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Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

Publication ,  Journal Article
Lafage, V; Schwab, F; Vira, S; Hart, R; Burton, D; Smith, JS; Boachie-Adjei, O; Shelokov, A; Hostin, R; Shaffrey, CI; Gupta, M; Akbarnia, BA ...
Published in: J Neurosurg Spine
February 2011

OBJECT: Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. METHODS: In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. RESULTS: Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). CONCLUSIONS: The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

Duke Scholars

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

February 2011

Volume

14

Issue

2

Start / End Page

184 / 191

Location

United States

Related Subject Headings

  • Thoracic Vertebrae
  • Spondylosis
  • Spondylitis, Ankylosing
  • Spinal Fusion
  • Scoliosis
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Postural Balance
  • Postoperative Complications
 

Citation

APA
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ICMJE
MLA
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Lafage, V., Schwab, F., Vira, S., Hart, R., Burton, D., Smith, J. S., … Farcy, J.-P. (2011). Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 14(2), 184–191. https://doi.org/10.3171/2010.9.SPINE10129
Lafage, Virginie, Frank Schwab, Shaleen Vira, Robert Hart, Douglas Burton, Justin S. Smith, Oheneba Boachie-Adjei, et al. “Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?J Neurosurg Spine 14, no. 2 (February 2011): 184–91. https://doi.org/10.3171/2010.9.SPINE10129.
Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine. 2011 Feb;14(2):184–91.
Lafage, Virginie, et al. “Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?J Neurosurg Spine, vol. 14, no. 2, Feb. 2011, pp. 184–91. Pubmed, doi:10.3171/2010.9.SPINE10129.
Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS, Boachie-Adjei O, Shelokov A, Hostin R, Shaffrey CI, Gupta M, Akbarnia BA, Bess S, Farcy J-P. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine. 2011 Feb;14(2):184–191.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

February 2011

Volume

14

Issue

2

Start / End Page

184 / 191

Location

United States

Related Subject Headings

  • Thoracic Vertebrae
  • Spondylosis
  • Spondylitis, Ankylosing
  • Spinal Fusion
  • Scoliosis
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Postural Balance
  • Postoperative Complications