COMPARISON OF THE USE OF PEDICLE SUBTRACTION OSTEOTOMY (PSO) IN PRIMARY AND REVISION OPERATIONS
- 作者: Panteleev A.A.1, Gorbatyuk D.S.1, Sazhnev M.L.1, Kaz’min A.I.1, Pereverzev V.S.1, Kolesov S.V.1
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隶属关系:
- N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
- 期: 卷 25, 编号 2 (2018)
- 页面: 5-12
- 栏目: Articles
- URL: https://bakhtiniada.ru/0869-8678/article/view/47151
- DOI: https://doi.org/10.32414/0869-8678-2018-2-5-12
- ID: 47151
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Purpose of study: to evaluate clinical and roentgenologic results of the use of pedicle subtraction osteotomy (PSO) in primary and revision operations to determine the feasibility of radical spinal sagittal imbalance correction at primary surgical intervention.Patients and methods. Retrospective review of 42 patients (30 men and 12 women, mean age — 58.5 years) with rigid spinal deformities who underwent PSO was performed. Revision interventions (group R) were performed in 23 cases, primary (group P) — in 19 cases. The comparative analysis of spino-pelvic parameters and global spine balance, demographic indices, volume of intraoperative blood loss, duration of surgical intervention, complications in the late postoperative period and quality-of-life indices by SRS-22 and ODI scores was performed. Results. Minimum follow up period was 12 months. Osteotomy was more often performed at L3 level. No differences in the extent of fixation, duration of surgical intervention and degree of segmental correction were detected. The average blood loss was significantly lower in group P (p<0.05). Analysis of the late postoperative period changes in roentgenologic parameters showed statistically significant differences for the lumbar lordosis index as well as inconsistency between the lumbar lordosis and pelvic index that were better in group P. Quality of life increased significantly in both groups with the only statistically significant difference in ODI that was better in group P. Serious complications were observed in 47.8 and 38.6% of cases in group R and group P, respectively (p<0.05). Revision interventions were required in 26.1% of cases in group R and in 15.8% — in group P. Conclusion. In primary surgical interventions use of PSO technique enables to correct global spinal sagittal balance more effectively. Its use in primary interventions ensures lower volume of intraoperative blood loss as well as lower risk of pseudarthrosis formation and neurologic disorders development.
作者简介
A. Panteleev
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
编辑信件的主要联系方式.
Email: apanteleyev@gmail.com
D. Gorbatyuk
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: info@eco-vector.com
M. Sazhnev
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: info@eco-vector.com
A. Kaz’min
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: info@eco-vector.com
V. Pereverzev
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: info@eco-vector.com
S. Kolesov
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: info@eco-vector.com
参考
- Bridwell K.H., Baldus C., Berven S. et al. Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to threeto five-years follow-up. Spine (Phila Pa 1976). 2010; 35 (20): 1849-54. doi: 10.1097/BRS.0b013e3181efa06a.
- Li G., Passias P., Kozanek M. et al. Adult scoliosis in patients over sixty-five years of age outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976). 2009; 34 (20): 2165-70. doi: 10.1097/BRS.0b013e3181b3ff0c.
- Daubs M.D., Lenke L.G., Cheh G. et al. Adult spinal deformity surgery: Complications and outcomes in patients over age 60. Spine (Phila Pa 1976). 2007; 32 (20): 2238-44. doi: 10.1097/BRS.0b013e31814cf24a.
- Drazin D., Shirzadi A., Rosner J. et al. Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg. Focus. 2011; 31 (4): E3. doi: 10.3171/2011.7.FOCUS11145.
- Bridwell K.H., Lewis S.J., Lenke L.G. et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J. Bone Joint Surg. Am. 2003; 85-A (3): 454-63.
- Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin. Orthop. Relat. Res. 1985; (194): 142-52.
- Gupta M.C., Kebaish K., Blondel B., Klineberg E. Spinal osteotomies for rigid deformities. Neurosurg. Clin. N. Am. 2013; 24 (2): 203-11. doi: 10.1016/j.nec.2012.12.001.
- Diebo B., Liu S., Lafage V., Schwab F. Osteotomies in the treatment of spinal deformities: Indications, classification, and surgical planning. Eur. J. Orthop. Surg. Traumatol. 2014; 24 Suppl 1: S11-20. doi: 10.1007/s00590-0141471-7.
- Van Royen B.J., Gast A.D. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann. Rheum. Dis. 1999; 58 (7): 399-406.
- Hassanzadeh H., Jain A., El Dafrawy M.H. et al. Threecolumn osteotomies in the treatment of spinal deformity in adult patients 60 years old and older. Spine (Phila Pa 1976). 2013; 38 (9): 726-31. doi: 10.1097/BRS.0b013e31827c2415.
- Hedlund R. Pedicle subtraction osteotomy in flat back syndrome 38 years after Harrington instrumentation for AIS. Eur. Spine J. 2012; 21 (3): 563-5.
