Artikel
Clinical and radiological outcome of pedicle subtraction osteotomy (PSO) to correct the sagittal balance in adult deformity
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Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: The goal of spinal deformity surgery is to re-establish a physiologic sagittal profile of the spine. If large angles of correction are needed, osteotomies are applied, but often associated with significant complications. We present our results of pedicle subtraction osteotomies in older patients with degenerative or iatrogenic sagittal imbalance.
Method: Demographic data, ASA score, symptoms and outcome (pain on VAS, walking distance, etc.) as well as complications were analysed retrospectively in 14 patients (65,6±6,4 years; 12 women) who underwent a PSO at our institution. Additionally radiologic parameters (lumbar lordosis, C7 plumb-line, pelvic incidence) were investigated pre- and postoperatively.
Results: There were significant comorbidities in the population (ASA scores of 2 in only 3 patients and ASA 3 in the remainder n=11). N= 7 patients received a spondylodesis without iliac screws and n=8 a long thoracolumbar construct (≥8 segments) with iliac screws. The PSO was performed at Th12 (n=2), L1 (n=2), L2 (n=1), L3 (n=6) and L4 (n=6), with three patients receiving two-level PSOs. In one patient an additional Smith-Peterson osteotomy was performed. Follow-up amounted to 12±8 months. Preoperatively, the C7 plumb-line was located 66,6±58,8mm in front of the heads of the femur indicating severe sagittal imbalance with a lumbar lordships of 23,6±18,2° (pelvic incidence: 55.9±9.9°). Surgery with an average duration of 7.5h corrected the C7 plumb-line to 0,6±28,1mm behind the heads of the femurs (p<0,001) and postoperative lumbar lordosis improved to 51,8±10,7° (p<0,001). At final follow-up pain improved dramatically from VAS 8,6±1,5 preoperatively to VAS 3,0±1,7 (p<0.001), while walking distance recovered from 142±147m to 1490±1745m (p<0,001). One patient died due to a cardiopulmonary complication within 30 days and there was a complication rate of 38% (wound infection, new radicular deficit, etc.).
Conclusions: The correction of adult deformity can be achieved adequately by PSO. Lumbar lordosis can be re-established with surprisingly good clinical outcome. Perioperative complications, however, are common in this population of old and comorbid patients, so that these operations must be indicated very cautiously.