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Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients

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Abstract

Three-column osteotomy (3-CO) is a powerful technique in adult deformity surgery, and pedicle subtraction osteotomy (PSO) is the workhorse to correct severe kyphotic spinal deformities. Aging of the population, increasing cases of iatrogenic flat back deformities and understanding the importance of sagittal balance have led to a dramatic increase of this surgical technique. Surgery, however, is demanding and associated with high complication rates so that every step of the procedure requires meticulous technique. Particularly, osteotomy closure is associated with risks like secondary fracture, translation, or iatrogenic stenosis. This step is traditionally performed by compression or a cantilever maneuver with sometimes excessive forces on the screws or instrumentation. Implant loosening or abrupt subluxation resulting in construct failure and/or neurological deficits can result. The aim of this prospective registry study was to assess the efficacy and safety of our surgical PSO technique as well as the osteotomy closure by flexing a hinge-powered OR table. In a series of 84 consecutive lumbosacral 3-CO, a standardized surgical technique with special focus on closure of the osteotomy was prospectively evaluated. The surgical steps with the patients positioned prone on a soft frame are detailed. Osteotomy closure was achieved by remote controlled bending of a standard OR table without compressive or cantilever forces in all 84 cases. This technique carries a number of advantages, particularly the reversibility and the slow speed of closure with minimum force. There was not a single mechanical intraoperative complication such as vertebral body fracture, subluxation, or adjacent implant loosening during osteotomy closure, compared to external cohorts using the cantilever technique (p = 0.130). The feasibility of controlled 3-CO closure by flexing a standard OR table is demonstrated. This technique enables a safe, gentle closure of the osteotomy site with minimal risk of implant failure or accidental neurological injury.

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Data availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

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Not applicable.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria

    Pierre-Pascal Girod, Nikolaus Kögl, Sara Lener, Sebastian Hartmann & Claudius Thomé

  2. Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland

    Granit Molliqaj

Authors
  1. Pierre-Pascal Girod
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  2. Nikolaus Kögl
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  3. Granit Molliqaj
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  4. Sara Lener
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  5. Sebastian Hartmann
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  6. Claudius Thomé
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Contributions

PPG is the first author. PPG, NK, and CT made substantial contributions to the conception. PPG, NK, SL, GM, and SH were actively involved in the acquisition as well as analysis and interpretation of data. PPG, NK, and CT drafted the paper, whereas all authors critically revised it. The final version was read by all authors, who gave the final approval of the version to be published. All authors are accountable for all aspects of the work. PPG should be approached in case of further questions as he is the first and corresponding author.

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Correspondence to Pierre-Pascal Girod.

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The research conducted has been performed in accordance with the Declaration of Helsinki and was approved by the local research ethics committee (AN2014-0234).

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Informed consent for study participation was obtained prior to surgery.

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Informed consent for publication was obtained along with the ICF.

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The authors declare no competing interests.

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Girod, PP., Kögl, N., Molliqaj, G. et al. Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients. Neurosurg Rev 45, 517–524 (2022). https://doi.org/10.1007/s10143-021-01559-5

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  • DOI: https://doi.org/10.1007/s10143-021-01559-5

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