- Bridwell K.H., Lewis S.J., Edwards C. et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976). 2003; 28 (18): 2093-101. doi: 10.1097/01.brs.0000090891.60232.70.
- Buchowski J.M., Bridwell K.H., Lenke L.G. et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007; 32 (20): 2245-52. doi: 10.1097/ BRS.0b013e31814b2d52.
- Schwab F.J., Hawkinson N., Lafage V. et al. Risk factors for major peri-operative complications in adult spinal deformity surgery: A multi-center review of 953 consecutive patients. Eur. Spine J. 2012; 21 (12): 2603-10. doi: 10.1007/s00586-012-2370-4.
- Cho S.K., Bridwell K.H., Lenke L.G. et al. Major complications in revision adult deformity surgery. Spine (Phila Pa 1976). 2012; 37 (6): 489-500. doi: 10.1097/ BRS.0b013e3182217ab5.
- Pichelmann M.A., Lenke L.G., Bridwell K.H. et al. Revision rates following primary adult spinal deformity surgery. Spine (Phila Pa 1976). 2010; 35 (2): 219-26. doi: 10.1097/BRS.0b013e3181c91180.
- Diebo B.G., Passias P.G., Marascalchi B.J. et al. Primary versus revision surgery in the setting of adult spinal deformity: a nationwide study on 10,912 patients. Spine (Phila Pa 1976). 2015; 40 (21): 1674-80. doi: 10.1097/ BRS.0000000000001114.
- Cho S.K., Bridwell K.H., Lenke L.G. et al. Comparative analysis of clinical outcome and complications in primary versus revision adult scoliosis surgery. Spine (Phila Pa 1976). 2012; 37 (5): 393-401. doi: 10.1097/ BRS.0b013e31821f0126.
- Chang M.S., Chang Y.H., Revella J., Crandall D.G. Revision spinal fusion in patients older than 75: Is it worth the risks? Spine (Phila Pa 1976). 2014; 39 (1): E35-9. doi: 10.1097/BRS.0000000000000067.
- Kurtz S.M., Lau E., Ong K. et al. Infection risk for primary and revision instrumented lumbar spine fusion in the Medicare population. J. Neurosurg. Spine. 2012; 17 (4): 342-7. doi: 10.3171/2012.7.SPINE12203.
- Schwender J.D., Casnellie M.T., Perra J.H. et al. Perioperative complications in revision anterior lumbar spine surgery: incidence and risk factors. Spine (Phila Pa 1976). 2009; 34 (1): 87-90. doi: 10.1097/ BRS.0b013e3181918ad0.
- Fu L., Chang M.S., Crandall D.G., Revella J. Comparative analysis of clinical outcomes and complications in patients with degenerative scoliosis undergoing primary versus revision surgery. Spine (Phila Pa 1976). 2014; 39 (10): 805-11. doi: 10.1097/BRS.0000000000000283.
- Lafage V., Schwab F., Skalli W. et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976). 2008; 33 (14): 1572-8. doi: 0.1097/BRS.0b013e31817886a2.
- Merrill R.K., Kim J.S., Leven D.M. et al. Beyond pelvic incidence–lumbar lordosis mismatch: the importance of assessing the entire spine to achieve global sagittal alignment. Global Spine J. 2017; 7 (6): 536-42. doi: 10.1177/2192568217699405.
- Gupta M.C., Ferrero E., Mundis G. et al.; International Spine Study Group. Pedicle subtraction osteotomy in the revision versus primary adult spinal deformity patient: is there a difference in correction and complications? Spine (Phila Pa 1976). 2015; 40 (22): E1169-75. doi: 10.1097/ BRS.0000000000001107.
- Lau D., Chan A.K., Deverin V., Ames C.P. Does prior spine surgery or instrumentation affect surgical outcomes following 3-column osteotomy for correction of thoracolumbar deformities? Neurosurg. Focus. 2017; 43 (6): E8. doi: 10.3171/2017.8.FOCUS17460.
- Bridwell K.H. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976). 2006; 31 (19 Suppl): S171-8. doi: 10.1097/01. brs.0000231963.72810.38.
- Schwab F.J., Patel A., Shaffrey C.I. et al. Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article. J. Neurosurg. Spine. 2012; 16 (6): 539-46. doi: 10.3171/2012.2.SPINE11120.
- Cho K.J., Bridwell K.H., Lenke L.G. et al. Comparison of Smith-Petersenversuspediclesubtractionosteotomyfor the correction of fixed sagittal imbalance. Spine (Phila Pa 1976). 2005; 30 (18): 2030-7.
- Dickson D.D., Lenke L.G., Bridwell K.H., Koester L.A. Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity. Spine (Phila Pa 1976). 2014; 39 (15): 1190-5. doi: 10.1097/ BRS.0000000000000380.
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