Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

Lafage, Virginie; Schwab, Frank; Vira, Shaleen; Hart, Robert; Burton, Douglas; Smith, Justin S; Boachie-Adjei, Oheneba; Shelokov, Alexis; Hostin, Richard; Shaffrey, Christopher I; Gupta, Munish; Akbarnia, Behrooz A; Bess, Shay; Farcy, Jean-Pierre

Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

dc.contributor.author	Lafage, Virginie
dc.contributor.author	Schwab, Frank
dc.contributor.author	Vira, Shaleen
dc.contributor.author	Hart, Robert
dc.contributor.author	Burton, Douglas
dc.contributor.author	Smith, Justin S
dc.contributor.author	Boachie-Adjei, Oheneba
dc.contributor.author	Shelokov, Alexis
dc.contributor.author	Hostin, Richard
dc.contributor.author	Shaffrey, Christopher I
dc.contributor.author	Gupta, Munish
dc.contributor.author	Akbarnia, Behrooz A
dc.contributor.author	Bess, Shay
dc.contributor.author	Farcy, Jean-Pierre
dc.date.accessioned	2023-10-11T18:37:43Z
dc.date.available	2023-10-11T18:37:43Z
dc.date.issued	2011-02
dc.date.updated	2023-10-11T18:37:42Z
dc.description.abstract	Object Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). Conclusions The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.
dc.identifier.issn	1547-5654
dc.identifier.issn	1547-5646
dc.identifier.uri	https://hdl.handle.net/10161/29248
dc.language	eng
dc.publisher	Journal of Neurosurgery Publishing Group (JNSPG)
dc.relation.ispartof	Journal of neurosurgery. Spine
dc.relation.isversionof	10.3171/2010.9.spine10129
dc.subject	Pelvis
dc.subject	Lumbar Vertebrae
dc.subject	Thoracic Vertebrae
dc.subject	Humans
dc.subject	Kyphosis
dc.subject	Lordosis
dc.subject	Scoliosis
dc.subject	Spondylitis, Ankylosing
dc.subject	Postoperative Complications
dc.subject	Radiography
dc.subject	Spinal Fusion
dc.subject	Osteotomy
dc.subject	Reoperation
dc.subject	Retrospective Studies
dc.subject	Adult
dc.subject	Middle Aged
dc.subject	Female
dc.subject	Male
dc.subject	Postural Balance
dc.subject	Spondylosis
dc.title	Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?
dc.type	Journal article
duke.contributor.orcid	Shaffrey, Christopher I\|0000-0001-9760-8386
pubs.begin-page	184
pubs.end-page	191
pubs.issue	2
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Orthopaedic Surgery
pubs.organisational-group	Neurosurgery
pubs.publication-status	Published
pubs.volume	14