Javier Pizones1, Francisco Javier Sánchez Perez-Grueso2, Lucía Moreno-Manzanaro2, Alba Vila-Casademunt3, Louis Boissiere4, Caglar Yilgor5, Nicomedes Fernández-Baíllo2, José Miguel Sánchez-Márquez2, Gloria Talavera2, Frank Kleinstück6, Emre R Acaroglu7, Ahmet Alanay5, Ferran Pellisé8, Ibrahim Obeid4. 1. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. javierpizones@gmail.com. 2. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. 3. Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain. 4. Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France. 5. Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. 6. Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland. 7. Orthopedic Spine Unit, Ankara Spine Center, Ankara, Turkey. 8. Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Abstract
STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To determine the influence of postoperative ideal lordosis distribution and ideal sagittal harmony on mechanical complications in patients undergoing one-level lumbar pedicle subtraction osteotomy (L-PSO). Many variables have been associated with mechanical complications after L-PSO. However, the impact of restoring the ideal inflexion point, lumbar apex, and sagittal shape is still underexplored. METHODS: Analyzed risk factors were: age and patient-related variables, PSO level, interbody cages, rod material/diameter, number of rods, upper instrumented vertebra, lower instrumented vertebra, PI-LL mismatch, global tilt (GT), postoperative level of lumbar apex (LApex), postoperative level of inflexion point (InfxP), and postoperative type of Roussouly sagittal profile (R-type). These last variables were compared to ideal (based on pelvic incidence). Univariate and multivariate analyses were performed to identify risks for mechanical complications with a minimum 2-year follow-up. RESULTS: A total of 87 patients were included. Mean follow-up was 4.5 ± 1.7 years. 40.2% of the patients suffered postoperative mechanical complications (7 PJK, 4 PJF, 18 pseudoarthrosis/rod breakage, 6 screw pullout). Mean time for complications was 584 ± 416 days from surgery. Univariate analysis showed that age (63 vs 57 years; P = 0.04), BMI (28.1 vs 25.9; P = 0.024), preoperative-GT (50.7° vs 38.7°; P < 0.001), postoperative-GT (28.9° vs 23.4°; P = 0.018), postoperative LApex location mismatched from ideal (77.8% vs 22.2%; P = 0.036), and postoperative R-type mismatched from ideal (67.6% vs 22.6%; P < 0.001) were significantly related to mechanical complications. The independent factors selected by multivariate analysis were: postoperative R-type mismatched from ideal OR 11.3 (95% CI 3.9-32.6; P < 0.001), age OR 1.05 (95% CI 1-1.1; P = 0.03), and LApex matching OR 0.5 (95% CI 0.27-0.97; P = 0.04). The further the LApex was from its ideal position, the higher the risk of mechanical complications (P = 0.036). CONCLUSIONS: Over other multiple suspected risk factors, proper lumbar apex position and ideal sagittal shape restoration played an important role in postoperative mechanical complications after L-PSO. LEVEL OF EVIDENCE: III.
STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To determine the influence of postoperative ideal lordosis distribution and ideal sagittal harmony on mechanical complications in patients undergoing one-level lumbar pedicle subtraction osteotomy (L-PSO). Many variables have been associated with mechanical complications after L-PSO. However, the impact of restoring the ideal inflexion point, lumbar apex, and sagittal shape is still underexplored. METHODS: Analyzed risk factors were: age and patient-related variables, PSO level, interbody cages, rod material/diameter, number of rods, upper instrumented vertebra, lower instrumented vertebra, PI-LL mismatch, global tilt (GT), postoperative level of lumbar apex (LApex), postoperative level of inflexion point (InfxP), and postoperative type of Roussouly sagittal profile (R-type). These last variables were compared to ideal (based on pelvic incidence). Univariate and multivariate analyses were performed to identify risks for mechanical complications with a minimum 2-year follow-up. RESULTS: A total of 87 patients were included. Mean follow-up was 4.5 ± 1.7 years. 40.2% of the patients suffered postoperative mechanical complications (7 PJK, 4 PJF, 18 pseudoarthrosis/rod breakage, 6 screw pullout). Mean time for complications was 584 ± 416 days from surgery. Univariate analysis showed that age (63 vs 57 years; P = 0.04), BMI (28.1 vs 25.9; P = 0.024), preoperative-GT (50.7° vs 38.7°; P < 0.001), postoperative-GT (28.9° vs 23.4°; P = 0.018), postoperative LApex location mismatched from ideal (77.8% vs 22.2%; P = 0.036), and postoperative R-type mismatched from ideal (67.6% vs 22.6%; P < 0.001) were significantly related to mechanical complications. The independent factors selected by multivariate analysis were: postoperative R-type mismatched from ideal OR 11.3 (95% CI 3.9-32.6; P < 0.001), age OR 1.05 (95% CI 1-1.1; P = 0.03), and LApex matching OR 0.5 (95% CI 0.27-0.97; P = 0.04). The further the LApex was from its ideal position, the higher the risk of mechanical complications (P = 0.036). CONCLUSIONS: Over other multiple suspected risk factors, proper lumbar apex position and ideal sagittal shape restoration played an important role in postoperative mechanical complications after L-PSO. LEVEL OF EVIDENCE: III.
Authors: Javier Pizones; Francisco Javier Sánchez Perez-Grueso; Lucía Moreno-Manzanaro; Fernando Escámez; Caglar Yilgor; Alba Vila-Casademunt; Nicomedes Fernández-Baíllo; José Miguel Sánchez-Márquez; Ibrahim Obeid; Frank Kleinstück; Ahmet Alanay; Ferran Pellisé Journal: Eur Spine J Date: 2021-11-08 Impact factor: 3.134
Authors: Anouar Bourghli; Louis Boissiere; Thomas Chevillotte; Maxime Huneidi; Clement Silvestre; Kariman Abelin-Genevois; Pierre Grobost; Javier Pizones; Pierre Roussouly; Ibrahim Obeid Journal: Eur Spine J Date: 2021-09-29 Impact factor: 3.134