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Sagittal Plane Deformity Surgery: Pedicle Subtraction Osteotomy (PSO) Complication

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Spinal Deformity

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Abstract

Sagittal malalignment has been recognized as a significant driver of morbidity in adult spinal deformity (ASD). Our current understanding of optimal sagittal alignment is built around the concepts of the sagittal vertical axis (SVA) and spinopelvic alignment, notably the relationship between pelvic incidence (PI) and lumbar lordosis (LL). In cases with sagittal deformity, surgeons will often attempt to restore LL such that the difference between PI and LL (PI-LL) is less than 10°. This relationship, however, assumes that surgeons can change LL but that PI is a constant morphologic parameter, i.e., surgeons can template a target LL passed on preoperative PI. In this chapter, however, we present a case where a postoperative change in PI was noted. In this case, a pedicle subtraction osteotomy (PSO) was utilized to correct LL such that it matched the preoperative PI. The patient subsequently experienced a 40° increase in PI and persistent sagittal malalignment despite adequate restoration of LL. We review the literature and explore the possible etiology of PI change in adults and discuss salvage options, such as sacral osteotomies, that might be utilized in these cases. This case emphasizes the importance of preoperative surgical planning and the utilization of pelvic fixation in long instrumentation to the sacrum in adult spinal deformity patients.

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Authors and Affiliations

  1. Hospital for Special Surgery, Weil-Cornell School of Medicine, New York, NY, USA

    Hongda Bao, Sravisht Iyer & Frank J. Schwab

Authors
  1. Hongda Bao
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  2. Sravisht Iyer
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  3. Frank J. Schwab
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Corresponding author

Correspondence to Hongda Bao .

Editor information

Editors and Affiliations

  1. Joan O’Reilly Endowed Professor in Spinal Surgery, Vice Chairman, Department of Neurosurgery, University of California, San Francisco, California, USA

    Praveen V. Mummaneni

  2. Professor, Director of Spinal Surgery, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

    Paul Park

  3. University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Charles H. Crawford III

  4. Chief, Division of Spine Surgery, Associate Professor of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Adam S. Kanter

  5. Department of Orthopedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Steven D. Glassman

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Bao, H., Iyer, S., Schwab, F.J. (2018). Sagittal Plane Deformity Surgery: Pedicle Subtraction Osteotomy (PSO) Complication. In: Mummaneni, P., Park, P., Crawford III, C., Kanter, A., Glassman, S. (eds) Spinal Deformity . Springer, Cham. https://doi.org/10.1007/978-3-319-60083-3_29

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  • DOI: https://doi.org/10.1007/978-3-319-60083-3_29

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60082-6

  • Online ISBN: 978-3-319-60083-3

  • eBook Packages: MedicineMedicine (R0)

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