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On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab’s spinal osteotomy classification

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Abstract

Purpose

To propose a complementary classification to the Schwab’s osteotomy classification that would regroup together under a common umbrella different published pedicle subtraction osteotomy (PSO) variations that are commonly used, to have a common language and complete the spine surgeon’s armamentarium when dealing with rigid spinal deformities.

Methods

The 2 general types corresponding to the grades 3 and 4 of the Schwab classification were separated into 6 gradual subtypes (grades 3A, 3B, 3C, 4A, 4B, 4C). The classification is based on the amount of resected pedicle, the inclusion or not of the disc above, and the location of the axis of rotation. Based on the proposed classification, a reliability study was performed using 18 cases that were classified by 8 readers with expertise in the management of adult deformities with the use of osteotomies.

Results

Clinical cases were classified according to the 6 grades proposed in the classification. The intra-rater reliability for the classification was “almost perfect agreement” with a Fleiss kappa coefficient average of 0.92 (range 0.85–1.00). The inter-rater reliability was “almost perfect agreement” with a coefficient average of 0.90 for the 2 readings that were done at an interval of 2 weeks.

Conclusion

The developed classification proved to be reliable and intuitive. It is an original way to display a catalog of different available PSO modifications including the original technique, in a logical and gradual order to help the surgeons in their decisions and show them that between a grade 2 osteotomy and a grade 5 osteotomy, many intermediate options are available. Further work with a treatment algorithm for clinical practice based on the current classification may be developed in the future.

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References

  1. Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 194:142–152

    Google Scholar 

  2. Jaffray D, Becker V, Eisenstein S (1992) Closing wedge osteotomy with transpedicular fixation in ankylosing spondylitis. Clin Orthop Relat Res 279:122–126

    Google Scholar 

  3. van Royen BJ, Slot GH (1995) Closing-wedge posterior osteotomy for ankylosing spondylitis. Partial corporectomy and transpedicular fixation in 22 cases. J Bone Jt Surg Br 77:117–121

    Article  Google Scholar 

  4. Thiranont N, Netrawichien P (1993) Transpedicular decancellation closed wedge vertebral osteotomy for treatment of fixed flexion deformity of spine in ankylosing spondylitis. Spine (Phila Pa 1976) 18:2517–2522

    Article  CAS  Google Scholar 

  5. Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Jt Surg Am 85-A:454–463

    Article  Google Scholar 

  6. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy JP, Lafage V (2014) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74:112–120. https://doi.org/10.1227/NEU.0000000000000182o ((discussion 120))

    Article  PubMed  Google Scholar 

  7. Kim KT, Park DH, Lee SH, Suk KS, Lee JH, Park KJ (2013) Partial pedicle subtraction osteotomy as an alternative option for spinal sagittal deformity correction. Spine (Phila Pa 1976) 38:1238–1243. https://doi.org/10.1097/BRS.0b013e31828e0e56

    Article  Google Scholar 

  8. Chang KW, Cheng CW, Chen HC, Chang KI, Chen TC (2008) Closing-opening wedge osteotomy for the treatment of sagittal imbalance. Spine (Phila Pa 1976) 33:1470–1477. https://doi.org/10.1097/BRS.0b013e3181753bcd

    Article  Google Scholar 

  9. Mehdian H, Arun R, Aresti NA (2015) V–Y vertebral body osteotomy for the treatment of fixed sagittal plane spinal deformity. Spine J 15:771–776. https://doi.org/10.1016/j.spinee.2015.01.014

    Article  PubMed  Google Scholar 

  10. Hu W, Yu J, Liu H, Zhang X, Wang Y (2016) Y shape osteotomy in ankylosing spondylitis, a prospective case series with minimum 2 year follow-up. PLoS ONE 11:e0167792. https://doi.org/10.1371/journal.pone.0167792

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Park JH, Hyun SJ, Kim KJ, Jahng TA (2017) Comparative study between pedicle subtraction osteotomy (PSO) and closing-opening wedge osteotomy (Fish-Mouth PSO) for sagittal plane deformity correction. Spine (Phila Pa 1976) 42:E899–E905. https://doi.org/10.1097/BRS.0000000000002007

    Article  Google Scholar 

  12. Gao R, Wu J, Yuan W, Yang C, Pan F, Zhou X (2015) Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis. Spine J 15:2009–2015. https://doi.org/10.1016/j.spinee.2015.04.047

    Article  PubMed  Google Scholar 

  13. Liu FY, Gu ZF, Zhao ZQ, Ren L, Wang LM, Yu JH, Hou SB, Ding WY, Sun XZ (2020) Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: a retrospective study of 42 patients. Medicine (Baltimore) 99:e22204. https://doi.org/10.1097/MD.0000000000022204

    Article  CAS  Google Scholar 

  14. Boachie-Adjei O, Ferguson JA, Pigeon RG, Peskin MR (2006) Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results. Spine (Phila Pa 1976) 31:485–492. https://doi.org/10.1097/01.brs.0000199893.71141.59

    Article  Google Scholar 

  15. Bourghli A, Boissiere L, Vital JM, Bourghli MA, Almusrea K, Khoury G, Obeid I (2015) Modified closing-opening wedge osteotomy for the treatment of sagittal malalignment in thoracolumbar fractures malunion. Spine J 15:2574–2582. https://doi.org/10.1016/j.spinee.2015.08.062

    Article  PubMed  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  Google Scholar 

  17. Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine (Phila Pa 1976) 24:1712–1720

    Article  CAS  Google Scholar 

  18. Buell TJ, Nguyen JH, Mazur MD, Mullin JP, Garces J, Taylor DG, Yen CP, Shaffrey ME, Shaffrey CI, Smith JS (2018) Radiographic outcome and complications after single-level lumbar extended pedicle subtraction osteotomy for fixed sagittal malalignment: a retrospective analysis of 55 adult spinal deformity patients with a minimum 2-year follow-up. J Neurosurg Spine 30:242–252. https://doi.org/10.3171/2018.7.SPINE171367

