STUDY DESIGN: Consecutive, multicenter retrospective review. OBJECTIVE: To evaluate if change in thoracic kyphosis (TK) has a positive or negative impact on spinopelvic alignment after lumbar pedicle subtraction osteotomy (PSO) with short fusions. SUMMARY OF BACKGROUND DATA: In the setting of sagittal malalignment, the effect of large vertebral resections can now be anticipated in long fusions, but their impact on unfused segments (reciprocal changes [RC]) remains poorly understood. METHODS: A total of 34 adult patients (mean age = 54 years; SD = 12) who underwent lumbar PSO with upper instrumented vertebra below T10 were included. Radiographic analysis included pre- and postassessment of TK, lumbar lordosis (LL), sagittal vertical axis (SVA), T1 spinopelvic inclination (T1SPI), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were analyzed to determine successful realignment. RC in the thoracic spine was designated favorable or unfavorable on the basis of impact on final SVA and PT. RESULTS: Mean PSO resection was 26°. LL increased from 20° to 49° (P < 0.001). SVA improved from 14 to 4 cm (P < 0.001), and PT improved from 33° to 25° (P < 0.001). Mean increase in TK was 13° (P = 0.002) but was unchanged in 11 patients. Five patients had a favorable RC, and 18 patients had an unfavorable RC. Unfavorable RC was attributed to junctional failure in 6 of 18 patients. Significant differences in the unfavorable RC group included age and greater preoperative PT, PI, SVA, and T1SPI. CONCLUSION: Significant postoperative alignment changes can occur through unfused thoracic spinal segments after lumbar PSO. Unfavorable RC may limit optimal correction and lead to clinical failures. Risk factors for unfavorable thoracic RC include older patients, larger preoperative PI and PT, and worse preoperative T1SPI and are not simply due to junctional failure. Care should be taken with selective lumbar fusion and PSO in older patients and in those with severe preoperative spinopelvic parameters.
STUDY DESIGN: Consecutive, multicenter retrospective review. OBJECTIVE: To evaluate if change in thoracic kyphosis (TK) has a positive or negative impact on spinopelvic alignment after lumbar pedicle subtraction osteotomy (PSO) with short fusions. SUMMARY OF BACKGROUND DATA: In the setting of sagittal malalignment, the effect of large vertebral resections can now be anticipated in long fusions, but their impact on unfused segments (reciprocal changes [RC]) remains poorly understood. METHODS: A total of 34 adult patients (mean age = 54 years; SD = 12) who underwent lumbar PSO with upper instrumented vertebra below T10 were included. Radiographic analysis included pre- and postassessment of TK, lumbar lordosis (LL), sagittal vertical axis (SVA), T1 spinopelvic inclination (T1SPI), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were analyzed to determine successful realignment. RC in the thoracic spine was designated favorable or unfavorable on the basis of impact on final SVA and PT. RESULTS: Mean PSO resection was 26°. LL increased from 20° to 49° (P < 0.001). SVA improved from 14 to 4 cm (P < 0.001), and PT improved from 33° to 25° (P < 0.001). Mean increase in TK was 13° (P = 0.002) but was unchanged in 11 patients. Five patients had a favorable RC, and 18 patients had an unfavorable RC. Unfavorable RC was attributed to junctional failure in 6 of 18 patients. Significant differences in the unfavorable RC group included age and greater preoperative PT, PI, SVA, and T1SPI. CONCLUSION: Significant postoperative alignment changes can occur through unfused thoracic spinal segments after lumbar PSO. Unfavorable RC may limit optimal correction and lead to clinical failures. Risk factors for unfavorable thoracic RC include older patients, larger preoperative PI and PT, and worse preoperative T1SPI and are not simply due to junctional failure. Care should be taken with selective lumbar fusion and PSO in older patients and in those with severe preoperative spinopelvic parameters.
Authors: Themistocles Protopsaltis; Nicolas Bronsard; Alex Soroceanu; Jensen K Henry; Renaud Lafage; Justin Smith; Eric Klineberg; Gregory Mundis; Han Jo Kim; Richard Hostin; Robert Hart; Christopher Shaffrey; Shay Bess; Christopher Ames Journal: Eur Spine J Date: 2016-07-20 Impact factor: 3.134
Authors: Subaraman Ramchandran; Themistocles S Protopsaltis; Daniel Sciubba; Justin K Scheer; Cyrus M Jalai; Alan Daniels; Peter G Passias; Virginie Lafage; Han Jo Kim; Gregory Mundis; Eric Klineberg; Robert A Hart; Justin S Smith; Christopher Shaffrey; Christopher P Ames Journal: Eur Spine J Date: 2017-11-28 Impact factor: 3.134
Authors: Hong Joo Moon; Keith H Bridwell; Alekos A Theologis; Micheal P Kelly; Thamrong Lertudomphonwanit; Han Jo Kim; Lawrence G Lenke; Munish C Gupta Journal: Eur Spine J Date: 2019-07-24 Impact factor: 3.134
Authors: Michael M Safaee; Joseph A Osorio; Kushagra Verma; Shay Bess; Christopher I Shaffrey; Justin S Smith; Robert Hart; Vedat Deviren; Christopher P Ames Journal: Oper Neurosurg (Hagerstown) Date: 2017-10-01 Impact factor: 2.703