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Lo YS, Shi BL, Lin ETE, Yeh CW, Tsai CH, Chen HT, Zhu ZZ, Qiu Y. Assessing Neurological Complications in Thoracic Three-Column Osteotomy: A Clinical Application of a Novel MRI-Based Classification Approach. Spine (Phila Pa 1976) 2024; 49:950-955. [PMID: 38221840 DOI: 10.1097/brs.0000000000004924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To investigate the occurrence of neurological complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an magnetic resonance imaging (MRI)-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid at the curve apex and evaluate its prognostic capacity for postoperative neurological deficits. SUMMARY OF BACKGROUND DATA Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. MATERIALS AND METHODS Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was used to describe spinal cord morphology at the apex. Intraoperative neurophysiological monitoring alerts were recorded, and preoperative and postoperative neurological functions were assessed using the Frankel score. Categorical data were compared using the χ 2 or the Fisher exact test. The paired t test was utilized to assess the mean difference between preoperative and postoperative measurements, while the one-way analysis of variance and independent t test were used for comparative analyses among the different spinal cord types. RESULTS Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve ( P <0.001). This disparity persisted both postoperatively and during follow-up ( P <0.05). Intraoperative neurophysiological monitoring alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies ( P <0.001). New neurological deficits were observed in 15 patients (9.5%), with 1, 3, and 11 cases in type 1, 2, and 3 morphologies, respectively. CONCLUSIONS Patients with type 3 morphology exhibited greater spinal deformity severity, a higher likelihood of preoperative neurological deficits, and an elevated risk of postoperative neurological complications. This underscores the utility of the classification as a tool for predicting postoperative neurological complications in patients undergoing thoracic 3CO. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yuan-Shun Lo
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan
| | - Ben-Long Shi
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Erh-Ti Ernest Lin
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chen-Wei Yeh
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ze-Zhang Zhu
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yong Qiu
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Caffard T, Medina SJ, Arzani A, Chiapparelli E, Schönnagel L, Tani S, Camino-Willhuber G, Zhu J, Dalton D, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy. Spine Deform 2024; 12:801-809. [PMID: 38472693 DOI: 10.1007/s43390-024-00828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE We aim to investigate the associations between lumbar paraspinal muscles and sagittal malalignment in patients undergoing lumbar three-column osteotomy. METHODS Patients undergoing three-column osteotomy between 2016 and 2021 with preoperative lumbar magnetic resonance imaging (MRI) and whole spine radiographs in the standing position were included. Muscle measurements were obtained using a validated custom software for segmentation and muscle evaluation to calculate the functional cross-sectional area (fCSA) and percent fat infiltration (FI) of the m. psoas major (PM) as well as the m. erector spinae (ES) and m. multifidus (MM). Spinopelvic measurements included pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L1-S1 lordosis (LL), T4-12 thoracic kyphosis (TK), spino-sacral angle (SSA), C7-S1 sagittal vertical axis (SVA), T1 pelvic angle (TPA) and PI-LL mismatch (PI - LL). Statistics were performed using multivariable linear regressions adjusted for age, sex, and body mass index (BMI). RESULTS A total of 77 patients (n = 40 female, median age 64 years, median BMI 27.9 kg/m2) were analyzed. After adjusting for age, sex and BMI, regression analyses demonstrated that a greater fCSA of the ES was significantly associated with greater SS and SSA. Moreover, our results showed a significant correlation between a greater FI of the ES and a greater kyphosis of TK. CONCLUSION This study included a large patient cohort with sagittal alignment undergoing three-column osteotomy and is the first to demonstrate significant associations between the lumbar paraspinal muscle parameters and global sagittal alignment. Our findings emphasize the importance of the lumbar paraspinal muscles in sagittal malalignment.
