Preoperative, Intraoperative, and Postoperative Standing Lordosis after Pedicle Subtraction Osteotomy: An Analysis of Radiographic Parameters and Surgical Strategy

被引：5
作者：
Leveque J.-C. [1 ]
Edwards A. [1 ]
Sethi R.K. [1 ,2 ,3 ]
机构：
[1] Department of Neurosurgery, Virginia Mason Medical Center, 1100 9th Avenue, Seattle, 98101, WA
[2] Department of Health Services, University of Washington Medical Center, 1959 NE Pacific St, Seattle, 98195, WA
[3] Group Health Research Institute, Seattle, WA
来源：
Spine Deformity | 2016年 / 4卷 / 3期
关键词：
Flatback deformity; Lumbar lordosis; Pedicle subtraction osteotomy; Sagittal balance; Spinal alignment;
D O I：
10.1016/j.jspd.2015.10.005
中图分类号：
学科分类号：
摘要：
Study Design Retrospective consecutive case series. Objectives The objective of this study was to investigate the relationship between intraoperative and postoperative lumbar spine measurements after pedicle subtraction osteotomy (PSO). We analyzed the amount of lordosis lost between the prone intraoperative image and the final upright standing film. The outcome of this analysis should be used in preoperative planning for osteotomy procedures. Methods Sixteen patients had pre-, intra- and postoperative measurements of lumbar lordosis. Pre- and postoperative measures of pelvic parameters were also determined. Comparisons were made between pre-, intra- and postoperative measures of pelvic parameters, with specific attention to lumbar lordosis correction and the loss of correction with transition to a standing position. Results The average pelvic mismatch between preoperative lumbar lordosis and pelvic incidence was 37 degrees whereas the postoperative mismatch measured 3.2 degrees. All patients had a significant correction of their lumbar lordosis. The lumbar lordosis showed a highly significant loss of 12.5 degrees from the intraoperative prone position to the postoperative standing position, with the average lumbar lordosis intraoperatively (67 degrees) decreasing to a standing lumbar lordosis of 54 degrees (p <.000001). Conclusions This analysis should aid in preoperative planning for sagittal global alignment correction and can reduce the chance of over- or under-correction in patients having a PSO procedure. Given the narrow postoperative target that is associated with better outcomes for patients, the loss of lumbar lordosis from prone to standing position may be a crucial variable in this planning process. © 2016 Scoliosis Research Society.
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页码：245 / 250
页数：5
相关论文
共 27 条
[1]  
Lafage V., Schwab F., Vira S., Et al., Spino-pelvic parameters after surgery can be predicted: A preliminary formula and validation of standing alignment, Spine (Phila Pa 1976), 36, pp. 1037-1045, (2011)
[2]  
Schwab F., Lafage V., Patel A., Et al., Sagittal plane considerations and the pelvis in the adult patient, Spine (Phila Pa 1976), 34, pp. 1828-1833, (2009)
[3]  
Schwab F., Patel A., Ungar B., Et al., Adult spinal deformity - Postoperative standing imbalance: How much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery, Spine (Phila Pa 1976), 35, pp. 2224-2231, (2010)
[4]  
Schwab F., Ungar B., Blondel B., Et al., Scoliosis Research Society - Schwab Adult Spinal Deformity Classification, Spine (Phila Pa 1976), 37, pp. 1077-1082, (2012)
[5]  
Cho K.J., Suk S.I., Park S.R., Et al., Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis, Spine (Phila Pa 1976), 35, pp. 1595-1601, (2010)
[6]  
Lee S.H., Kim K.T., Suk K.S., Et al., Sagittal decompensation after corrective osteotomy for lumbar degenerative kyphosis: Classification and risk factors, Spine (Phila Pa 1976), 36, pp. E538-E544, (2011)
[7]  
Bridwell K.H., Lewis S.J., Rinella A., Et al., Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique, J Bone Joint Surg Am, 86 A, pp. 44-50, (2004)
[8]  
Bridwell K.H., Decision making regarding Smith-Petersen vs. Pedicle subtraction osteotomy vs. Vertebral column resection for spinal deformity, Spine (Phila Pa 1976), 31, 19, pp. S171-S178, (2006)
[9]  
Wiggins G.C., Ondra S.L., Shaffrey C.I., Management of iatrogenic flat-back syndrome, Neurosurg Focus, 15, (2003)
[10]  
Aubin C.E., Labelle H., Chevrefils C., Et al., Preoperative planning simulator for spinal deformity surgeries, Spine (Phila Pa 1976), 33, pp. 2143-2152, (2008)
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