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Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article.

Publication ,  Journal Article
Schwab, FJ; Patel, A; Shaffrey, CI; Smith, JS; Farcy, J-P; Boachie-Adjei, O; Hostin, RA; Hart, RA; Akbarnia, BA; Burton, DC; Bess, S; Lafage, V
Published in: J Neurosurg Spine
June 2012

OBJECT: Pedicle subtraction osteotomy (PSO) is a surgical procedure that is frequently performed on patients with sagittal spinopelvic malalignment. Although it allows for substantial spinopelvic realignment, suboptimal realignment outcomes have been reported in up to 33% of patients. The authors' objective in the present study was to identify differences in radiographic profiles and surgical procedures between patients achieving successful versus failed spinopelvic realignment following PSO. METHODS: This study is a multicenter retrospective consecutive PSO case series. The authors evaluated 99 cases involving patients who underwent PSO for sagittal spinopelvic malalignment. Because precise cutoffs of acceptable residual postoperative sagittal vertical axis (SVA) values have not been well defined, comparisons were focused between patient groups with a postoperative SVA that could be clearly considered either a success or a failure. Only cases in which the patients had a postoperative SVA of less than 50 mm (successful PSO realignment) or more than 100 mm (failed PSO realignment) were included in the analysis. Radiographic measures and PSO parameters were compared between successful and failed PSO realignments. RESULTS: Seventy-nine patients met the inclusion criteria. Successful realignment was achieved in 61 patients (77%), while realignment failed in 18 (23%). Patients with failed realignment had larger preoperative SVA (mean 217.9 vs 106.7 mm, p < 0.01), larger pelvic tilt (mean 36.9° vs 30.7°, p < 0.01), larger pelvic incidence (mean 64.2° vs 53.7°, p < 0.01), and greater lumbar lordosis-pelvic incidence mismatch (-47.1° vs -30.9°, p < 0.01) compared with those in whom realignment was successful. Failed and successful realignments were similar regarding the vertebral level of the PSO, the median size of wedge resection 22.0° (interquartile range 16.5°-28.5°), and the numerical changes in pre- and postoperative spinopelvic parameters (p > 0.05). CONCLUSIONS: Patients with failed PSO realignments had significantly larger preoperative spinopelvic deformity than patients in whom realignment was successful. Despite their apparent need for greater correction, the patients in the failed realignment group only received the same amount of correction as those in the successfully realigned patients. A single-level standard PSO may not achieve optimal outcome in patients with high preoperative spinopelvic sagittal malalignment. Patients with large spinopelvic deformities should receive larger osteotomies or additional corrective procedures beyond PSOs to avoid undercorrection.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

June 2012

Volume

16

Issue

6

Start / End Page

539 / 546

Location

United States

Related Subject Headings

  • Treatment Failure
  • Spine
  • Scoliosis
  • Retrospective Studies
  • Radiography
  • Pelvis
  • Osteotomy
  • Orthopedics
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Schwab, F. J., Patel, A., Shaffrey, C. I., Smith, J. S., Farcy, J.-P., Boachie-Adjei, O., … Lafage, V. (2012). Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article. J Neurosurg Spine, 16(6), 539–546. https://doi.org/10.3171/2012.2.SPINE11120
Schwab, Frank J., Ashish Patel, Christopher I. Shaffrey, Justin S. Smith, Jean-Pierre Farcy, Oheneba Boachie-Adjei, Richard A. Hostin, et al. “Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article.J Neurosurg Spine 16, no. 6 (June 2012): 539–46. https://doi.org/10.3171/2012.2.SPINE11120.
Schwab FJ, Patel A, Shaffrey CI, Smith JS, Farcy J-P, Boachie-Adjei O, et al. Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article. J Neurosurg Spine. 2012 Jun;16(6):539–46.
Schwab, Frank J., et al. “Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article.J Neurosurg Spine, vol. 16, no. 6, June 2012, pp. 539–46. Pubmed, doi:10.3171/2012.2.SPINE11120.
Schwab FJ, Patel A, Shaffrey CI, Smith JS, Farcy J-P, Boachie-Adjei O, Hostin RA, Hart RA, Akbarnia BA, Burton DC, Bess S, Lafage V. Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article. J Neurosurg Spine. 2012 Jun;16(6):539–546.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

June 2012

Volume

16

Issue

6

Start / End Page

539 / 546

Location

United States

Related Subject Headings

  • Treatment Failure
  • Spine
  • Scoliosis
  • Retrospective Studies
  • Radiography
  • Pelvis
  • Osteotomy
  • Orthopedics
  • Middle Aged
  • Male