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Affiliation(s)
- Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Samuel J Medina
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Gaston Camino-Willhuber
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - David Dalton
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Timo Zippelius
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Cottone C, Kim D, Lucasti C, Scott MM, Graham BC, Aronoff N, Hasanspahic B, Kowalski D, Bird J, Patel D. Causes of Intraoperative Neuromonitoring Events in Adult Spine Deformity Surgery: A Systematic Review. Global Spine J 2024:21925682241242693. [PMID: 38532704 DOI: 10.1177/21925682241242693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Intraoperative neuromonitoring (IOMN) has become a standard practice in the detection and prevention of nerve damage and postoperative deficit. While multicenter studies have addressed this inquiry, there have been no systematic reviews to date. This systematic review identifies the leading causes of IONM alerts during adult spinal deformity (ASD) surgeries. METHODS Following PRISMA guidelines, a literature search was performed in PubMed and Embase. IONM alert causes were grouped by equivalent terms used across different studies and binned into larger categories, including surgical maneuver, Changes in blood pressure/temperature, Oxygenation, Anesthesia, Patient position, and Unknown. RESULTS Inclusion criteria were studies on adult patients receiving ASD correction surgery using IONM with documented alert causes. 1544 references were included in abstract review, 128 in full text review, and 16 studies qualified for data extraction. From those studies, there was a total of 3945 adult patients with 299 IONM alerts. Surgical maneuver led the alert causes (258 alerts/86.3%), with signal loss most commonly occurring at correction or osteotomy (101/33.8% and 95/31.8% respectively). Pedicle screw placement caused 35 alerts (11.7%). Changes in temperature and blood pressure were the third largest category (34/11.4%). CONCLUSIONS The most frequent causes of IONM alerts in ASD surgery were surgical maneuvers such as correction, osteotomy, and pedicle screw placement. This information provides spine surgeons with a quantitative perspective on the causes of IONM changes and show that most occur at predictable times during ASD surgery.
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Affiliation(s)
- Chloe Cottone
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - David Kim
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Christopher Lucasti
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Maxwell M Scott
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Benjamin C Graham
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Nell Aronoff
- University Libraries, University at Buffalo, Buffalo, NY, USA
| | - Bilal Hasanspahic
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - David Kowalski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Justin Bird
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Dil Patel
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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Yang X, Wang Q, Meng Z, Liu H, Wu H, Juma T, Pan L, Wang Y, Cao Y. A Femoral Neck Osteotomy for the Patients with Ankylosing Spondylitis and Thoracolumbar Kyphosis Combined with Hip Flexion Contracture. Orthop Surg 2024; 16:245-253. [PMID: 37975214 PMCID: PMC10782266 DOI: 10.1111/os.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The surgical treatment of patients with ankylosing spondylitis and severe thoracolumbar kyphosis combined with hip flexion contracture is very difficult for all the surgeons. The femoral neck osteotomy (FNO) is the first step to break the ice. The evaluation of a new modified FNO method is very important to improve the curative effect. METHODS Five male patients with nine bone-fused hips who underwent the new femoral neck osteotomy were included from October 2021 to March 2022. The FNO was designed that the saw blade was manipulated from the lateral femoral neck base to the inferior part of the femoral head, keeping Pauwels' angle less than 30° on the coronal plane. On the transverse plane, the angle between the saw blade and the coronal plane was more than 15°. On the sagittal plane, the saw blade cut through the femoral neck. They accepted pedicle subtraction osteotomy (PSO) after FNO according to the patient' recovery. Then, 2 weeks later, the patients underwent total hip arthroplasty (THA). The visual analogue scale (VAS), Harris hip score (HHS) and passive hip flexion-extension range of motion (ROM) were used to evaluate hip function. The data were analyzed by paired t-test. RESULTS The average operation time and blood loss of FNO, the average interval between FNO and THA were collected. The average angle of the trunk and lower limb (ATL) was 36.33° ± 16.36° pre-FNO, 82.89° ± 13.51° post-FNO and 175.22° ± 3.42° post-THA. The average VAS scores were 0 pre-FNO, 5 ± 1.58 post-FNO and 2.6 ± 0.55 post-THA. The average HHS was 43.56 ± 1.59 preoperatively and 83.89 ± 2.21 postoperatively. The average hip extension ROM was 23.89° ± 12.69° pre-FNO, -22.67° ± 14.18° post-FNO and - 3.33° ± 2.50 post-THA°. The average hip flexion ROM was 23.89° ± 12.69° pre-FNO, 35.56° ± 12.11° post-FNO and 104.44° ± 5.27° post-THA. The differences among them were significant (p < 0.05). Only one hip (11.11%) displaced completely after FNO. CONCLUSION A new modified FNO was developed, which can provide osteotomy with a certain degree of stability and greater ease for performing PSO and THA.
