Clinical outcomes and complications after pedicle subtraction osteotomy for correction of thoracolumbar kyphosis

Object. Many patient complications have been reported after the use of the pedicle subtraction osteotomy (PSO) technique. To the authors' knowledge, no previous reseachers have reported On the causes of complications after using the single-stage PSO technique with a posterior approach. The purpose of this study was to investigate complications after the procedure, to clarify the factors influencing the complications, and to identify ways to minimize complications. Methods. Records for 67 patients treated with the PSO technique were examined retrospectively. All complications were recorded and analyzed in relation to the radiological and clinical outcomes. No patient died or became paraplegic as a result of surgery. There were 48 surgery-related complications in 27 patients (40%): six intraoperative, four perioperative, and 38 late-onset postoperative complications. As the study progressed and more patients were treated, the rate of intraoperative complications decreased significantly. The incidence of late-onset complications associated with an adjacent-segment progression of kyphosis was lower in patients with a long fusion from a midthoracic vertebra to the sacrum or pelvis than in patients treated with a shorter fusion. The C-7 plumb line values and postoperative complications were closely correlated with clinical results. Conclusions. Intraoperative complications can be prevented or the risks minimized with adequate surgical training. Most of the late-onset complications in these patients were related to the progression of kyphosis. The frequency of complications was closely correlated with patient satisfaction at follow up. Correcting the C-7 plumb line value with minimal complications appeared to lead to better clinical results.