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Pedicle subtraction osteotomy in the lumbar spine: indications, technical aspects, results and complications

  • Cedric BarreyEmail author
  • Gilles Perrin
  • Frederic Michel
  • Jean-Marc Vital
  • Ibrahim Obeid
Original Article

Abstract

Pedicle subtraction osteotomy (PSO) consists of creating posteriorly trapezoidal shape of a vertebra, usually L3 or L4, in order to recreate lordosis in the lumbar spine. It is usually indicated to treat rigid kyphotic lumbar spine associated with sagittal imbalance and due to degenerative changes or to iatrogenic flat back. PSO is technically demanding with high rates of complications and should be performed by experienced teams. We presently report our experience about PSO performed in the lumbar spine (below L1) through a series of 25 cases with a special focus on technical aspects and complications associated with the surgical procedure. Mean age was 64 ± 11 years old. PSO was performed at L4 in the majority of cases. Mean blood loss was 1,070 ± 470 ml, and mean duration of the surgery was 241 ± 44 min. VAS decreased from 7.5 ± 2 preoperatively to 3.2 ± 2.5 at 1 year, and ODI decreased from 64 ± 12 preoperatively to 32 ± 18 at 1 year, p < 0.05. Mean gain of lordosis after PSO varies from 20° to 40° and was measured to 27° ± 10° on average. Lumbar lordosis (T12-S1) was measured to 21° ± 10° preoperatively to 50° ± 11° postoperatively at 1 year, p < 0.05. A total of five major complications (20 %) were observed (two mechanical, one neurological and two infections) necessitating five reoperations. In conclusion, PSO was highly efficient to restore lumbar lordosis and correct sagittal imbalance. It was associated with a non-negligible, but acceptable rate of complications. To limit the risk of mechanical complications, we recommend fusing the adjacent disks whatever the approach (PLIF/TLIF/XLIF). Most complications can be reduced with adequate environment, informed anesthesiologists and experienced surgical team.

Keywords

Lumbar spine Osteotomy Lordosis Pedicle subtraction osteotomy Spine surgery 

Notes

Conflict of interest

None.

References

  1. 1.
    Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 194:142–152PubMedGoogle Scholar
  2. 2.
    Herbert JJ (1954) Considerations on the technique and results of 42 cases of vertebral osteotomy. Rev Chir 73(11–12):357–377 [in French]PubMedGoogle Scholar
  3. 3.
    Debeyre J, Juteau B (1962) A propos of a case of lumbar osteotomy for ankylosing spondylitis. Rev Rhum Mal Osteoartic 29:291–293 [in French]PubMedGoogle Scholar
  4. 4.
    Hyun SJ, Kim YJ, Rhim SC (2013) Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients. World J Clin Cases 1(8):242–248PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9PubMedGoogle Scholar
  7. 7.
    Kim YJ, Bridwell KH, Lenke LG, Boachie-Adjei O, Hamill C, Kim YB. Sagittal spinopelvic alignment change after lumbar pedicle subtraction osteotomy: a multicenter analysis of 114 patients with a minimum 2-year follow-up. SRS 2008: Proceedings of the 43rd annual meeting of scoliosis research society, 2008, Salt Lake City, Utah (USA)Google Scholar
  8. 8.
    Suk SI, Kim JH, Lee SM, Chung ER, Lee JH (2003) Anterior-posterior surgery versus posterior closing wedge osteotomy in post-traumatic kyphosis with neurologica compromised osteoporotic fracture. Spine 28:2170–2175PubMedCrossRefGoogle Scholar
  9. 9.
    Bridwell KH (2006) Decision making regarding Smith-Petersen versus pedicle subtraction osteotomy versus vertebral column resection for spinal deformity. Spine 31:S171–S178PubMedCrossRefGoogle Scholar
  10. 10.
    Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey C, Glassman S, Farcy JP, Lafage V (2014) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74:112–120PubMedCrossRefGoogle Scholar
  11. 11.
    Amzallag J (2008) Complications of spinal osteotomies: multicenter study of 402 cases [in French]. Paris Val-de-Marne University, CréteilGoogle Scholar
  12. 12.
    Hyun SJ, Rhim SC (2010) Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc 47:95–101PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Barrey C, Roussouly P, LeHuec JC, D’Acunzi G, Perrin G (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22:S834–S841PubMedCrossRefGoogle Scholar
  14. 14.
    Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231PubMedCrossRefGoogle Scholar
  15. 15.
    Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, Baldus C, Blanke K (2003) Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine 28:2093–2101PubMedCrossRefGoogle Scholar
  16. 16.
    Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA, Kim YJ, Stewart D, Baldus C (2007) Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine 32:2245–2252PubMedCrossRefGoogle Scholar
  17. 17.
    Gavaret M, Jouve JL, Pereon Y, Accadbled F, Andre-Obadia N, Blondel B, Bollini G, Delecrin J, Farcy J, Fournet-Fayard J, Garin C, Henry P, Manel V, Mutschler V, Perrin G, Sales de Gauzy J, French Society of Spine Surgery SFCR (2013) Intraoperative neurophysiologic monitoring in spine surgery. Development and state of the art in France in 2011. Orthop Traum Surg Res 99:S319–S327CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Cedric Barrey
    • 1
    • 2
    • 3
    Email author
  • Gilles Perrin
    • 1
    • 2
  • Frederic Michel
    • 1
    • 2
  • Jean-Marc Vital
    • 4
    • 5
  • Ibrahim Obeid
    • 4
    • 5
  1. 1.Department of Neurosurgery, P Wertheimer Hospital, Hospices Civils de LyonUniversity Claude Bernard Lyon 1LyonFrance
  2. 2.Department of Spine Surgery, P Wertheimer Hospital, Hospices Civils de LyonUniversity Claude Bernard Lyon 1LyonFrance
  3. 3.Laboratory of BiomechanicsENSAM, Arts et Metiers ParisTechParisFrance
  4. 4.Department of OrthopaedicsUniversity Hospital of BordeauxBordeauxFrance
  5. 5.Department of Spine SurgeryUniversity Hospital of BordeauxBordeauxFrance

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