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Affiliation(s)
- Xin Yang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Qiwei Wang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Zhicao Meng
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Heng Liu
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Hao Wu
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Talante Juma
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Liping Pan
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Yu Wang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Yongping Cao
- Department of OrthopaedicsPeking University First HospitalBeijingChina
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Lee A, Lucasti C, Scott MM, Patel DV, Kohut K, Pavlesen S, Bayers-Thering M, Hamill CL. The Surgical Outcomes of Pedicle Subtraction Osteotomy per Different First Assistant: Retrospective Analysis of 312 Cases. J Am Acad Orthop Surg 2024; 32:e33-e43. [PMID: 37467386 DOI: 10.5435/jaaos-d-23-00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Pedicle subtraction osteotomies (PSOs) are complex spinal deformity surgeries that are associated with high complication rates. They are typically done by an experienced spine surgeon with another attending, resident, or physician assistant serving as the first assistant. The purpose of this study was to determine whether selecting a surgical team for single-level PSO based on case difficulty and fusion length could equalize intraoperative and perioperative outcomes among three groups: dual-attending (DA), attending and orthopaedic resident (RS), and attending and physician assistant (PA). METHODS This study was a retrospective cohort analysis of 312 patients undergoing single-level thoracic or lumbar PSO from January 2007 to December 2020 by a fellowship-trained orthopaedic spine surgeon. Demographic, intraoperative, and perioperative data within 30 days and 2 years of the index procedure were analyzed. RESULTS Patient demographics did not markedly differ between surgical groups. The mean cohort age was 64.5 years with BMI 31.9 kg/m 2 . Patients with the DA approach had a significantly longer surgical time (DA = 412 min vs. resident = 372 min vs. physician assistant = 323 min; P < 0.001). Patients within the DA group experienced a significantly lower rate of infection (DA = 2.1% [3/140] vs. RS = 7.9% [9/114] vs. PA = 1.7% [1/58], P = 0.043), surgical complication rate (DA = 26% [37/140] vs. RS = 41% [47/114] vs. PA = 33% [19/58], P < 0 .001), and readmission rate (DA = 6.4% [9/140] vs. RS = 12.3% [14/114] vs. PA = 19% [11/58] P = 0.030) within 30 days of surgery. No notable differences were observed among groups in 2-year complication, infection, readmission, or revision surgery rates. CONCLUSIONS These study results support the DA surgeon approach. Resident involvement, even in less complex cases, can still negatively affect perioperative outcomes. Additional selection criteria development is needed.
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Affiliation(s)
- Andrew Lee
- From the Department of Orthopaedic Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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Yahanda AT, Wegner AM, Klineberg EO, Gupta MC. Assessing Alignment Using GAP Score and Complications for Pedicle Subtraction Osteotomy Revision Surgeries for Sagittal Deformity in Previously Fused Spines Using a Satellite Rod Technique. World Neurosurg 2023; 179:e262-e268. [PMID: 37625635 DOI: 10.1016/j.wneu.2023.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Pedicle subtraction osteotomy (PSO) is a surgical technique to restore lumbar lordosis in patients with rigid sagittal deformity. Herein, we report on outcomes of a surgical technique utilizing a 4-rod PSO with satellite rods. METHODS A retrospective study was performed for a cohort of patients who underwent 4-rod PSO revision surgery for sagittal deformity. Procedures were performed by one surgeon at 2 different academic centers between 2004-2018. Alignment outcomes and complications specifically for revision surgeries in previously fused spines were assessed. RESULTS 40 patients underwent PSO with the satellite rod technique (n = 29 at L3, 72.5%; n = 7 at L4, 17.5%). Mean PSO angle was 28.7 ± 7.6°. Two patients (5%) had rod fracture necessitating revision surgery at 32 and 34 months. Three patients (7.5%) developed proximal junctional kyphosis (PJK), but none required revision. No patients developed pseudoarthrosis. Mean preoperative sagittal vertical axis (SVA) was 13.5 ± 7.3 cm, which decreased to 4.8 ± 7.3 cm (P = 0.002) postoperatively. Mean preoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch improved from 35.9 ± 16.6° preoperatively to 11.8 ± 14.6° postoperatively (P < 0.001). Mean preoperative pelvic tilt (PT) improved from 34.7 ± 9.8° preoperatively to 30.1 ± 9.0° (P = 0.026) postoperatively. Mean global alignment and proportion (GAP) score improved from 10 ± 2 preoperatively to 8 ± 2 postoperatively (P < 0.001), which was still considered severely disproportioned. CONCLUSIONS Rod failure rate after PSO with the 4-rod satellite configuration was low. SVA, PI-LL mismatch, and PT significantly improved for these previously-fused patients. Mean GAP score also improved, but was still considered severely disproportioned, likely due to the inability of PSO to correct low LL or PT in previously-fused spines.
