Anterior Column Reconstruction vs Pedicle Subtraction Osteotomy for Severe Sagittal Plane Deformity: Early Clinical and Radiographic Outcomes Using a Hyperlordotic Expandable Lateral Interbody Device

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lara Walsh Massie ◽  
Mohamed Macki ◽  
Hesham M Zakaria ◽  
Michelle Gilmore ◽  
Azam Basheer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Sagittal Plane ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Significant Difference ◽  
Sagittal Parameters ◽  
Plane Deformity ◽  
Lateral Interbody ◽  
Anterior Column Reconstruction

Abstract INTRODUCTION Anterior Column Reconstruction (ACR) is an increasingly utilized minimally invasive alternative to Pedicle Subtraction Osteotomy (PSO) for correction of sagittal plane deformity in patients with an available unfused lumbar disc. METHODS Fifteen consecutive patients with significant sagittal plane imbalance (SVA > 10 cm or PI-LL mismatch/planned correction > 30?) after prior lumbar fusion were analyzed. Patients underwent either an ACR (N = 11) using an expandable, hyperlordotic lateral interbody device if possible via an unfused disc space, or PSO (n = 4). RESULTS There were no significant differences between the baseline sagittal parameters in the ACR and PSO groups: PI: 59.09? vs 57.67?, P = .88; LL 18.36? vs 28.50?, P = .38; PT: 32.72? vs 37.00?, P = .64; SVA: 12.72 cm vs 11.95 cm P = .77; segmental angulation 2.72? vs 2.75?, P = .99. ACR produced significant improvements in sagittal parameters after surgery compared with preoperative parameters: LL 55.27?, P = .0001; Pi-LL Mismatch 3.45?, P = .0001; PT 22.45?, P = .0254; SVA 4.621 cm P = .0019; segmental angle 25.09?, P < .0001. PSO also produced significant segmental lordosis (29.00?, P = .0032), which was not significantly different from the correction achieved by ACR (25.09? vs 29.00?, P = .47). In ACR, an average of 24.31? of lordosis was achieved at the index level, with an average cage expansion of 24.08?. There was no significant difference in the number of levels fused posteriorly between the ACR and PSO groups (7 vs 8.75 levels, P = .175) or length of surgery (375.25 min vs 370.5 min, P = .47). However, there was significantly less blood loss in the ACR group (311.15 mL vs 962.5 mL, P = .0004) and shorter length of stay (7.41 d vs 11 d, P = .034). CONCLUSION ACR with a hyperlordotic, expandable lateral interbody cage for significant sagittal deformity produced an equivalent degree of sagittal correction to PSO with significantly less blood loss and shorter hospital length of stay.

Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity

2017 ◽  
Vol 105 ◽  
pp. 249-256 ◽  
Author(s):  
Gregory M. Mundis ◽  
Jay D. Turner ◽  
Nima Kabirian ◽  
Jeff Pawelek ◽  
Robert K. Eastlack ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Plane Deformity

scholarly journals Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

2021 ◽  
Author(s):  
Jing-Yu Wang ◽  
Fu-Sheng Liu ◽  
Jing Li ◽  
Xiao-Bin Wang
Keyword(s):  
Sagittal Plane ◽  
Pearson Correlation ◽  
Isthmic Spondylolisthesis ◽  
Improvement Rate ◽  
Clinical Prognosis ◽  
Vas Score ◽  
Score Improvement ◽  
Significant Difference ◽  
Sagittal Parameters

Abstract Background: Spinal and pelvic sagittal plane balance is closely related to good clinical prognosis, so in the treatment of 2-level isthmic spondylolisthesis, attention should be paid not only to adequate nerve decompression, but also to the correction of lumbosacral sagittal plane parameters. The purpose of this study was to observe the clinical prognosis and sagittal parameters of patients with isthmic spondylolisthesis treated with PLIF, and to find out the risk factors leading to poor prognosis. Methods: From January 2006 to August 2018, the clinical data of patients with 2-level isthmic spondylolisthesis treated with PLIF in the Second Xiangya Hospital of Central South University were retrospectively collected. The clinical symptoms (JOA score and VAS score) and the sagittal parameters of lumbosacral segment (PI, PT, LL, L4-S1 SL, LDI, PI-LL, LL and L4-S1 SL) were recorded before operation, immediately after operation and at the last follow-up. According to the improvement rate of JOA score, the patients were divided into two subgroups, poor(P) group and good(G) group. The parameters within and between the two subgroups were compared. Meanwhile, Pearson correlation analysis was conducted between sagittal parameters and JOA score improvement rate.Results: A total of 52 patients were enrolled in this study, the average age was (59.96 ±9.11) years, and the mean follow-up time was (31.88 ±8.37) months. Group G (n = 37) and group P (n = 15). In terms of clinical symptom improvement and sagittal plane parameters, except PI, the other parameters of the patients were improved compared with those before operation, and the difference was statistically significant. In the intra-group comparison, except PI, other indexes in group G were significantly improved, while in group P, there was no significant difference in PI, LL, L4-S1 SL, LDI, PI-LL before and after operation. In the comparison between groups, there was no significant difference in baseline data between group G and group P; postoperative VAS score(back pain) in group G was lower than that in group P, but there was no significant difference in VAS score( leg pain); in terms of JOA score and JOA score improvement rate, group G was significantly better; △L4-S1 SL ,L4-S1 SL and LDI were larger in group G, and the proportion of patients with normal LDI was higher than that in group P. Pearson correlation analysis showed that postoperative △L4-S1 SL, LDI and L4-S1 SL were positively correlated with JOA improvement rate. 2 patients with failed internal fixation occurred in group P, and the postoperative LDI was less than 50%. Conclusion: PLIF is an effective method for the treatment of 2-level isthmic spondylolisthesis. ΔL4-S1 SL, L4-S1 SL and good LDI may be important sagittal parameters affecting the clinical prognosis of L4 and L5 isthmus spondylolisthesis.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

scholarly journals Surgical management of global sagittal deformity in ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E8 ◽  
Author(s):  
Charles A. Sansur ◽  
Kai-Ming G. Fu ◽  
Rod J. Oskouian ◽  
Jay Jagannathan ◽  
Charles Kuntz ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Preoperative Planning ◽  
Sagittal Plane ◽  
Axial Skeleton ◽  
Pedicle Subtraction Osteotomy ◽  
Review Article ◽  
Cervicothoracic Junction ◽  
Plane Deformity ◽  
Sagittal Deformity ◽  
Review Current

✓ Ankylosing spondylitis (AS) is an inflammatory rheumatic disease whose primary effect is on the axial skeleton, causing sagittal-plane deformity at both the thoracolumbar and cervicothoracic junctions. In the present review article the authors discuss current concepts in the preoperative planning of patients with AS. The authors also review current techniques used to treat sagittal-plane deformity, focusing on pedicle subtraction osteotomy at the thoracolumbar junction, as well as cervical extension osteotomy at the cervicothoracic junction.

The advantages of performing anterior column reconstruction prior to pedicle subtraction osteotomy in staged revision adult deformity surgery

2015 ◽  
Vol 15 (3) ◽  
pp. S84-S85
Author(s):  
Joseph Butler ◽  
M.L. Suarez-Huerta ◽  
H. Yu ◽  
A. Benton ◽  
S. Selvadurai ◽  
...  
Keyword(s):  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Adult Deformity ◽  
Anterior Column Reconstruction
Sign in / Sign up

Export Citation Format

Share Document