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Greenberg J, Patel AA, Magro M, Srivatsa S, Spiessberger A. T1 Pedicle Subtraction Osteotomy With Subaxial Cervical Pedicle Screw Fixation. Clin Spine Surg 2024; 37:92-96. [PMID: 38409672 DOI: 10.1097/bsd.0000000000001587] [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: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Abstract
Patients suffering from ankylosing spondylitis are not only predisposed to the development of rigid cervicothoracic deformities but are also at an increased risk of cervical fractures. Deformity correction and stabilization are particularly challenging in this patient population due to the brittle bone quality and low bone mineral density. Thoracic pedicle subtraction osteotomy is a workhorse approach for the correction of focal severe kyphotic deformity with lower complication rates than 3-column osteotomy. Successful execution of an upper thoracic PSO requires careful presurgical planning as well as anticipation of the patient's postoperative needs. Here, we describe the use of a T1 PSO in the correction of a rigid cervicothoracic chin-on-chest deformity in a patient with AS. The risk of implant failure was reduced by the use of a multi-rod construct, navigated cervical pedicle screws, and dual-pitched thoracic pedicle screws.
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Affiliation(s)
- Jacob Greenberg
- Department of Neurological Surgery, Cleveland Clinic Main Campus
- Center for Spine Health, Cleveland Clinic Main Campus, Cleveland Clinic Foundation, Cleveland
| | - Arpan A Patel
- Department of Neurological Surgery, Cleveland Clinic Main Campus
| | - Matt Magro
- Heritage College of Osteopathic Medicine Ohio University Warrensville Heights, OH
| | | | - Alexander Spiessberger
- Department of Neurological Surgery, Cleveland Clinic Main Campus
- Center for Spine Health, Cleveland Clinic Main Campus, Cleveland Clinic Foundation, Cleveland
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Wang Y, Huang Y, Zheng G, Zhang X, Wang T, Qi D, Hu W, Xue C, Zhao Y, Mao K, Wang Z. Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space. BRAIN & SPINE 2022; 3:101707. [PMID: 36685706 PMCID: PMC9845419 DOI: 10.1016/j.bas.2022.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/01/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
•This is a diagnostic study for a classification for posterior spinal osteotomy procedures via the intervertebral space.•Proposed a novel classification with excellent reliability and validity, differ from the SRS-Schwab osteotomy classification.•Give a novel definition of "trans-intervertebral osteotomy" (TIO) for posterior spinal osteotomy procedures.•Thoroughly discussed about the histories of posterior spinal osteotomy procedures via the intervertebral space.•Systematically introduced the TIO technique with fine original schematics.
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Affiliation(s)
- Yan Wang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China,Corresponding author.
| | - Yi Huang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China,Nankai University School of Medicine, Nankai University, Tianjin, 300071, China
| | - GuoQuan Zheng
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xuesong Zhang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Tianhao Wang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Dengbin Qi
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Wenhao Hu
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Chao Xue
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yongfei Zhao
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Keya Mao
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Zheng Wang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
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North RY, Yee TJ, Strong MJ, Saadeh YS, Garton HJL, Park P. Syrinx regression after correction of iatrogenic kyphotic deformity: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 3:CASE21483. [PMID: 36130582 PMCID: PMC9379703 DOI: 10.3171/case21483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/22/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Syringomyelia has a long-established association with pediatric scoliosis, but few data exist on the relationship of syringomyelia to pediatric kyphotic deformities. OBSERVATIONS This report reviewed a unique case of rapid and sustained regression of syringomyelia in a 13-year-old girl after surgical correction of iatrogenic kyphotic deformity. LESSONS In cases of syringomyelia associated with acquired spinal deformity, treatment of deformity to resolve an associated subarachnoid block should be considered because it may obviate the need for direct treatment of syrinx.