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Affiliation(s)
- Alexander T Yahanda
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - Adam M Wegner
- Spine Division, OrthoCarolina, Winston-Salem, North Carolina, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, UC Davis School of Medicine, Sacramento, California, USA
| | - Munish C Gupta
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Yearley AG, Chalif JI, Zaidi HA. Utility of Expandable Interbody Cages in Open Transforaminal Interbody Fusions: A Comparison With Static Cages. Cureus 2023; 15:e40262. [PMID: 37440805 PMCID: PMC10335839 DOI: 10.7759/cureus.40262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Background Expandable interbody cages, while popular in minimally invasive fusions due to their slim profile and increased ease of insertion, have not been widely explored in open surgery. The benefits of expandable cages may also extend to open fusions through their potential to achieve a greater restoration of lumbar lordosis while minimizing intraoperative complications. To highlight these benefits, we present a case series of adult spinal deformity (ASD) patients treated with an open transforaminal lumbar interbody fusion (TLIF) using expandable cages and compare outcomes to those of patients treated with static cages from the literature. Methods A retrospective cohort study of patients who underwent a deformity correction procedure and TLIF with expandable interbody cages at Brigham and Women's Hospital between 2018 and 2022 was conducted. Patient demographics, complications, and pre- and postoperative radiographic parameters of spinopelvic alignment were collected. A literature search was completed to identify studies employing static cages. T-tests were performed to compare postoperative changes in radiographic parameters by cage type. Results Forty-five patients (mean age of 62.6 years) with an average of 2.1 cages placed met the inclusion criteria. Patients experienced five intraoperative complications and 23 neurologic deficits (from minor to major), while nine patients required a revision operation. Lumbar lordosis increased by 9.8° ± 14.5° (p < 0.0001), the sagittal vertical axis (SVA) decreased by 25.5 mm ± 56.7 mm (p = 0.0048), and pelvic incidence-lumbar lordosis mismatch decreased by 13.3° ± 17.5° (p < 0.0001) with the use of expandable cages. Expandable cages yielded similar changes in lumbar lordosis to 15° and 8° cages but improved the lumbar lordosis generated from rectangular and 4° cages. When compared to static cages, expandable cages mildly reduced intraoperative complications. Conclusions Expandable interbody cages are an effective means of restoring spinopelvic alignment in ASD that have the potential to improve patient outcomes in open fusions compared to standard static cages. Especially when compared to rectangular and 4° static cages, expandable cages provide a clear benefit in the correction of lumbar lordosis. The impact of open spinal fusions with expandable cages on outcomes should continue to be explored in other cohorts.
