Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy

Osteotomies for the Treatment of Adult Spinal Deformities: A Critical Analysis Review

»

Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications.

»

The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions.

»

Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques.

»

There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.

Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

OBJECTIVE

The aim of this study was to analyze the specific patterns and risk factors of sagittal reconstruction failure in ankylosing spondylitis (AS)-related thoracolumbar kyphosis after pedicle subtraction osteotomy (PSO).

METHODS

A retrospective study was performed in patients with AS and thoracolumbar kyphosis after lumbar PSO with a minimum follow-up of 2 years. Patients were classified as having successful realignment (group A), inadequate correction immediately postoperatively (group B), and sagittal decompensation during follow-up (group C) according to the immediately postoperative and latest follow-up sagittal vertical axis (SVA). Radiographic parameters and clinical outcomes were collected. Pelvic tilt (PT) was used to assess the magnitude of pelvic backward rotation. Hip structural damage and ossification of the anterior longitudinal ligament (ALL) at the proximal junction, PSO level, and distal junction were also evaluated on radiographs.

RESULTS

Overall, 109 patients with a mean age of 35.3 years were included. Patients in both group B (n = 16) and group C (n = 13) were older than those in group A (n = 80) (mean ages 43.6 vs 32.9 years, p < 0.011; and 39.2 vs 32.9 years, p = 0.018; respectively). Age (OR 1.102, p = 0.011), and preoperative PT (OR 1.171, p = 0.041) and SVA (OR 1.041, p = 0.016) were identified as independent risk factors of inadequate correction. Additionally, a higher distribution of patients with adequate ALL ossification at the PSO level was found in group B than in group A (37.5% vs 22.5%, p = 0.003). Age (OR 1.101, p = 0.011) and preoperative SVA (OR 1.013, p = 0.020) were identified as independent risk factors of sagittal decompensation. Furthermore, compared with group A, group C showed a higher distribution of patients with severe hip structural damage (15.4% vs 0, p = 0.018) and higher incidences of rod fracture (RF) (38.5% vs 8.8%, p = 0.011) and pseudarthrosis (15.4% vs 0, p = 0.018). Additionally, the incidence of RF (19.6% vs 6.9%, p = 0.045) and changes in the proximal junctional angle (0.5° vs 2.2°, p = 0.027) and the distal junctional angle (0.3° vs 2.2°, p = 0.019) were lower during follow-up in patients with adequate ALL ossification than in those without adequate ossification.

CONCLUSIONS

Sagittal reconstruction failure in patients with AS could be attributed to inadequate correction immediately after surgery (14.7%) and sagittal decompensation during follow-up (11.9%). Adequate ALL ossification was a risk factor of inadequate correction. However, adequate ALL ossification could decrease the development of RF and relieve the junctional kyphotic change during follow-up. Older age and greater baseline SVA were independent risk factors for both inadequate correction and sagittal decompensation.