This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bridwell, K. H.
Right arrow Articles by Blanke, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bridwell, K. H.
Right arrow Articles by Blanke, K.
Related Collections
Right arrow Surgical Techniques
Right arrow Spine
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 86:44-49 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Imbalance

Surgical Technique

Keith H. Bridwell, MD1, Stephen J. Lewis, MD, MSc, FRCSC1, Anthony Rinella, MD2, Lawrence G. Lenke, MD1, Christy Baldus, RN1 and Kathy Blanke, RN1

1 Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300 West Pavilion, St. Louis, MO 63110. E-mail address for K.H. Bridwell: bridwellk{at}wustl.edu
2 Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Macguire Center, Suite 1700, 2160 South First Avenue, Maywood, IL 60153

Investigation performed at the Department of Orthopaedic Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 85-A, pp. 454-463, March 2003

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The line drawings in this article are the work of Elizabeth Roselius (roselius{at}optonline.net).

BACKGROUND:

Fixed sagittal imbalance (a syndrome in which the patient is only able to stand with the weight-bearing line in front of the sacrum) has many etiologies. The most commonly reported technique for correction is the Smith-Petersen osteotomy. Few reports on pedicle subtraction procedures (resection of the posterior elements, pedicles, and vertebral body through a posterior approach) are available in the peer-reviewed literature. We are aware of no report involving a substantial number of patients with coexistent scoliosis who underwent pedicle/vertebral body subtraction for the treatment of fixed sagittal imbalance.

METHODS:

Twenty-seven consecutive patients in whom sagittal imbalance was treated with lumbar pedicle subtraction osteotomy at one institution were analyzed. Radiographic analysis included assessment ofthoracic kyphosis, lumbar lordosis, lordosis through the pedicle subtraction osteotomy site, and the C7 sagittal plumb line. Outcomes analysis was performed with use of a before-and-after pain scale, items from the Oswestry questionnaire, and the Scoliosis Research Society (SRS) questionnaire after a minimum duration of follow-up of two years. Complications and radiographic findings were also analyzed for the entire group.

RESULTS:

Overall, the average increase in lordosis was 34.1° and the average improvement in the sagittal plumb line was 13.5 cm. One patient had development of a lumbar pseudarthrosis through the area of pedicle subtraction osteotomy, and six patients had development of a thoracic pseudarthrosis. Two patients had development of increased kyphosis at L5/S1, caudad to the fusion, resulting in some loss of sagittal correction. There were significant improvements in the overall Oswestry score (p < 0.0001) and the pain-scale score (p = 0.0002). Most patients reported improvement in terms of pain and self-image as well as overall satisfaction with the procedure.

CONCLUSIONS:

Pedicle subtraction osteotomy is a useful procedure for patients with fixed sagittal imbalance. A worse clinical result is associated with increasing patient comorbidities, pseudarthrosis in the thoracic spine, and subsequent breakdown caudad to the fusion.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
J. T. Smith, S. Gollogly, and H. K. Dunn
Simultaneous Anterior-Posterior Approach Through a Costotransversectomy for the Treatment of Congenital Kyphosis and Acquired Kyphoscoliotic Deformities
J. Bone Joint Surg. Am., October 1, 2005; 87(10): 2281 - 2289.
[Abstract] [Full Text] [PDF]