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Affiliation(s)
- Alexander G Yearley
- Department of Neurological Surgery, Harvard Medical School, Boston, USA
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, USA
| | - Joshua I Chalif
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, USA
| | - Hasan A Zaidi
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, USA
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Babu JM, Wang KY, Jami M, Durand WM, Neuman BJ, Kebaish KM. Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy. Clin Spine Surg 2023; 36:190-194. [PMID: 37264520 DOI: 10.1097/bsd.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/25/2023] [Indexed: 06/03/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The objective was to determine if sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and define categories of complication risk by sarcopenia severity. SUMMARY OF BACKGROUND DATA Sarcopenia is linked to morbidity and mortality in several orthopedic procedures. Data concerning sarcopenia in ASD surgery is limited, particularly with respect to complex techniques performed such as PSO. With the high surgical burden of PSOs, appropriate patient selection is critical for minimizing complications. METHODS We identified 73 ASD patients with lumbar CT/MRI scans who underwent PSO with spinal fusion ≥5 levels at a tertiary care center from 2005 to 2014. Sarcopenia was assessed by the psoas-lumbar vertebral index (PLVI). Using stratum-specific likelihood ratio analysis, patients were separated into 3 sarcopenia groups by complication risk. The primary outcome measure was any 2-year complication. Secondary outcome measures included intraoperative blood loss and length of stay. RESULTS The mean PLVI was 0.84±0.28, with 47% of patients having complications. Patients with a complication had a 27% lower PLVI on average than those without complications (0.76 vs. 0.91, P=0.021). Stratum-specific likelihood ratio analysis produced 3 complication categories: 32% complication rate for PLVI ≥ 0.81; 61% for PLVI 0.60-0.80; and 69% for PLVI < 0.60. Relative to patients with PLVI ≥ 0.81, those with PLVI 0.60-0.80 and PLVI < 0.60 had 3.2× and 4.3× greater odds of developing a complication (P<0.05). For individual complications, patients with PLVI < 1.0 had a significantly higher risk of proximal junctional kyphosis (34% vs. 0%, P=0.022), while patients with PLVI < 0.8 had a significantly higher risk of wound infection (12% vs. 0%, P=0.028) and dural tear (14% vs. 0%, P=0.019). There were no significant associations between sarcopenia, intraoperative blood loss, and length of stay. CONCLUSIONS The increasing severity of sarcopenia is associated with a significantly and incrementally increased risk of complications following ASD surgery that require PSO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jacob M Babu
- Illinois Bone & Joint Institute, 720 Florsheim Drive, Libertyville, IL
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Meghana Jami
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Wesley M Durand
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD
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Cheng J, Zhang S, Sheng W. Evaluation of preoperative calculation methods of osteotomy size in ankylosing spondylitis with thoracolumbar or lumbar kyphosis. BMC Musculoskelet Disord 2022; 23:1076. [PMID: 36482380 PMCID: PMC9733216 DOI: 10.1186/s12891-022-06043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate the accuracy of different preoperative calculation methods of osteotomy size in ankylosing spondylitis with thoracolumbar or lumbar kyphosis and analyze its clinical significance. METHODS Twenty-two cases of AS patients with thoracolumbar or lumbar kyphosis, from January 2015 to December 2018, who underwent one-level SPO surgery in our hospital, were retrospectively reviewed. The sagittal parameters were measured at pre-operation and last follow up using Surgimap software, and theoretical values of sagittal parameters were calculated according to pre-operative PI. The osteotomy angles of different methods were measured using Surgimap software. Paired t test was used to for the statistical analysis. RESULTS The mean follow-up time of all patients was 30.00 [Formula: see text] 3.56 months. The osteotomy sites were located at T12 in 3 cases, L1 in 6 cases, L2 in 9 cases, and L3 in 4 cases. Compared to pre-operative sagittal parameters, post-operative PT, SS, LL, and SVA were significantly improved (P [Formula: see text] 0.05). Compared to the OVA (46.57 [Formula: see text] 2.32 [Formula: see text]), there was a significantly larger angle predicted by Surgimap method (53.80 [Formula: see text] 9.79 [Formula: see text]), CAM-HA method (56.61 [Formula: see text] 8.58 [Formula: see text]), and HP-HA method (60.07 [Formula: see text] 13.58 [Formula: see text]), respectively (P [Formula: see text] 0.05). But no significant difference was found between the postoperative osteotomy angle and those of SFA method (51.24 [Formula: see text] 12.14 [Formula: see text]) and FBI method (48.08 [Formula: see text] 12.49 [Formula: see text]) (P [Formula: see text] 0.05). CONCLUSION For AS patients with thoracolumbar or lumbar kyphosis, the SFA method, FBI method, and Surgimap method can be used to predict the osteotomy angle precisely, however, considering the rationality of parameter settings and the operability, SFA method is relatively more suitable for such population.
