In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Pet...In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The longterm overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.展开更多
Background： Sagittal translation （ST） is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis （AS）. However, there is a paucity of...Background： Sagittal translation （ST） is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis （AS）. However, there is a paucity of effective techniques to prevent ST. The purpose of this study was to propose a pedicle subtraction osteotomy （PSO） with a cage as a method to prevent ST and to explore the efficacy and feasibility of this method in the treatment of kyphosis in AS. Methods： We retrospectively reviewed 89 consecutive patients with AS kyphosis who underwent a PSO （Group B, 46 patients） or a PSO with a cage （Group A, 43 patients） from February 2009 to December 2013. Pre- and post-operative radiographic results were reviewed. ST and complications were analyzed in both groups. Clinical assessment was performed using the Scoliosis Research Society-22 （SRS-22） outcomes metric. The patients were followed up for at least 2 years. Results： Group A achieved the same re-alignment of the kyphotic spine as Group B. Two （4.7%） of the 43 patients in Group A and 14 （30.4%） of the 46 patients in Group B had intraoperative ST （2＂2 = 10.020, P = 0.002）. Significant differences were identified between the two groups in the height change of the osteotomized column. SRS-22 scores improved significantly in both groups. Seven patients experienced neurologic complications （1 in Group A and 6 in Group B）. Eight patients had cerebrospinal fluid leakage （2 in Group A and 6 in Group B）. Conclusion： PSO with a cage significantly avoided ST during the osteotomy procedure and might represent a new, safe, and feasible choice tbr treating patients with AS kyphosis.展开更多
文摘In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The longterm overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.
文摘Background： Sagittal translation （ST） is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis （AS）. However, there is a paucity of effective techniques to prevent ST. The purpose of this study was to propose a pedicle subtraction osteotomy （PSO） with a cage as a method to prevent ST and to explore the efficacy and feasibility of this method in the treatment of kyphosis in AS. Methods： We retrospectively reviewed 89 consecutive patients with AS kyphosis who underwent a PSO （Group B, 46 patients） or a PSO with a cage （Group A, 43 patients） from February 2009 to December 2013. Pre- and post-operative radiographic results were reviewed. ST and complications were analyzed in both groups. Clinical assessment was performed using the Scoliosis Research Society-22 （SRS-22） outcomes metric. The patients were followed up for at least 2 years. Results： Group A achieved the same re-alignment of the kyphotic spine as Group B. Two （4.7%） of the 43 patients in Group A and 14 （30.4%） of the 46 patients in Group B had intraoperative ST （2＂2 = 10.020, P = 0.002）. Significant differences were identified between the two groups in the height change of the osteotomized column. SRS-22 scores improved significantly in both groups. Seven patients experienced neurologic complications （1 in Group A and 6 in Group B）. Eight patients had cerebrospinal fluid leakage （2 in Group A and 6 in Group B）. Conclusion： PSO with a cage significantly avoided ST during the osteotomy procedure and might represent a new, safe, and feasible choice tbr treating patients with AS kyphosis.