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Kim HJ, Virk S, Elysee J, Ames C, Passias P, Shaffrey C, Mundis G, Protopsaltis T, Gupta M, Klineberg E, Hart R, Smith JS, Bess S, Schwab F, Lafage R, Lafage V. Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity. J Clin Med 2021; 10:jcm10214826. [PMID: 34768346 PMCID: PMC8584313 DOI: 10.3390/jcm10214826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based on different morphologies of cervical deformity. Methods: Adult patients enrolled in a prospective cervical deformity database were classified into four deformity types (Flatneck (FN), Focal kyphosis (FK), Cervicothoracic kyphosis (CTK) and Coronal (C)), as previously described. We analyzed group differences in demographics, preoperative symptoms, health-related quality of life scores (HRQOLs), and surgical strategies were evaluated, and postop radiographic and HROQLs at 1+ year follow up were compared. Results: 90/109 eligible patients (mean age 63.3 ± 9.2, 64% female, CCI 1.01 ± 1.36) were evaluated. Group distributions included FN = 33%, FK = 29%, CTK = 29%, and C = 9%. Significant differences were noted in the surgical approaches for the four types of deformities, with FN and FK having a high number of anterior/posterior (APSF) approaches, while CTK and C had more posterior only (PSF) approaches. For FN and FK, PSF was utilized more in cases with prior anterior surgery (70% vs. 25%). For FN group, PSF resulted in inferior neck disability index compared to those receiving APSF suggesting APSF is superior for FN types. CTK types had more three-column osteotomies (3CO) (p < 0.01) and longer fusions with the LIV below T7 (p < 0.01). There were no differences in the UIV between all deformity types (p = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (p < 0.05) with their respective surgical strategies. Conclusions: The four types of cervical deformities had different surgical strategies to achieve improvements in HRQOLs. FN and FK types were more often treated with APSF surgery, while types CTK and C were more likely to undergo PSF. CTK deformities had the highest number of 3COs. This information may provide guidelines for the successful management of cervical deformities.
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Affiliation(s)
- Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
- Correspondence:
| | - Sohrab Virk
- Department of Orthopedics, Northwell Health, Great Neck, New York, NY 11021, USA;
| | - Jonathan Elysee
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
| | - Christopher Ames
- Department of Neurosurgery, University of San Francisco School of Medicine, San Francisco, CA 94143, USA;
| | - Peter Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY 10016, USA; (P.P.); (T.P.)
| | - Christopher Shaffrey
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27708, USA;
| | - Gregory Mundis
- Division of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, CA 92037, USA;
| | | | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO 63010, USA;
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of California Davis, Davis, CA 95616, USA;
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 22904, USA;
| | - Shay Bess
- Denver International Spine Center, Rocky Mountain Hospital for Children at Presbyterian St. Luke’s, Denver, CO 80218, USA;
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
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Lau D, Guo L, Deviren V, Ames CP. Utility of intraoperative neuromonitoring and outcomes of neurological complication in lower cervical and upper thoracic posterior-based three-column osteotomies for cervical deformity. J Neurosurg Spine 2021:1-9. [PMID: 34624840 DOI: 10.3171/2021.5.spine202057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For severe and rigid adult cervical deformity, posterior-based three-column osteotomies (3COs) are warranted, but neurological complications are relatively high with such procedures. The performance measures of intraoperative neuromonitoring (IONM) during cervicothoracic 3CO have yet to be studied, and there remains a paucity of literature regarding the topic. Therefore, the authors of this study examined the performance of IONM in predicting new neurological weakness following lower cervical and upper thoracic 3CO. In addition, they report the 6-month, 1-year, and 2-year outcomes of patients who experienced new postoperative weakness. METHODS The authors performed a retrospective review of a single surgeon's experience from 2011 to 2018 with all patients who had undergone posterior-based 3CO in the lower cervical (C7) or upper thoracic (T1-4) spine. Medical and neuromonitoring records were independently reviewed. RESULTS A total of 56 patients were included in the analysis, 38 of whom had undergone pedicle subtraction osteotomy and 18 of whom had undergone vertebral column resection. The mean age was 61.6 years, and 41.1% of the patients were male. Among the study cohort, 66.1% were myelopathic and 33.9% had preoperative weakness. Mean blood loss was 1565.0 ml, and length of surgery was 315.9 minutes. Preoperative and postoperative measures assessed were cervical sagittal vertical axis (6.5 and 3.8 cm, respectively; p < 0.001), cervical lordosis (2.3° and -6.7°, p = 0.042), and T1 slope (48.6° and 35.8°, p < 0.001). The complication rate was 49.0%, and the new neurological deficit rate was 17.9%. When stratifying by osteotomy level, there were significantly higher rates of neurological deficits at C7 and T1: C7 (37.5%), T1 (44.4%), T2 (16.7%), T3 (14.3%), and T4 (0.0%; p = 0.042). Most new neurological weakness was the nerve root pattern rather than the spinal cord pattern. Overall, there were 16 IONM changes at any threshold: 14 at 50%, 8 at 75%, and 13 if only counting patients who did not return to baseline (RTB). Performance measures for the various thresholds were accuracy (73.2% to 77.8%), positive predictive value (25.0% to 46.2%), negative predictive value (81.3% to 88.1%), sensitivity (18.2% to 54.5%), and specificity (77.8% to 86.7%). Sensitivity to detect a spinal cord pattern of weakness was 100% and 28.6% for a nerve root pattern of weakness. In patients with a new postoperative deficit, 22.2% were unchanged, 44.4% improved, and 33.3% had a RTB at the 2-year follow-up. CONCLUSIONS Complication rates are high following posterior 3CO for cervical deformity. 3CO at C7 and T1 has the highest rates of neurological deficit. Current IONM modalities have modest performance in predicting postoperative deficits, especially for nerve root neuropraxia. A large prospective multicenter study is warranted.