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Affiliation(s)
- Jie Cheng
- grid.413390.c0000 0004 1757 6938Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Shuwen Zhang
- grid.410644.3Department of Orthopedic, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumchi, 830001 Xinjiang China
| | - Weibin Sheng
- grid.412631.3Department of Spine Surgery, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Urumqi, 830054 Xinjiang China
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10
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Kim HJ, Yang JH, Chang DG, Lenke LG, Suh SW, Nam Y, Park SC, Suk SI. Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions. Asian Spine J 2022; 16:776-788. [PMID: 36274246 PMCID: PMC9633249 DOI: 10.31616/asj.2022.0376] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Corresponding author: Dong-Gune Chang Spine Center and Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1284, Fax: +82-2-950-1287, E-mail:
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, Columbia University, New York, NY, USA
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yunjin Nam
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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11
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The Reliability of Computer-Assisted Three-Dimensional Surgical Simulation of Posterior Osteotomies in Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis Patients. Mediators Inflamm 2022; 2022:8134242. [PMID: 36072573 PMCID: PMC9444461 DOI: 10.1155/2022/8134242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives. The study was aimed at investigating the reliability of computer-assisted three-dimensional surgical simulation (CA3DSS) of posterior osteotomies in thoracolumbar kyphosis secondary to ankylosing spondylitis (TLKAS) patients. Methods. Eligible TLKAS patients who underwent posterior correction surgery with posterior osteotomies were consecutively included. Simulated posterior osteotomies were performed in Mimics and 3-Matic Medical software. Coronal and sagittal angle and alignment parameters were measured in preoperative full-length X-ray, preoperative original 3D spine (Pre-OS), simulated 3D spine (SS), and postoperative original 3D spine (Post-OS). Reliability was tested by both intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Results. A total of 30 TLKAS patients were included. Excellent consistency of radiological parameters was shown between preoperative X-ray and Pre-OS model. In SS and Post-OS models, excellent reliabilities were shown in global kyphosis (ICC 0.832, 95% CI 0.677-0.916), thoracic kyphosis (ICC 0.773, 95% CI 0.577-0.885), and lumbar lordosis (ICC 0.896, 95% CI 0.794-0.949) and good reliabilities were exhibited in the main curve (ICC 0.680, 95% CI 0.428-0.834) and sagittal vertical axis (ICC 0.619, 95% CI 0.338-0.798). ICCs of correction angle achieved by pedicle subtraction osteotomy (PSO) was 0.754 (95% CI 0.487-0.892), and that of posterior column osteotomies (PCO) was 0.703 (95% CI 0.511-0.829). Bland-Altman analysis also showed good agreement for both Cobb angle and distance measurements in Pre-OS and SS models, and good reliabilities were shown in PCO and PSO in real spine and SS models. Conclusions. CA3DSS can provide an accurate measurement, and it is a reliable and effective method to conduct proper simulation for correction surgery with posterior osteotomies in TLKAS patients. This trial is registered with Chinese Clinical Trial Registry ChiCTR2100053808.
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Luan H, Liu K, Kahaer A, Wang Y, Sheng W, Maimaiti M, Guo H, Deng Q. Pedicle subtraction osteotomy for the corrective surgery of ankylosing spondylitis with thoracolumbar kyphosis: experience with 38 patients. BMC Musculoskelet Disord 2022; 23:731. [PMID: 35907844 PMCID: PMC9338567 DOI: 10.1186/s12891-022-05693-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the sagittal parameters and clinical outcome of pedicle subtraction osteotomy (PSO) for the treatment of ankylosing spondylitis (AS) combined with thoracolumbar kyphosis. METHODS The clinical data of 38 patients with AS combined with thoracolumbar kyphosis who underwent PSO were enrolled and divided into the lumbar lordosis group and the lumbar kyphosis group according to the preoperative sagittal morphology. They were subdivided into the lumbar lordosis T12 group, lordosis L1 group, kyphosis L2 group, and kyphosis L3 group. The spine sagittal parameters were compared between the preoperative and the postoperative. Outcome evaluation was performed by the Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS), and the Oswestry Disability Index (ODI). RESULTS A total of 38 patients with AS combined with thoracolumbar kyphosis were successfully treated by PSO, with a mean follow-up time of 26.9 ± 11.9 months. There were 30 males and 8 females with a mean age of 41.6 ± 7.1 years. Twenty patients consisted in the lumbar lordosis group and 18 patients in the lumbar kyphosis group. GK, SVA, and CBVA were improved significantly (P < 0.05) at the final follow-up between the lumbar lordosis T12 group and the L1 group. Patients in the lumbar kyphosis L2 group and L3 group all received satisfactory, including LL, GK, and SVA (P < 0.05). There was no statistically significant difference in the preoperative TK, GK, SVA, PT, and PI between the lumbar lordosis and lumbar kyphosis groups (P > 0.05). Postoperative complications occurred in three cases. CONCLUSION PSO was a practical method for the treatment of patients with AS combined with thoracolumbar kyphosis. PSO at L3 was recommended to be selected for the lumbar kyphosis to obtain greater SVA correction. CBVA of single-segment PSO may be significantly lower than the two-segment PSO in the management of patients with kyphosis of lower CBVA.
