So Kato1, Stephen J Lewis2,3, Sam Keshen1, Nasir Quraishi1,4. 1. Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. 2. Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. stephen.lewis@uhn.ca. 3. Arthritis Program, Division of Orthopaedics Surgery, Toronto Western Hospital, University Health Network, East Wing 1-E442, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. stephen.lewis@uhn.ca. 4. Nottingham University Hospital, 748 Mansfield Road, Queen's Medical Centre Campus, Woodthorpe, Nottingham, NG5 3FZ, UK.
Abstract
STUDY DESIGN: A case report. It is important to achieve optimal sagittal balance in spinal deformity surgery by matching LL to PI. A Lumbar osteotomy to increase lordosis is often the method used to achieve this in adult patients. However, in patients with high PI with compensatory lumbar hyperlordosis, providing further lordosis does not address the root cause. The paper will describe a technique of lumbosacral osteotomy to address sagittal malalignment with associated coronal imbalance and pelvic incidence (PI)-lumbar lordosis (LL) mismatch. METHODS: A 16-year-old female patient presented with low back pain and right leg pain. Standing anteroposterior X-ray showed scoliosis with a Cobb angle of 34º and 5.7 cm of coronal imbalance. Lateral X-ray showed a sacralized L5 with a PI of 85º and LL of 47º. Pedicle subtraction osteotomy through the sacralized L5 addressed the malalignment secondary to a high PI-LL mismatch of 38º. RESULTS: Following alar resection, an osteotomy was performed below the L5 pedicles. The cranial parts including the superior endplate and intervertebral disc were removed. Osteotomy closure was achieved using the central rod technique. L5 incidence was reduced from 59º to 33º with reduced coronal malalignment. Back pain was significantly improved and PI-LL mismatch was improved to 10º two years post-operatively with no local loss of sagittal correction. CONCLUSIONS: A lumbosacral osteotomy at the lumbosacral junction is useful to improve high PI - LL mismatch in patients with abnormally high PI with compensatory lumbar hyperlordosis.
STUDY DESIGN: A case report. It is important to achieve optimal sagittal balance in spinal deformity surgery by matching LL to PI. A Lumbar osteotomy to increase lordosis is often the method used to achieve this in adult patients. However, in patients with high PI with compensatory lumbar hyperlordosis, providing further lordosis does not address the root cause. The paper will describe a technique of lumbosacral osteotomy to address sagittal malalignment with associated coronal imbalance and pelvic incidence (PI)-lumbar lordosis (LL) mismatch. METHODS: A 16-year-old female patient presented with low back pain and right leg pain. Standing anteroposterior X-ray showed scoliosis with a Cobb angle of 34º and 5.7 cm of coronal imbalance. Lateral X-ray showed a sacralized L5 with a PI of 85º and LL of 47º. Pedicle subtraction osteotomy through the sacralized L5 addressed the malalignment secondary to a high PI-LL mismatch of 38º. RESULTS: Following alar resection, an osteotomy was performed below the L5 pedicles. The cranial parts including the superior endplate and intervertebral disc were removed. Osteotomy closure was achieved using the central rod technique. L5 incidence was reduced from 59º to 33º with reduced coronal malalignment. Back pain was significantly improved and PI-LL mismatch was improved to 10º two years post-operatively with no local loss of sagittal correction. CONCLUSIONS: A lumbosacral osteotomy at the lumbosacral junction is useful to improve high PI - LL mismatch in patients with abnormally high PI with compensatory lumbar hyperlordosis.
Authors: Stephen J Lewis; Chandan Mohanty; Aaron M Gazendam; So Kato; Sam G Keshen; Noah D Lewis; Sofia P Magana; David Perlmutter; Jennifer Cape Journal: Eur Spine J Date: 2017-09-21 Impact factor: 3.134
Authors: Marcin Czyz; Stephen Forster; James Holton; Babak Shariati; David J Clarkson; Bronek M Boszczyk Journal: Eur Spine J Date: 2017-07-07 Impact factor: 3.134
Authors: Jamie Terran; Frank Schwab; Christopher I Shaffrey; Justin S Smith; Pierre Devos; Christopher P Ames; Kai-Ming G Fu; Douglas Burton; Richard Hostin; Eric Klineberg; Munish Gupta; Vedat Deviren; Gregory Mundis; Robert Hart; Shay Bess; Virginie Lafage Journal: Neurosurgery Date: 2013-10 Impact factor: 4.654