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Affiliation(s)
- Darryl Lau
- 1Department of Neurosurgery, New York University, New York, New York
| | - Lanjun Guo
- 2Department of Neurophysiology, University of California, San Francisco
| | - Vedat Deviren
- 3Department of Orthopaedic Surgery, University of California, San Francisco; and
| | - Christopher P Ames
- 4Department of Neurological Surgery, University of California, San Francisco, California
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Bourghli A, Boissière L, Konbaz F, Al Eissa S, Al-Habib A, Qian BP, Qiu Y, Hayashi K, Pizones J, Ames C, Vital JM, Obeid I. On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab's spinal osteotomy classification. Spine Deform 2021; 9:515-528. [PMID: 33206354 DOI: 10.1007/s43390-020-00247-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To propose a complementary classification to the Schwab's osteotomy classification that would regroup together under a common umbrella different published pedicle subtraction osteotomy (PSO) variations that are commonly used, to have a common language and complete the spine surgeon's armamentarium when dealing with rigid spinal deformities. METHODS The 2 general types corresponding to the grades 3 and 4 of the Schwab classification were separated into 6 gradual subtypes (grades 3A, 3B, 3C, 4A, 4B, 4C). The classification is based on the amount of resected pedicle, the inclusion or not of the disc above, and the location of the axis of rotation. Based on the proposed classification, a reliability study was performed using 18 cases that were classified by 8 readers with expertise in the management of adult deformities with the use of osteotomies. RESULTS Clinical cases were classified according to the 6 grades proposed in the classification. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92 (range 0.85-1.00). The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.90 for the 2 readings that were done at an interval of 2 weeks. CONCLUSION The developed classification proved to be reliable and intuitive. It is an original way to display a catalog of different available PSO modifications including the original technique, in a logical and gradual order to help the surgeons in their decisions and show them that between a grade 2 osteotomy and a grade 5 osteotomy, many intermediate options are available. Further work with a treatment algorithm for clinical practice based on the current classification may be developed in the future.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, PO Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Faisal Konbaz
- Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sami Al Eissa
- Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bang-Ping Qian
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Jean-Marc Vital
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Obeid I, Boissiere L, Bourghli A. Cervical Deformity Arising From Upper Thoracic Malalignment. Neurospine 2020; 17:568-573. [PMID: 33022161 PMCID: PMC7538347 DOI: 10.14245/ns.2040412.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/22/2020] [Indexed: 11/22/2022] Open
Abstract
This study aims to describe the surgical management of cervical deformity arising from outside the cervical spine because of upper thoracic malalignment, using pedicle subtraction osteotomy (PSO). Cervical spine deformity is a complex topic and it can be generally divided into 2 categories, the first category is when the primary deformity is inside the cervical spine and the treatment will focus on the cervical spine itself, whereas the second category is when the primary deformity is outside the cervical spine usually in the adjacent upper thoracic area, the cervical deformity is a compensation for the adjacent malalignment, and thus in this situation, the management will occur in the upper thoracic area. Description of a single surgeon’s technique for performing PSO to treat rigid upper thoracic deformity. PSO in the upper thoracic spine is a safe and effective procedure and can result in satisfying clinical and radiological outcome with indirect correction of the compensatory cervical deformity. Cervical deformity arising from upper thoracic malalignment should be dealt with by treating the problem at its origin outside the cervical spine by performing a PSO in the upper thoracic spine.
