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L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyphosis deformity: a more than 2-year follow-up report

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Abstract

Purpose

L5 pedicle subtraction osteotomy (PSO) is a demanding technique; thus, PSOs are usually performed at the L3/L4 level to correct the lack of lumbar lordosis. Mid- to long-term improvements in clinical outcomes after L5 PSO are unknown. We aimed to determine the efficacy and safety of L5 PSO for rigid kyphosis deformities.

Methods

We retrospectively reviewed the records of 57 patients with a rigid kyphosis deformity (mean age: 68 years) who underwent extensive corrective surgery incorporating PSO with a > 2-year follow-up. Radiographic parameters, postoperative complication rates, and the Oswestry Disability Index (ODI) scores were compared in the L5, L4, and L1-3 PSO groups preoperatively and at 1, 2, and 5 years postoperatively.

Results

There were 12, 25, and 20 patients in the L5, L4, and L1-3 PSO groups, respectively. Significant between-group differences were found in preoperative L4–S1 lordosis (L5:L4:L1-3 PSO groups =  − 8.9°:8.9°:16.2°, P < 0.001). The surgeries improved the postoperative spinopelvic alignment (similar in all groups). There was no significant between-group difference in the postoperative complication rate; no irreversible complications occurred. In the L5 PSO group, there was one case of a common iliac vein injury. The ODI scores improved postoperatively in all groups; this was maintained for 5 years postoperatively.

Conclusion

L5 PSO for L4-5/L5 kyphosis deformities resulted in adequate correction and ODI improvement, which were maintained up to 5 years postoperatively. The surgical invasiveness, complication rates, and long-term prognosis associated with L5 PSO were similar to those of PSOs performed at other levels.

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Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We express our appreciation to Sho Kobayashi and Daisuke Togawa for their assistance in collecting the cases and engaging in discussions regarding the manuscript. We would like to thank Editage (www.editage.jp) for English language editing.

Funding

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan

    Hiroki Ushirozako, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Yuki Mihara, Tomohiro Yamada, Koichiro Ide, Yuh Watanabe, Keichi Nakai & Yukihiro Matsuyama

  2. Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Yu Yamato & Shin Oe

  3. Department of Orthopaedic Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan

    Tatsuya Yasuda

Authors
  1. Hiroki Ushirozako
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  2. Tomohiko Hasegawa
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  3. Yu Yamato
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  4. Go Yoshida
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  5. Tatsuya Yasuda
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  6. Tomohiro Banno
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  7. Hideyuki Arima
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  8. Shin Oe
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  9. Yuki Mihara
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  10. Tomohiro Yamada
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  11. Koichiro Ide
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  12. Yuh Watanabe
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  13. Keichi Nakai
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  14. Yukihiro Matsuyama
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Contributions

YM supervised the study. TH was responsible for the study’s conception and design. HU acquired, analysed, and interpreted the data; drafted the article; and approved the final version on behalf of all authors. All authors have critically revised the article and reviewed the submitted version.

Corresponding author

Correspondence to Tomohiko Hasegawa.

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Conflict of interest

Dr. Yamato and Dr. Oe work for a donation-funded laboratory called the “Division of Geriatric Musculoskeletal Health”. Donations to this laboratory were received from Medtronic Sofamor Danek, Inc., Japan Medical Dynamic Marketing, Inc., and Meitoku Medical Institution Jyuzen Memorial Hospital. The other authors declare no conflicts of interest.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

Ethical approval

The study protocol was approved by the Institutional Review Board of Hamamatsu University School of Medicine (No. 14-306). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Ushirozako, H., Hasegawa, T., Yamato, Y. et al. L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyphosis deformity: a more than 2-year follow-up report. Eur Spine J 29, 3018–3027 (2020). https://doi.org/10.1007/s00586-020-06616-z

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