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Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?
J Neurosurg Spine. 2011 Feb; 14(2):184-91.JN

Abstract

OBJECT

Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters.

METHODS

In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed.

RESULTS

Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005).

CONCLUSIONS

The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

Authors+Show Affiliations

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York 10010, USA. virginie.lafage@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21184642

Citation

Lafage, Virginie, et al. "Does Vertebral Level of Pedicle Subtraction Osteotomy Correlate With Degree of Spinopelvic Parameter Correction?" Journal of Neurosurgery. Spine, vol. 14, no. 2, 2011, pp. 184-91.
Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine. 2011;14(2):184-91.
Lafage, V., Schwab, F., Vira, S., Hart, R., Burton, D., Smith, J. S., Boachie-Adjei, O., Shelokov, A., Hostin, R., Shaffrey, C. I., Gupta, M., Akbarnia, B. A., Bess, S., & Farcy, J. P. (2011). Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? Journal of Neurosurgery. Spine, 14(2), 184-91. https://doi.org/10.3171/2010.9.SPINE10129
Lafage V, et al. Does Vertebral Level of Pedicle Subtraction Osteotomy Correlate With Degree of Spinopelvic Parameter Correction. J Neurosurg Spine. 2011;14(2):184-91. PubMed PMID: 21184642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? AU - Lafage,Virginie, AU - Schwab,Frank, AU - Vira,Shaleen, AU - Hart,Robert, AU - Burton,Douglas, AU - Smith,Justin S, AU - Boachie-Adjei,Oheneba, AU - Shelokov,Alexis, AU - Hostin,Richard, AU - Shaffrey,Christopher I, AU - Gupta,Munish, AU - Akbarnia,Behrooz A, AU - Bess,Shay, AU - Farcy,Jean-Pierre, Y1 - 2010/12/24/ PY - 2010/12/28/entrez PY - 2010/12/28/pubmed PY - 2011/3/16/medline SP - 184 EP - 91 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 14 IS - 2 N2 - OBJECT: Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. METHODS: In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. RESULTS: Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). CONCLUSIONS: The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/21184642/Does_vertebral_level_of_pedicle_subtraction_osteotomy_correlate_with_degree_of_spinopelvic_parameter_correction L2 - https://thejns.org/doi/10.3171/2010.9.SPINE10129 DB - PRIME DP - Unbound Medicine ER -