Comparative Study Between Pedicle Subtraction Osteotomy (PSO) and Closing-Opening Wedge Osteotomy (Fish-Mouth PSO) for Sagittal Plane Deformity Correction

Spine ◽  
2017 ◽  
Vol 42 (15) ◽  
pp. E899-E905 ◽  
Author(s):  
Jong-Hwa Park ◽  
Seung-Jae Hyun ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng
Keyword(s):  
Comparative Study ◽  
Sagittal Plane ◽  
Deformity Correction ◽  
Pedicle Subtraction Osteotomy ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Plane Deformity

Spondylolisthesis following a pedicle subtraction osteotomy

2010 ◽  
Vol 28 (3) ◽  
pp. E16 ◽  
Author(s):  
Cheerag D. Upadhyaya ◽  
Sigurd Berven ◽  
Praveen V. Mummaneni
Keyword(s):  
Sagittal Plane ◽  
Deformity Correction ◽  
Pedicle Subtraction Osteotomy ◽  
Pedicle Screw Fixation ◽  
History Of ◽  
Plane Deformity ◽  
Correction Surgery ◽  
Flat Back ◽  
Rod Fracture ◽  
Rare Instance

Pedicle subtraction osteotomy (PSO) is a powerful technique for correcting a fixed sagittal plane deformity. The authors report the case of a 51-year-old man with a history of multiple prior lumbar operations, flat-back syndrome, thoracic kyphosis, and radiculopathy, who underwent deformity correction surgery with T3–S1 pedicle screw fixation and L-3 PSO. Progressive spondylolisthesis of the PSO segment associated with rod fracture then developed. The patient subsequently underwent anterior and posterior revision surgery. This case is a rare instance of spondylolisthesis following PSO.

scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

2015 ◽  
Vol 15 (10) ◽  
pp. S126-S127
Author(s):  
International Spine Study Group ◽  
Gregory M. Mundis ◽  
Jay D. Turner ◽  
Vedat Deviren ◽  
Juan S. Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Critical Analysis ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Follow Up Study ◽  
Spinal Deformity Surgery ◽  
Plane Deformity

Opening Wedge Tibial Osteotomy: The 3-Triangle Method to Correct Axial Alignment and Tibial Slope

2005 ◽  
Vol 33 (3) ◽  
pp. 378-387 ◽  
Author(s):  
Frank R. Noyes ◽  
Steven X. Goebel ◽  
John West
Keyword(s):  
Proximal Tibia ◽  
Sagittal Plane ◽  
Wedge Angle ◽  
Tibial Slope ◽  
Tibial Tubercle ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Axial Alignment ◽  
Tibial Cortex ◽  
Valgus Alignment

Background Although a change in tibial slope may occur during a medial opening wedge osteotomy, calculations have not been defined to address this problem. The authors investigated geometric factors important to correct axial alignment and tibial slope during osteotomy. Purpose To calculate, through 3-dimensional analysis of the proximal tibia, how the angle of the opening wedge along the anteromedial tibial cortex influences the tibial slope (sagittal plane) and valgus correction (coronal plane) during osteotomy, and to analyze the different radiographic methods reported in the literature to measure medial and lateral tibial slope. The authors postulated that differences in reported normal values of tibial slope in the sagittal plane were technique dependent. Study Design Descriptive laboratory study Methods The proximal anteromedial tibial cortex obliquity on magnetic resonance imaging was measured in 35 knees. Serial computed tomography images of the proximal tibia were digitized, allowing a series of virtual opening wedge osteotomies to be performed. Algebraic calculations defined the effect of an opening wedge osteotomy on the anteromedial tibial cortex opening wedge angle, sagittal tibial slope angle, and coronal valgus alignment. Results The anteromedial tibial cortex oblique angle at the medial osteotomy site was 45°± 6° and determined, along with the degrees of valgus correction, the degrees of the opening wedge angle in the oblique plane. The anterior osteotomy gap at the tibial tubercle was generally one half of the posteromedial gap to maintain the normal sagittal tibial slope. Every millimeter of gap error at the tibial tubercle resulted in approximately 2° of change in the tibial slope. The width of the buttress plate along the anteromedial tibial cortex was 2 to 3 mm less than the computed coronal valgus posteromedial osteotomy gap to achieve tibiofemoral valgus correction. Conclusions A series of measurements preoperatively and intraoperatively are required to obtain the desired correction of tibial slope and valgus alignment.

