STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To assess the prevalence, risk factors, and clinical outcomes for pseudarthrosis after a lumbar pedicle subtraction osteotomy (PSO). SUMMARY OF BACKGROUND DATA: There exists no large series that examines pseudarthrosis rates of PSOs. METHODS: Data of 171 consecutive patients with adult deformity who underwent a lumbar PSO by 2 surgeons at a single institution with a minimum 2-year follow-up were analyzed. Pseudarthrosis diagnosed through sagittal malalignment and instrumentation failure noted on radiograph was confirmed intraoperatively. RESULTS: Eighteen (10.5%) of 171 patients developed pseudarthrosis after a PSO. Eleven of the 18 patients (6.4% of all patients, 61.1% of the 18 patients with pseudarthrosis) had pseudarthrosis at the PSO site, L3 being the most common; other locations included the lumbosacral junction (4/18), thoracolumbar junction (2/18), and upper thoracic spine (1/18). Preoperative pseudarthrosis level was a predictor of the postoperative level of pseudarthrosis (93%). Fifteen of the 18 patients (83%) had no interbody fusion directly above or below the PSO site, 16 (88%) had a history of pseudarthrosis at the time of PSO surgery and 2 of 3 patients who had prior radiation to the lumbar region developed pseudarthrosis. Most pseudarthroses occurred within the first 2 years (n = 13/18), between 2 and 5 years (n = 3/18), and more than 5 years (n = 2/18) postoperatively. Prior pseudarthrosis (P < 0.0001), pseudarthrosis at the PSO site (P < 0.0001), prior decompression in the lumbar region (P = 0.0037), prior radiation to the lumbar region (P < 0.0001), and presence of inflammatory/neurological disorders (P < 0.0036) were identified as risk factors. All 18 patients with pseudarthroses required revision surgery (posterior-only surgery, n = 12; anteroposterior surgery, n = 6) due to loss of sagittal alignment and pain. The mean pre-revision Scoliosis Research Society score was 85, post-revision score was 95 (P = 0.0166), and the mean pre-revision Oswestry Disability Index score was 42.5, post-revision score was 34.5 (P = 0.0203). CONCLUSION: The overall prevalence of pseudarthrosis was 10.5% of which 61% occurred at the actual PSO site and Scoliosis Research Society and Oswestry Disability Index scores improved significantly after pseudarthrosis repair. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To assess the prevalence, risk factors, and clinical outcomes for pseudarthrosis after a lumbar pedicle subtraction osteotomy (PSO). SUMMARY OF BACKGROUND DATA: There exists no large series that examines pseudarthrosis rates of PSOs. METHODS: Data of 171 consecutive patients with adult deformity who underwent a lumbar PSO by 2 surgeons at a single institution with a minimum 2-year follow-up were analyzed. Pseudarthrosis diagnosed through sagittal malalignment and instrumentation failure noted on radiograph was confirmed intraoperatively. RESULTS: Eighteen (10.5%) of 171 patients developed pseudarthrosis after a PSO. Eleven of the 18 patients (6.4% of all patients, 61.1% of the 18 patients with pseudarthrosis) had pseudarthrosis at the PSO site, L3 being the most common; other locations included the lumbosacral junction (4/18), thoracolumbar junction (2/18), and upper thoracic spine (1/18). Preoperative pseudarthrosis level was a predictor of the postoperative level of pseudarthrosis (93%). Fifteen of the 18 patients (83%) had no interbody fusion directly above or below the PSO site, 16 (88%) had a history of pseudarthrosis at the time of PSO surgery and 2 of 3 patients who had prior radiation to the lumbar region developed pseudarthrosis. Most pseudarthroses occurred within the first 2 years (n = 13/18), between 2 and 5 years (n = 3/18), and more than 5 years (n = 2/18) postoperatively. Prior pseudarthrosis (P < 0.0001), pseudarthrosis at the PSO site (P < 0.0001), prior decompression in the lumbar region (P = 0.0037), prior radiation to the lumbar region (P < 0.0001), and presence of inflammatory/neurological disorders (P < 0.0036) were identified as risk factors. All 18 patients with pseudarthroses required revision surgery (posterior-only surgery, n = 12; anteroposterior surgery, n = 6) due to loss of sagittal alignment and pain. The mean pre-revision Scoliosis Research Society score was 85, post-revision score was 95 (P = 0.0166), and the mean pre-revision Oswestry Disability Index score was 42.5, post-revision score was 34.5 (P = 0.0203). CONCLUSION: The overall prevalence of pseudarthrosis was 10.5% of which 61% occurred at the actual PSO site and Scoliosis Research Society and Oswestry Disability Index scores improved significantly after pseudarthrosis repair. LEVEL OF EVIDENCE: 4.
Authors: Pedro Berjano; Ming Xu; Marco Damilano; Thomas Scholl; Claudio Lamartina; Michael Jekir; Fabio Galbusera Journal: Eur Spine J Date: 2019-05-25 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
Authors: Mitsuru Takemoto; Louis Boissière; Felipe Novoa; Jean-Marc Vital; Ferran Pellisé; Francisco Javier Sanchez Pérez-Grueso; Frank Kleinstück; Emre R Acaroglu; Ahmet Alanay; Ibrahim Obeid; Ibrahim Obeid Journal: Eur Spine J Date: 2016-05-25 Impact factor: 3.134
Authors: Peter G Passias; Cole Bortz; Haddy Alas; Frank A Segreto; Samantha R Horn; Yael U Ihejirika; Dennis Vasquez-Montes; Katherine E Pierce; Avery E Brown; Kartik Shenoy; Edward M DelSole; Bradley Johnson; Cheongeun Oh; Peter L Zhou; Chloe Deflorimonte; Ekhamjeet S Dhillon; Pawel P Jankowski; Bassel G Diebo; Virginie Lafage; Renaud Lafage; Shaleen N Vira; John A Bendo; Jeffrey A Goldstein; Frank J Schwab; Michael C Gerling Journal: J Orthop Date: 2018-12-20
Authors: Whoan Jeang Kim; Hyun Min Shin; Dae Geon Song; Jae Won Lee; Kun Young Park; Shann Haw Chang; Jin Hyun Bae; Won Sik Choy Journal: Clin Orthop Surg Date: 2021-04-23