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Preoperative Planning for Pedicle Subtraction Osteotomy: Does Pelvic Tilt Matter?

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Abstract

Study Design

Multicenter, retrospective radiographic analysis.

Objectives

To evaluate the impact that preoperative spinopelvic parameters have on postoperative sagittal vertical axis (SVA). The researchers hypothesized that patients with a large preoperative pelvic tilt (PT) would require more extensive lumbar pedicle subtraction osteotomy (LPSO) procedures to reestablish anatomic postoperative SVA than patients with normal preoperative PT.

Summary of Background Data

Restoration of anatomic sagittal spinal alignment has been demonstrated to improve clinical outcomes. However, the degree to which spinopelvic parameters contribute to sagittal spinal malalignment is poorly understood.

Methods

Multicenter, retrospective analysis of 183 consecutively enrolled adult spinal deformity patients treated with LPSO procedures for correction of sagittal malalignment. Preoperative and postoperative freestanding full-length sagittal X-rays were analyzed for regional curves, pelvic parameters, and global alignment. Only patients with a preoperative SVA greater than 10 cm and a postoperative SVA less than 5 cm were retained for analysis. Patients were divided into 2 groups according to preoperative PT (low PT, less than 30°; and high PT, 3⩾30°). Independent t test analysis was used to determine differences in correction required to achieve postoperative SVA less than 5 cm.

Results

A total of 55 patients were identified for analysis. Low PT (n = 30) had lower preoperative PT than high PT (n = 25; 25° vs. 42°, respectively; p <.001). Analysis of the osteotomy performed demonstrated that the high PT group required a larger osteotomy resection (30° vs. 23°; p =.039) and a larger correction of lumbar lordosis (−43° vs. −31°;p =.006) to achieve an acceptable postoperative SVA (less than 5 cm).

Conclusions

This study demonstrates that patients with high PT in conjunction with sagittal spinal malalignment require larger lumbar osteotomy procedures, including a greater osteotomy resection and larger lumbar lordosis correction, to obtain a satisfactory postoperative SVA. Surgeons performing LPSO procedures must evaluate preoperative spinopelvic parameters, including PT, to avoid undercorrection and residual deformity after complex sagittal realignment procedures.

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Author information

Authors and Affiliations

  1. Spine Division, NYU Hospital for Joint Diseases, 306 E 15th Street, New York, NY, 10003, USA

    Virginie Lafage PhD, Benjamin Blondel MD & Frank Schwab MD

  2. Universite Aix-Marseille, Marseille, 3 Place Victor Hugo, 13331, Marseille Cédex 3, France

    Benjamin Blondel MD

  3. Neurological Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA

    Justin S. Smith MD, PhD

  4. Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Oheneba Boachie-Adjei MD

  5. Orthopedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd #800, Piano, TX, 75093, USA

    Richard A. Hostin MD

  6. Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Douglas Burton MD

  7. San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr, La Jolla, CA, 92037, USA

    Gregory Mundis MD & Behrooz Akbarnia MD

  8. Department of Orthopedic Surgery, University of California, Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA, 95817, USA

    Eric Klineberg MD

  9. Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA

    Christopher Ames MD

  10. Orthopedic Center, Rocky Mountain Hospital for Children, 1719 E 19th Ave, Denver, CO, 80218, USA

    Shay Bess MD

Authors
  1. Virginie Lafage PhD
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  2. Benjamin Blondel MD
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  3. Justin S. Smith MD, PhD
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  12. Frank Schwab MD
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Consortia

International Spine Study Group

Corresponding author

Correspondence to Virginie Lafage PhD.

Additional information

Author disclosures: VL (none); BBL (none); JSS (none); OBA (none); RH (none); DB (none); GM (none); EK (none); CA (none); BA (none); SB (none); FS (none).

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Lafage, V., Blondel, B., Smith, J.S. et al. Preoperative Planning for Pedicle Subtraction Osteotomy: Does Pelvic Tilt Matter?. Spine Deform 2, 358–366 (2014). https://doi.org/10.1016/j.jspd.2014.05.006

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  • DOI: https://doi.org/10.1016/j.jspd.2014.05.006

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