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.

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.

Treatment of a Paediatric Distal Femoral Malunion Deformity

2018 ◽  
Vol 31 (03) ◽  
pp. 222-228
Author(s):  
Greta Pavarotti ◽  
Randy Boudrieau
Keyword(s):  
Bone Growth ◽  
External Rotation ◽  
Guide Wire ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Distal Epiphysis ◽  
Femoral Deformity

Objective The aim of this article was to describe the surgical re-alignment technique and stabilization of a distal femoral deformity in a 6-week-old, male, Foxhound. Methods A healing metaphyseal fracture, resulting in a valgus deformity with internal rotation, was observed just proximal to the distal femoral physis. The deformity was treated by an opening wedge osteotomy with lateral translation and external rotation of the distal epiphysis using a guide-wire technique; a corticocancellous allograft bridged the defect, which was stabilized with a 2.0-mm locking Y-plate designed for human phalangeal fractures. Results Successful deformity correction was obtained with subsequent healing of the osteotomy and maintained longitudinal bone growth. Sciatic neurapraxia developed as a result of a migrating adjunct pin (9 days post-operatively), which was removed. At long-term follow-up (4 years), a 12% shortening of the femur did result in addition to an asymptomatic grade 2 medial patellar luxation (MPL). The cause of the MPL was not evident; the owners declined treatment and the dog continued to function as an active hunting dog. Clinical Significance Prior to ossification of the epiphyses in very young animals, which precludes effective radiographic pre-planning, the guide-wire technique can be utilized as the primary tool for performing angular deformity correction. Adequate fixation and stabilization can be obtained with small human specialty locking plates.

PEDICLE SUBTRACTION OSTEOTOMY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A171-A176 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Sanjay S. Dhall ◽  
Stephen L. Ondra ◽  
Valli P. Mummaneni ◽  
Sigurd Berven
Keyword(s):  
Sagittal Plane ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Pedicle Subtraction Osteotomy ◽  
Morbidity Rate ◽  
Perioperative Morbidity ◽  
The Past ◽  
Avoidance Strategies ◽  
Plane Deformity ◽  
Dural Tears

ABSTRACT OBJECTIVE Pedicle subtraction osteotomy (PSO) is an effective tool for the correction of fixed sagittal plane deformity. However, there is potentially significant perioperative morbidity associated with this technique. We report our perioperative morbidity rate in recently performed PSO cases treated with our present surgical, anesthetic, and monitoring techniques and discuss complication-avoidance strategies. METHODS We conducted a retrospective study of 10 patients (mean age, 56 yr; range, 7–77 yr) undergoing thoracolumbar PSO at a single institution in the past 3 years. Two patients underwent PSO at T12, seven patients underwent PSO at L3, and one patient underwent PSO at L2. Eight of the patients had undergone at least one previous spine surgery in the region of the PSO, and nine of the patients had comorbidities that increased their surgical risk stratification. We identified all causes of perioperative morbidity. RESULTS We classified perioperative complications into two categories: intraoperative and early postoperative. Intraoperative complications included dural tears in two patients, cardiovascular instability in one patient, and coagulopathy in two patients. Early postoperative complications included neurological deficit (one patient), wound infection (two patients), urinary tract infection (one patient), and delirium (two patients). All patients recovered fully from these complications. There was no mortality in this series. CONCLUSION In this series, most patients undergoing PSO had multiple previous spine surgeries and comorbidities. The risk of perioperative morbidity for revision cases undergoing PSO was in excess of 50%. We discuss complication-avoidance strategies.

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