Ponte osteotomies in thoracic deformities

Pérez-Grueso, Francisco Sánchez; Cecchinato, Riccardo; Berjano, Pedro

doi:10.1007/s00586-014-3617-z

Cited by 13 publications

(4 citation statements)

References 13 publications

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“…Simultaneous correction in both planes is necessary. If the major curve is flexible, posterior column osteotomies [11] are usually sufficient to correct the curve, which improves and corrects the CM. The sagittal plane is usually addressed efficiently by the same actions (Figs.…”

Section: A1 Type 1a1: Flexible L/tl Main Curvementioning

confidence: 99%

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

et al. 2018

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Introduction In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction.Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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Section: A1 Type 1a1: Flexible L/tl Main Curvementioning

confidence: 99%

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

et al. 2018

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“…Osteotomies are classified by anatomic grades of resection [43] and increase in complexity from partial facet resection to complete removal of the vertebral body. The risk of neural injury may increase with bony resection and has been found to be greater with three-column (3COs) compared to posterior column-only osteotomies in some studies [44,45], but not in others [46•]. …”

Section: Neurologic Complications Based On Surgical Approach Posteriormentioning

confidence: 99%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.

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“…A PSO, with or without superior diskectomy (Schwab 4 and 3 respectively), enables corrections of 30°to 45°, and is indicated to address short-angle hyperkyphosis. 1,9,[27][28][29][30][31] However, in cases of severe kyphosis, mainly higher than 60°, vertebral column resection might be needed. [32][33][34][35][36][37] Thus, through a single posterior approach, a three-column osteotomy (PSO or vertebral column resection [VCR]) may enable the correction of sagittal misalignment in pathologies such as posttraumatic kyphosis, postinfection kyphosis, congenital deformities, adult spinal deformities, ankylosing spondylitis, and iatrogenic flat back.…”

Section: Discussionmentioning

confidence: 99%

Four-rod Technique Stabilization after Pedicle Subtraction Osteotomy (PSO) for the Treatment of Thoracolumbar Hyperkyphosis Secondary to Pott Disease: A Two-Year Follow-Up Case Report

et al. 2019

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Pedicle subtraction osteotomy (PSO) is a powerful tool for the management of sagittal misalignment. However, this procedure has a high rate of implant failure, particularly rod breakages. The four-rod technique diminishes this complication in the lumbar spine. The aim of the present study is to provide a case report regarding PSO and four-rod technique stabilization in the treatment of short-angle hyperkyphosis in the thoracolumbar (TL) junction. The authors describe the case of a patient with TL hyperkyphosis secondary to spinal tuberculosis treated with L1 PSO and fixation with a four-rod technique. There were no major surgical complications. The self-reported quality of life questionnaires (the Short-Form Health Survey 36 [SF-36] and the Oswestry disability index) and radiological parameters were assessed preoperatively, as well as 6, 12 and 24 months after surgery, and they showed considerable and sustained improvements in pain control and quality of life. No hardware failure was observed at the two-year follow-up.

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Ponte osteotomies in thoracic deformities

Cited by 13 publications

References 13 publications

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

Neurological complications in adult spinal deformity surgery

Four-rod Technique Stabilization after Pedicle Subtraction Osteotomy (PSO) for the Treatment of Thoracolumbar Hyperkyphosis Secondary to Pott Disease: A Two-Year Follow-Up Case Report

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