Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy

Eichler, David; Charles, Yann Philippe; Baldairon, Florent; Ntilikina, Yves; Sauleau, Erik; Steib, Jean-Paul

doi:10.1007/s00586-018-5767-x

Cited by 2 publications

(4 citation statements)

References 32 publications

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“…8 Despite the improved sagittal alignment, reconstruction failure after PSO has frequently been reported in ASD. 3,6,[8][9][10] Reconstruction failure could be attributed to inadequate correction immediately after surgery and sagittal decompensation caused by mechanical complications, including RF, PJK, and DJK, during follow-up. 6,[8][9][10] However, due to heterotopic ossification, the rates and patterns of sagittal reconstruction failure following PSO might be different in AS-related rigid thoracolumbar kyphosis.…”

Section: Discussionmentioning

confidence: 99%

“…Loss of correction within the fusion levels was mostly caused by pseudarthrosis. 10 In ASD, pseudarthrosis was highly associated with RF. However, due to the superior bone fusion capacity in AS, pseudarthrosis developed less frequently following PSO.…”

Section: Sagittal Decompensation During Follow-upmentioning

confidence: 99%

“…8 Additionally, mechanical complications of junctional kyphosis, screw loosening, and RF during follow-up have also been confirmed as causes of sagittal decompensation after ASD correction surgery. Moreover, the rate of sagittal malalignment recurrence could be up to 38%, 6,9,10 and the risk factors include age, upper instrumented vertebra (UIV) level, lower instrumented vertebra (LIV) level, fusion levels, and the magnitude of deformity correction. 11,12 Recently, the role of spinal mobility in the development of mechanical complications during follow-up has been emphasized.…”

mentioning

confidence: 99%

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Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

Zhao

Qian

Huang

et al. 2021

Neurosurgical Focus

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OBJECTIVE The aim of this study was to analyze the specific patterns and risk factors of sagittal reconstruction failure in ankylosing spondylitis (AS)–related thoracolumbar kyphosis after pedicle subtraction osteotomy (PSO). METHODS A retrospective study was performed in patients with AS and thoracolumbar kyphosis after lumbar PSO with a minimum follow-up of 2 years. Patients were classified as having successful realignment (group A), inadequate correction immediately postoperatively (group B), and sagittal decompensation during follow-up (group C) according to the immediately postoperative and latest follow-up sagittal vertical axis (SVA). Radiographic parameters and clinical outcomes were collected. Pelvic tilt (PT) was used to assess the magnitude of pelvic backward rotation. Hip structural damage and ossification of the anterior longitudinal ligament (ALL) at the proximal junction, PSO level, and distal junction were also evaluated on radiographs. RESULTS Overall, 109 patients with a mean age of 35.3 years were included. Patients in both group B (n = 16) and group C (n = 13) were older than those in group A (n = 80) (mean ages 43.6 vs 32.9 years, p < 0.011; and 39.2 vs 32.9 years, p = 0.018; respectively). Age (OR 1.102, p = 0.011), and preoperative PT (OR 1.171, p = 0.041) and SVA (OR 1.041, p = 0.016) were identified as independent risk factors of inadequate correction. Additionally, a higher distribution of patients with adequate ALL ossification at the PSO level was found in group B than in group A (37.5% vs 22.5%, p = 0.003). Age (OR 1.101, p = 0.011) and preoperative SVA (OR 1.013, p = 0.020) were identified as independent risk factors of sagittal decompensation. Furthermore, compared with group A, group C showed a higher distribution of patients with severe hip structural damage (15.4% vs 0, p = 0.018) and higher incidences of rod fracture (RF) (38.5% vs 8.8%, p = 0.011) and pseudarthrosis (15.4% vs 0, p = 0.018). Additionally, the incidence of RF (19.6% vs 6.9%, p = 0.045) and changes in the proximal junctional angle (0.5° vs 2.2°, p = 0.027) and the distal junctional angle (0.3° vs 2.2°, p = 0.019) were lower during follow-up in patients with adequate ALL ossification than in those without adequate ossification. CONCLUSIONS Sagittal reconstruction failure in patients with AS could be attributed to inadequate correction immediately after surgery (14.7%) and sagittal decompensation during follow-up (11.9%). Adequate ALL ossification was a risk factor of inadequate correction. However, adequate ALL ossification could decrease the development of RF and relieve the junctional kyphotic change during follow-up. Older age and greater baseline SVA were independent risk factors for both inadequate correction and sagittal decompensation.

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Section: Discussionmentioning

confidence: 99%

Section: Sagittal Decompensation During Follow-upmentioning

confidence: 99%

mentioning

confidence: 99%

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Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

Zhao

Qian

Huang

et al. 2021

Neurosurgical Focus

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“…Eichler et al 36 demonstrated that, at an average follow-up of 3.8 years, pelvic tilt and SVA increases pointed toward the recurrence of anterior malalignment. On the other hand, there seems to be a learning curve.…”

Section: Learning Curve and Newer Conceptsmentioning

confidence: 99%

Osteotomies for the Treatment of Adult Spinal Deformities

et al. 2022

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Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications. » The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions. » Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques.» There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.

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Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy

Cited by 2 publications

References 32 publications

Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

Osteotomies for the Treatment of Adult Spinal Deformities

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