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Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yao Wang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Maierdan Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Huang R, Pan F, Zhu W, Kong C, Lu S. Predictors for the restoration of the sagittal spinal malalignment in patients with lumbar stenosis after short-segment decompression and fusion surgery. BMC Musculoskelet Disord 2022; 23:711. [PMID: 35883059 PMCID: PMC9316683 DOI: 10.1186/s12891-022-05666-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background To explore the predictors for the restoration of the sagittal spinal malalignment in the elderly patients with lumbar spinal stenosis (LSS) after short-segment decompression and fusion surgery. Methods We retrospectively reviewed 82 LSS patients with sagittal malalignment (SVA ≥ 50 mm or PT ≥ 20° or PI-LL ≥ 20°) who underwent short-segment decompression and fusion surgery between January 2019 and March 2021. Patients’ characteristic, radiographic and paravertebral muscle parameters were assessed. The patients were divided into group A (postoperative malalignment) and B (postoperative alignment) according to whether the postoperative restoration of the sagittal alignment was achieved. Results There existed more males in group B than in group A (p = 0.002). The age of group A (73.36 ± 8.02) was greater than that of group B (69.08 ± 6.07, p = 0.009). Preoperative PT in group A (27.40 ± 5.82) was greater than that in group B (19.30 ± 7.32, p < 0.001). The functional cross-sectional area (fCSA) in group A (28.73 ± 4.23) was lower than that in group B (36.94 ± 7.81, p < 0.001). And the fatty infiltration rate (FI) of group A (27.16% ± 5.58%) was higher than that of group B (22.61% ± 5.81%, p = 0.001). The fCSA was negatively correlated with the postoperative PT and PTr (p < 0.05). Conclusion Stronger lumbar paravertebral muscles, smaller preoperative PI, PT or PI-LL, male and younger age are the predictors for the restoration of the sagittal spinal malalignment in the elderly LSS patients after short-segment decompression and fusion surgery.
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Affiliation(s)
- Rufeng Huang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. 45, Beijing, 100053, P.R, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. 45, Beijing, 100053, P.R, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. 45, Beijing, 100053, P.R, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. 45, Beijing, 100053, P.R, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. 45, Beijing, 100053, P.R, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Zuckerman SL, Cerpa M, Lai CS, Lenke LG. Coronal Alignment in Adult Spinal Deformity Surgery: Definitions, Measurements, Treatment Algorithms, and Impact on Clinical Outcomes. Clin Spine Surg 2022; 35:196-203. [PMID: 33843764 DOI: 10.1097/bsd.0000000000001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
The major focus of realignment in adult spinal deformity (ASD) surgery has been on the sagittal plane, and less emphasis has been given to the coronal plane. In light of this overlooked area within ASD surgery, we aimed to refocus the narrative on coronal alignment in ASD surgery. The objectives of the current narrative review were to (1) define coronal alignment and discuss existing measurements; (2) report the incidence and prevalence of coronal malalignment (CM); (3) discuss the impact of CM on clinical outcomes; and (4) describe our preferred treatment algorithm of surgical correction of CM in ASD.
