European Spine Journal

, Volume 26, Issue 8, pp 2204–2210 | Cite as

New method for correction of lumbo-sacral kyphosis deformity in patient with high pelvic incidence

  • Marcin Czyz
  • Stephen Forster
  • James Holton
  • Babak Shariati
  • David J. Clarkson
  • Bronek M. Boszczyk
Ideas and Technical Innovations

Abstract

Study design

Technical note.

Objective

We describe a novel technique of bilateral longitudinal sacral osteotomy allowing direct reduction of high pelvic incidence (PI) and correction of sagittal imbalance.

Methods

A 25-year-old female patient presented with a disabling lumbo-sacral kyphosis fused in situ through previous operations with residual low-grade wound infection and grade IV L5/S1 spondylolisthesis with severity index (SI) of 65%. A two-stage correction was performed. First anterior in situ fixation of the L4–L5–S1 segments was performed using a hollow modular anchorages (HMA) screw and L3/L4 anterior interbody cage. The second stage consisted of instrumentation of the lower lumbar spine and pelvis; placement of an S1 transverse K-wire as pivot point and bilateral longitudinal sacral osteotomy which allowed for gradual retroversion of the central sacrum relative to the pelvis.

Results

Sacrum was derotated by 30° which allowed to restore spinal sagittal balance and decrease SI by 15%. Postoperative recovery was complicated by a flare up of the pre-existing deep wound infection.

Conclusions

Bilateral longitudinal sacral osteotomy appears to be a safe and efficient way of correcting the sagittal imbalance caused by an extremely high PI. Although technically demanding, it achieves good radiological and functional outcomes and avoids entering the spinal canal.

Keywords

Lumbo-sacral kyphosis High-grade spondylolisthesis High pelvic incidence Sacral osteotomy Spinal balance HMA screw 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bodin A, Roussouly P (2015) Sacral and pelvic osteotomies for correction of spinal deformities. Eur Spine J 24(Suppl 1):S72–S82. doi: 10.1007/s00586-014-3651-x CrossRefPubMedGoogle Scholar
  2. 2.
    Chiffolot X, Lemaire JP, Bogorin I, Steib JP (2006) Pedicle closing-wedge osteotomy for the treatment of fixed sagittal imbalance. Rev Chir Orthop Reparatrice Appar Mot 92:257–265CrossRefPubMedGoogle Scholar
  3. 3.
    Enercan M, Ozturk C, Kahraman S, Sarier M, Hamzaoglu A, Alanay A (2013) Osteotomies/spinal column resections in adult deformity. Eur Spine J 22(Suppl 2):S254–S264. doi: 10.1007/s00586-012-2313-0 CrossRefPubMedGoogle Scholar
  4. 4.
    Hsieh PC, Ondra SL, Wienecke RJ, O’Shaughnessy BA, Koski TR (2007) A novel approach to sagittal balance restoration following iatrogenic sacral fracture and resulting sacral kyphotic deformity. Technical note. J Neurosurg Spine 6:368–372. doi: 10.3171/spi.2007.6.4.15 CrossRefPubMedGoogle Scholar
  5. 5.
    Min K, Liebscher T, Rothenfluh D (2012) Sacral dome resection and single-stage posterior reduction in the treatment of high-grade high dysplastic spondylolisthesis in adolescents and young adults. Eur Spine J 21(Suppl 6):S785–S791. doi: 10.1007/s00586-011-1949-5 CrossRefPubMedGoogle Scholar
  6. 6.
    Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836. doi: 10.1007/s00586-010-1476-9 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lamartina C, Zavatsky JM, Petruzzi M, Specchia N (2009) Novel concepts in the evaluation and treatment of high-dysplastic spondylolisthesis. Eur Spine J 18(Suppl 1):133–142. doi: 10.1007/s00586-009-0984-y CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Osaka S, Yoshida Y, Ryu J (2007) Longitudinal osteotomy of lateral sacrum for malignant iliac tumor using modified threadwire saw. J Surg Oncol 95:258–260. doi: 10.1002/jso.20646 CrossRefPubMedGoogle Scholar
  9. 9.
    Konig MA, Boszczyk BM (2012) Limited access surgery for 360 degrees in situ fusion in a dysraphic patient with high-grade spondylolisthesis. Eur Spine J 21:390–395. doi: 10.1007/s00586-011-1994-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Moreau S, Lonjon G, Guigui P, Lenoir T, Garreau de Loubresse C, Chopin D (2016) Reduction and fusion in high-grade L5–S1 spondylolisthesis by a single posterior approach. Results in 50 patients. Orthop Traumatol Surg Res OTSR 102:233–237. doi: 10.1016/j.otsr.2015.12.016 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.The Centre for Spinal Studies and SurgeryNottingham University Hospitals NHS TrustNottinghamUK
  2. 2.Spinal ServiceThe Royal Orthopaedic Hospital NHS TrustBirminghamUK
  3. 3.Department of Trauma and OrthopaedicsManor Hospital, Walsall Healthcare NHS TrustWalsallUK
  4. 4.Department of Plastic and Reconstructive SurgeryNottingham City HospitalNottinghamUK

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