Pedicle Subtraction Osteotomy in the Revision Versus Primary Adult Spinal Deformity Patient: Is There a Difference in Correction and Complications?

Abstract

Study design

Multicenter, prospective study of consecutive adult spinal deformity (ASD) patients.

Objective

To compare alignment correction and perioperative complications after pedicle subtraction osteotomies (PSO) in the primary versus revision surgery setting for ASD.

Summary of background data

PSO are performed to correct sagittal plane deformity; however, these are difficult procedures that have potential for large blood loss and risk for intraoperative and postoperative complications.

Methods

Inclusion criteria were age at least 18 years, lumbar PSO, and available data on perioperative (up to 6 weeks after surgery) complication data. Patients were classified according to SRS-Schwab sagittal modifiers: PT (pelvic tilt), SVA (sagittal vertical axis), and lumbo-pelvic mismatch (pelvic incidence-lumbar lordosis). Patients were divided into primary (P; no previous spine fusion surgery) or revision (R; previous fusion). Baseline and 1-year demographic, radiographic parameters, complications and revision rates were analyzed.

Results

A total of 421 patients were included. P (n = 70) and R (n = 351) were similar for age, body mass index, sex, mean total Posterior Spinal Fusion (PSF) levels (P = 10.0; R = 10.5), PSO angle (P = 27°; R = 25°), estimated blood loss (P = 2.76L; R = 2.92L), and operative time (P = 437 min; R = 434 min). The most common osteotomy site was L3 for both primary (31.8%) and revision groups (43.6%). Both groups demonstrated improvement in sagittal spinopelvic parameters from baseline to 1 year, with similar changes in sagittal modifiers except for the pelvic mismatch that improved to a grade 0 (i.e., less than 10°) more often for primary PSO group (83%) than revision PSO group (57%; P = 0.004). Complication rates were similar (P > 0.05) for the following: new motor deficit (P = 4.2%, R = 9.4%), bowel/bladder deficit (P = 1.4%, R = 2.8%), 1-year revision rate (P = 4.3%, R = 7.4%), and pseudarthrosis rate (P = 1.4%; R = 2.5%; P < 0.05).

Conclusion

PSO may be performed in primary or revision ASD patient with similar sagittal deformity correction and similar complication rates; however, primary PSO patients were more likely to achieve better lumbo-pelvic mismatch correction.

Level of evidence

3.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1097/brs.0000000000001107

Publication Info

Gupta, Munish C, Emmanuelle Ferrero, Gregory Mundis, Justin S Smith, Christopher I Shaffrey, Frank Schwab, Han Jo Kim, Oheneba Boachie-Adjei, et al. (2015). Pedicle Subtraction Osteotomy in the Revision Versus Primary Adult Spinal Deformity Patient: Is There a Difference in Correction and Complications?. Spine, 40(22). pp. E1169–E1175. 10.1097/brs.0000000000001107 Retrieved from https://hdl.handle.net/10161/28486.

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Scholars@Duke

Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.


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