Cervical Pedicle Subtraction Osteotomy

Pedicle Subtraction Osteotomy for Deformity Correction in the Upper Cervical Spine: A Technical Note

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