    Article  PubMed  Google Scholar 

  19. Laouissat F, Sebaaly A, Gehrchen M, Roussouly P (2018) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 27:2002–2011. https://doi.org/10.1007/s00586-017-5111-x

    Article  PubMed  Google Scholar 

  20. Ponte A, Orlando G, Siccardi GL (2018) The True Ponte osteotomy: by the one who developed it. Spine Deform 6:2–11. https://doi.org/10.1016/j.jspd.2017.06.006

    Article  PubMed  Google Scholar 

  21. Turner JD, Akbarnia BA, Eastlack RK, Bagheri R, Nguyen S, Pimenta L, Marco R, Deviren V, Uribe J, Mundis GM Jr (2015) Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis. Eur Spine J 24(Suppl 3):427–432. https://doi.org/10.1007/s00586-015-3842-0

    Article  PubMed  Google Scholar 

  22. Bodin A, Roussouly P (2015) Sacral and pelvic osteotomies for correction of spinal deformities. Eur Spine J 24(Suppl 1):S72-82. https://doi.org/10.1007/s00586-014-3651-x

    Article  PubMed  Google Scholar 

  23. Obeid I, Diebo BG, Boissiere L, Bourghli A, Cawley DT, Larrieu D, Pointillart V, Challier V, Vital JM, Lafage V (2017) Single level proximal thoracic pedicle subtraction osteotomy for fixed hyperkyphotic deformity: surgical technique and patient series. Oper Neurosurg (Hagerstown). https://doi.org/10.1093/ons/opx158

    Article  Google Scholar 

  24. Tokala DP, Lam KS, Freeman BJ, Webb JK (2007) C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J 16:1471–1478. https://doi.org/10.1007/s00586-006-0290-x

    Article  PubMed  PubMed Central  Google Scholar 

  25. Danisa OA, Turner D, Richardson WJ (2000) Surgical correction of lumbar kyphotic deformity: posterior reduction “eggshell” osteotomy. J Neurosurg 92:50–56

    CAS  PubMed  Google Scholar 

  26. Thambiraj S, Boszczyk BM (2012) Asymmetric osteotomy of the spine for coronal imbalance: a technical report. Eur Spine J 21(Suppl 2):S225-229. https://doi.org/10.1007/s00586-012-2171-9

    Article  PubMed  Google Scholar 

  27. Wang Y, Zhang Y, Mao K, Zhang X, Wang Z, Zheng G, Li G, Wood KB (2010) Transpedicular bivertebrae wedge osteotomy and discectomy in lumbar spine for severe ankylosing spondylitis. J Spinal Disord Tech 23:186–191. https://doi.org/10.1097/BSD.0b013e3181a5abde

    Article  PubMed  Google Scholar 

  28. 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):S254-264. https://doi.org/10.1007/s00586-012-2313-0

    Article  PubMed  Google Scholar 

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Funding

No funds were received for the current study.

Author information

Authors and Affiliations

  1. Orthopedic and Spinal Surgery Department, Kingdom Hospital, PO Box 84400, Riyadh, 11671, Saudi Arabia

    Anouar Bourghli

  2. Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France

    Louis Boissière & Ibrahim Obeid

  3. Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

    Faisal Konbaz & Sami Al Eissa

  4. Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Amro Al-Habib

  5. Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

    Bang-Ping Qian & Yong Qiu

  6. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Kazunori Hayashi

  7. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain

    Javier Pizones

  8. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA

    Christopher Ames

  9. Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France

    Jean-Marc Vital

Authors
  1. Anouar Bourghli
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  2. Louis Boissière
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  3. Faisal Konbaz
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  4. Sami Al Eissa
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  5. Amro Al-Habib
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  7. Yong Qiu
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  8. Kazunori Hayashi
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  10. Christopher Ames
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  11. Jean-Marc Vital
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Contributions

AB, FK, SA, AA, BPQ, YQ, KH, JP: none. LB: Consultant Spineart, Medicrea. CA: Consultant Depuy Synthes, Medtronic, Stryker, Medicrea, K2M and Zimmer Biomet, receipt of royalties from Stryker, Zimmer Biomet, Depuy Synthes, Nuvasive, K2M, Medicrea, Research support from Titan Spine, Depuy Synthes, and ISSG. JMV: Consultant Depuy Synthes, LDR. IO: Consultant Alphatec spine, Depuy Synthes and Medtronic, receives research support from Depuy Synthes, receipt of royalties from Alphatec, Clariance and Spineart. AB: conception, drafting, final approval, and agreement to be accountable for all aspects of the work. LB: conception, critical revision, final approval, and agreement to be accountable for all aspects of the work approval. FK: conception, drafting, final approval, and agreement to be accountable for all aspects of the work. SAE: interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work. AA-H: interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work. B-PQ: interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work. YQ: design, critical revision, final approval, and agreement to be accountable for all aspects of the work. KH interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work. JP: interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work. CA: design, critical revision, final approval, and agreement to be accountable for all aspects of the work. J-MV: design, critical revision, final approval, and agreement to be accountable for all aspects of the work. IO: design, critical revision, final approval, and agreement to be accountable for all aspects of the work.

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Correspondence to Anouar Bourghli.

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Bourghli, A., Boissière, L., Konbaz, F. et al. On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab’s spinal osteotomy classification. Spine Deform 9, 515–528 (2021). https://doi.org/10.1007/s43390-020-00247-6

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  • DOI: https://doi.org/10.1007/s43390-020-00247-6

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