STUDY DESIGN: Retrospective study. OBJECTIVE: To report results at a minimum 5 years after pedicle subtraction osteotomy for fixed sagittal imbalance. SUMMARY OF BACKGROUND DATA: No one has reported results of pedicle subtraction osteotomies with a 5- to 8-year follow-up. METHOD: Thirty-five consecutive patients with sagittal imbalance (29 females/6 males, average age at surgery, 53.1 years) treated with lumbar pedicle subtraction osteotomies (1 at L1, 13 at L2, 20 at L3, and 1 at L4) at 1 institution were analyzed (average follow-up, 5.8 years; range, 5-7.6 years). Radiographic and clinical outcomes analysis was performed. RESULTS: There were no significant regional radiographic changes between 2 years postoperative and the ultimate follow-up (proximal junctional change, P = 0.30; thoracic kyphosis, P = 0.38; and lumbar lordosis, P = 0.84), although many patients did demonstrate an increasingly anterior C7 sagittal plumb with time. Ten pseudarthroses (29%) occurred in 8 patients and were revised between 2 and 5 years postoperative. There were no pseudarthroses at the osteotomy level (9 at the thoracolumbar junction, 1 at the LS junction), but at the levels added to the previous fusions. There was no degradation in Oswestry and Scoliosis Research Society (SRS) outcome scores between 2 years postoperative and ultimate follow-up (P = 0.23 and 0.90, respectively). Patients reported very good satisfaction (87%), good self-image (76%), good function (69%), and fair pain subscales (66%) at ultimate follow-up. Sagittal vertical axis <8 cm at ultimate follow-up was significant for better SRS outcomes scores (P = 0.038). Eight patients with revised pseudarthroses did not demonstrate poorer SRS outcomes scores (P = 0.52). Those 8 patients were queried after their pseudarthrosis revision surgery. CONCLUSION: Pedicle subtraction osteotomy can provide satisfactory clinical and radiographic outcomes for patients with a minimum 5-year follow-up despite needing pseudarthrosis revision and some component of increasingly positive sagittal vertical axis between 2 years and 5 to 8 years of follow-up. The level of patient satisfaction and self-image subscales were high after more than 5 years of follow-up. Restoration and maintenance of sagittal vertical axis <8 cm were important to the ultimate sagittal reconstruction.
STUDY DESIGN: Retrospective study. OBJECTIVE: To report results at a minimum 5 years after pedicle subtraction osteotomy for fixed sagittal imbalance. SUMMARY OF BACKGROUND DATA: No one has reported results of pedicle subtraction osteotomies with a 5- to 8-year follow-up. METHOD: Thirty-five consecutive patients with sagittal imbalance (29 females/6 males, average age at surgery, 53.1 years) treated with lumbar pedicle subtraction osteotomies (1 at L1, 13 at L2, 20 at L3, and 1 at L4) at 1 institution were analyzed (average follow-up, 5.8 years; range, 5-7.6 years). Radiographic and clinical outcomes analysis was performed. RESULTS: There were no significant regional radiographic changes between 2 years postoperative and the ultimate follow-up (proximal junctional change, P = 0.30; thoracic kyphosis, P = 0.38; and lumbar lordosis, P = 0.84), although many patients did demonstrate an increasingly anterior C7 sagittal plumb with time. Ten pseudarthroses (29%) occurred in 8 patients and were revised between 2 and 5 years postoperative. There were no pseudarthroses at the osteotomy level (9 at the thoracolumbar junction, 1 at the LS junction), but at the levels added to the previous fusions. There was no degradation in Oswestry and Scoliosis Research Society (SRS) outcome scores between 2 years postoperative and ultimate follow-up (P = 0.23 and 0.90, respectively). Patients reported very good satisfaction (87%), good self-image (76%), good function (69%), and fair pain subscales (66%) at ultimate follow-up. Sagittal vertical axis <8 cm at ultimate follow-up was significant for better SRS outcomes scores (P = 0.038). Eight patients with revised pseudarthroses did not demonstrate poorer SRS outcomes scores (P = 0.52). Those 8 patients were queried after their pseudarthrosis revision surgery. CONCLUSION: Pedicle subtraction osteotomy can provide satisfactory clinical and radiographic outcomes for patients with a minimum 5-year follow-up despite needing pseudarthrosis revision and some component of increasingly positive sagittal vertical axis between 2 years and 5 to 8 years of follow-up. The level of patient satisfaction and self-image subscales were high after more than 5 years of follow-up. Restoration and maintenance of sagittal vertical axis <8 cm were important to the ultimate sagittal reconstruction.
Authors: Virginie Lafage; Justin S Smith; Shay Bess; Frank J Schwab; Christopher P Ames; Eric Klineberg; Vincent Arlet; Richard Hostin; Douglas C Burton; Christopher I Shaffrey Journal: Eur Spine J Date: 2011-08-12 Impact factor: 3.134
Authors: Luigi La Barbera; Hans-Joachim Wilke; Christian Liebsch; Tomaso Villa; Andrea Luca; Fabio Galbusera; Marco Brayda-Bruno Journal: Eur Spine J Date: 2019-08-14 Impact factor: 3.134
Authors: Benny T Dahl; Jonathan A Harris; Manasa Gudipally; Mark Moldavsky; Saif Khalil; Brandon S Bucklen Journal: Eur Spine J Date: 2017-08-02 Impact factor: 3.134