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Affiliation(s)
- Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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Gupta MC, Gupta S, Kelly MP, Bridwell KH. Pedicle Subtraction Osteotomy. JBJS Essent Surg Tech 2020; 10:ST-D-19-00028. [PMID: 32368407 DOI: 10.2106/jbjs.st.19.00028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pedicle subtraction osteotomy (PSO) was originally performed in cases of ankylosing spondylitis. This procedure was invented because it was safer than trying to lengthen the anterior column via osteoclasis, which risked vascular injury and death1-4. PSO involves the removal of the posterior elements and the use of a vertebral body wedge to shorten the spine posteriorly and achieve sagittal-plane correction5,6. PSO has been used to correct sagittal-plane deformities not only in patients with ankylosing spondylitis but also in those with degenerative conditions or those who have previously undergone surgical procedures resulting in a loss of lumbar lordosis7,8. Description The fixation points are placed with pedicle screws above and below the planned osteotomy level. The posterior elements are decompressed at the level of the osteotomy and at 1 level proximally. In addition to the use of straight and angled curets, a high-speed burr is used to decancellate the vertebral body. Pedicle osteotomes are used to remove the pedicle. Temporary rods are placed. The posterior wall of the body is then impacted into the vertebral body, and the temporary rods are loosened. To close the osteotomy, the bed is extended or the spine is pushed manually, resulting in correction of the lordosis. The temporary rods are tightened. The main rods, independent of the short rods, are used to connect multiple segments several levels above and below the osteotomy site to provide final stabilization. Alternatives The alternatives to PSO depend on the surgical history of the patients, as well as the flexibility and alignment of the spine. In a spine with mobile disc spaces, Smith-Petersen osteotomies can be performed posteriorly to shorten the posterior column over multiple segments to gain lordosis. A formal anterior or lateral approach can be performed to release the disc spaces and restore the disc height. A posterior release through the facet joints with segmental compression can achieve desired lumbar lordosis. A vertebral column resection can also be performed to achieve lordosis. Rationale PSO is ideal for patients who have undergone multiple spinal fusions and who have a very rigid, flat lumbar spine. A single posterior approach can be used to provide adequate correction of the flat lumbar spine up to 40°. Asymmetric PSO can also be performed to allow for correction in the coronal plane. Recently, PSO has been performed more frequently because of the improved osteotomy instrumentation, exposure to resection techniques, and improved positioning tables that allow correction of the osteotomy.
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Affiliation(s)
- Munish C Gupta
- Washington University School of Medicine, Saint Louis, Missouri
| | - Sachin Gupta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Kelly
- Washington University School of Medicine, Saint Louis, Missouri
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9
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Is Multilevel Anterior Lumbar Interbody Fusion (ALIF) Superior to Pedicle Subtraction Osteotomy (PSO) for Degenerative Lumbar Deformity? Clin Spine Surg 2020; 33:1-4. [PMID: 30932932 DOI: 10.1097/bsd.0000000000000817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Yuk FJ, Rasouli JJ, Arginteanu MS, Steinberger AA, Moore FM, Yao KC, Caridi JM, Gologorsky Y. The case for T2 pedicle subtraction osteotomy in the surgical treatment of rigid cervicothoracic deformity. J Neurosurg Spine 2019; 32:248-257. [PMID: 31653807 DOI: 10.3171/2019.7.spine19350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rigid cervicothoracic kyphotic deformity (CTKD) remains a difficult pathology to treat, especially in the setting of prior cervical instrumentation and fusion. CTKD may result in chronic neck pain, difficulty maintaining horizontal gaze, and myelopathy. Prior studies have advocated for the use of C7 or T1 pedicle subtraction osteotomies (PSOs). However, these surgeries are fraught with danger and, most significantly, place the C7, C8, and/or T1 nerve roots at risk. METHODS The authors retrospectively reviewed their experience with performing T2 PSO for the correction of rigid CTKD. Demographics collected included age, sex, details of prior cervical surgery, and coexisting conditions. Perioperative variables included levels decompressed, levels instrumented, estimated blood loss, length of surgery, length of stay, complications from surgery, and length of follow-up. Radiographic measurements included C2-7 sagittal vertical axis (SVA) correction, and changes in the cervicothoracic Cobb angle, lumbar lordosis, and C2-S1 SVA. RESULTS Four male patients were identified (age range 55-72 years). Three patients had undergone prior posterior cervical laminectomy and instrumented fusion and developed postsurgical kyphosis. All patients underwent T2 PSO: 2 patients received instrumentation at C2-T4, and 2 patients received instrumentation at C2-T5. The median C2-7 SVA correction was 3.85 cm (range 2.9-5.3 cm). The sagittal Cobb angle correction ranged from 27.8° to 37.6°. Notably, there were no neurological complications. CONCLUSIONS T2 PSO is a powerful correction technique for the treatment of rigid CTKD. Compared with C7 or T1 PSO, there is decreased risk of injury to intrinsic hand muscle innervators, and there is virtually no risk of vertebral artery injury. Laminectomy may also be safer, as there is less (or no) scar tissue from prior surgeries. Correction at this distal level may allow for a greater sagittal correction. The authors are optimistic that these findings will be corroborated in larger cohorts examining this challenging clinical entity.
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Obeid I, Berjano P, Lamartina C, Chopin D, Boissière L, Bourghli A. Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:94-113. [PMID: 30460601 DOI: 10.1007/s00586-018-5826-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/06/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. METHODS This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. RESULTS Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. CONCLUSION Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
| | | | | | - Daniel Chopin
- Neuro-Orthopedic Spine Unit, Lille University Hospital, Lille, France
| | - Louis Boissière
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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