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Affiliation(s)
- Scott L Zuckerman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY
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15
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Mumtaz M, Mendoza J, Vosoughi AS, Unger AS, Goel VK. A Comparative Biomechanical Analysis of Various Rod Configurations Following Anterior Column Realignment and Pedicle Subtraction Osteotomy. Neurospine 2021; 18:587-596. [PMID: 34610690 PMCID: PMC8497251 DOI: 10.14245/ns.2142450.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the biomechanical differences of different rod configurations following anterior column realignment (ACR) and pedicle subtraction osteotomy (PSO) for an optimal correction technique and rod configuration that would minimize the risk of rod failure. METHODS A validated spinopelvic (L1-pelvis) finite element model was used to simulate ACR at the L3-4 level. The ACR procedure was followed by dual-rod fixation, and for 4-rod constructs, either medial/lateral accessory rods (connected to primary rods) or satellite rods (directly connected to ACR level screws). The range of motion (ROM), maximum von Mises stress on the rods, and factor of safety (FOS) were calculated for the ACR models and compared to the existing literature of different PSO rod configurations. RESULTS All of the 4-rod ACR constructs showed a reduction in ROM and maximum von Mises stress compared to the dual-rod ACR construct. Additionally, all of the 4-rod ACR constructs showed greater percentage reduction in ROM and maximum von Mises stress compared to the PSO 4-rod configurations. The ACR satellite rod construct had the maximum stress reduction i.e., 47.3% compared to dual-rod construct and showed the highest FOS (4.76). These findings are consistent with existing literature that supports the use of satellite rods to reduce the occurrence of rod fracture. CONCLUSION Our findings suggest that the ACR satellite rod construct may be the most beneficial in reducing the risk of rod failure compared to all other PSO and ACR constructs.
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Affiliation(s)
- Muzammil Mumtaz
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| | - Justin Mendoza
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| | - Ardalan Seyed Vosoughi
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| | - Anthony S Unger
- Department of Orthopaedic Surgery, Sibley Gildenhorn Institute, Johns Hopkins University, Washington, District of Columbia, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
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Burkhard MD, Suter D, Sigrist B, Fuernstahl P, Farshad M, Spirig JM. Pedicle subtraction osteotomy with patient-specific instruments. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 7:100075. [PMID: 35141640 PMCID: PMC8820003 DOI: 10.1016/j.xnsj.2021.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/13/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
Background Although the utility of patient-specific instruments (PSI) has been well established for complex osteotomies in orthopedic surgery, it is yet to be comparatively analyzed for complex spinal deformity correction, such as pedicle subtraction osteotomy (PSO). Methods Six thoracolumbar human cadavers were used to perform nine PSOs using the free-hand (FH) technique and nine with PSI (in total 18 PSOs). Osteotomy planes were planned on the basis of preoperative computed tomography (CT). A closing-wedge angle of 30° was targeted for each PSO. Postoperative CT scans were obtained to measure segmental lordosis correction and the deviation from the planned 30° correction as well as the osseous gap of posterior elements. Results The time required to perform a PSO was 18:22 (range 10:22–26:38) min and 14:14 (range 10:13–22:16) min in the PSI and FH groups, respectively (p = 0.489). The PSI group had a significantly higher lordosis gain (29°, range 23–31° vs. 21°, range 13–34°; p = 0.015). The lordosis gain was significantly more accurate with PSI (deviation angle: 1°; range 0–7°) than with the FH technique (9°; range 4–17°; p = 0.003). PSI achieved a significantly smaller residual osseous gap of the posterior elements (5 mm; range 0–9 mm) than the FH group (11 mm; range 3–27 mm; p = 0.043). With PSI, an angular difference of 3° (range 1–12°), a translational offset of 1 (range 0–6) mm at the level of the lamina, and a vertebral body entry point deviation of 1 (range 0–4) mm was achieved in the osteotomies. Conclusions PSI-guided PSO can be a more feasible and accurate approach in achieving a planned lordosis angle than the traditional FH technique in a cadaver model. This approach further reduced osseous gaps, potentially promoting higher fusion rates in vivo.
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Affiliation(s)
- Marco D. Burkhard
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- Corresponding author at: Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - Daniel Suter
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Bastian Sigrist
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Philipp Fuernstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
| | - José Miguel Spirig
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
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