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Guo DX, Guo XW, Yang GH, Sun YB, Song Y, Wang JL, Jiang WB, Yu T. A technical note on the posterior approach BDBO for treating Kümmell disease. Sci Rep 2025; 15:9892. [PMID: 40121202 PMCID: PMC11929767 DOI: 10.1038/s41598-025-91923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 02/24/2025] [Indexed: 03/25/2025] Open
Abstract
To evaluate the therapeutic efficacy of bone-disc-bone osteotomy (BDBO) via a posterior approach in combination with biomimetic bone grafting and pedicle screw implantation for the treatment of Kümmell disease complicated with kyphosis. Between March 2012 and June 2020, we retrospectively analyzed 22 patients who had Kümmell disease complicated with kyphosis and underwent BDBO in combination with biomimetic bone grafting and pedicle screw implantation. The kyphotic Cobb angle, visual analog scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association (ASIA) Impairment Scale were used to evaluate the effects of surgery. In addition, surgical conditions, including duration of surgery, intraoperative blood loss, and surgical complications, were recorded. The mean follow-up time was 32.86 months (range, 28.27 to 36.67). The mean operative time was 176.68 ± 25.96 min and the mean intraoperative blood loss was 281.24 ± 43.26 mL. The VAS, ODI, and kyphotic Cobb angles were significantly improved 1 week after surgery compared with preoperative assessments and remained well maintained at final follow-up. Eight patients (36.4%) had mild neurologic impairment before surgery, and their neurologic function normalized at final follow-up. The rate of intervertebral fusion at the final follow-up was 100%. One patient (4.5%) had an infected incision that healed after debridement. There was no case of instrumentation failure. BDBO in combination with biomimetic bone grafting and pedicle screw implantation is a novel, safe, effective and elective treatment strategy for patients who experienced Kümmell disease complicated by kyphosis.
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Affiliation(s)
- De-Xin Guo
- Department of Spinal Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan Province, China
| | - Xiao-Wei Guo
- Department of Spinal Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan Province, China
| | - Guang-Hui Yang
- Department of Spinal Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan Province, China
| | - Yi-Bao Sun
- Department of Spinal Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan Province, China
| | - Ya Song
- Department of Spinal Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan Province, China
| | - Jin-Lu Wang
- Department of Spinal Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan Province, China
| | - Wei-Bo Jiang
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tong Yu
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Kawabata A, Sakai K, Yamada K, Utagawa K, Hashimoto J, Morishita S, Matsukura Y, Oyaizu T, Hirai T, Inose H, Tomori M, Torigoe I, Onuma H, Kusano K, Otani K, Arai Y, Shindo S, Okawa A, Yoshii T. The lower Osteotomy Level is Associated With Decreased Revision Surgery Due to Mechanical Complications After Three-Column Osteotomy in Patients With Adult Spinal Deformity: A Multi-Institutional Retrospective Study. Global Spine J 2025; 15:498-505. [PMID: 37596769 PMCID: PMC11877564 DOI: 10.1177/21925682231196449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
STUDY DESIGN A multi-institutional retrospective study. OBJECTIVES To investigate risk factors of mechanical failure in three-column osteotomy (3COs) in patients with adult spinal deformity (ASD), focusing on the osteotomy level. METHODS We retrospectively reviewed 111 patients with ASD who underwent 3COs with at least 2 years of follow-up. Radiographic parameters, clinical data on early and late postoperative complications were collected. Surgical outcomes were compared between the low-level osteotomy group and the high-level osteotomy group: osteotomy level of L3 or lower group (LO group, n = 60) and osteotomy of L2 or higher group (HO group, n = 51). RESULTS Of the 111 patients, 25 needed revision surgery for mechanical complication (mechanical failure). A lower t-score (odds ratio [OR] .39 P = .002) and being in the HO group (OR 4.54, P = .03) were independently associated with mechanical failure. In the analysis divided by the osteotomy level (LO and HO), no difference in early complications or neurological complications was found between the two groups. The rates of overall mechanical complications, rod failure, and mechanical failure were significantly higher in the HO group than in the LO group. After propensity score matching, mechanical complications and failures were still significantly more observed in the HO group than in the LO group (P = .01 and .029, respectively). CONCLUSIONS A lower t-score and osteotomy of L2 or higher were associated with increased risks of mechanical failure. Lower osteotomy was associated with better correction of sagittal balance and a lower rate of mechanical complications.
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Affiliation(s)
- Atsuyuki Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kentaro Yamada
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Kurando Utagawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Takuya Oyaizu
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kazuo Kusano
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyoda, Japan
| | - Kazuyuki Otani
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyoda, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Shigeo Shindo
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyoda, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Japan
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Calcagni J, Tello CA, Piantoni L, Remondino R, Galaretto E, Arispe JP, Noel M. Surgical treatment algorithm for thoracic and lumbar hyperkyphosis in pediatric population. Spine Deform 2025; 13:449-457. [PMID: 39432190 DOI: 10.1007/s43390-024-00986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 10/07/2024] [Indexed: 10/22/2024]
Abstract
PURPOSE There is no standardized and universally accepted surgical treatment for thoracic and lumbar hyperkyphosis in children. A surgical treatment algorithm was developed to aid in the choice of the appropriate corrective technique. METHODS A retrospective analysis was conducted of patients younger than 18 years who underwent primary correction surgery and posterior fusion for thoracic and lumbar hyperkyphosis. Patients were categorized according to the classification of Rajasekaran et al. and divided into 2 groups: a posterior column osteotomies (PCO) group and a three-column osteotomies (3CO) group. We analyzed the angularity and flexibility of the curve, global sagittal balance, and preoperative neurological status of the patient. RESULTS Forty-nine patients were included. The mean age was 12.8 years (1-18) and the mean preoperative kyphosis was 93.5° (40°-175°). In the PCO group (N = 30), the sagittal deformity angular ratio (DAR) was less than 16.5 in 26 patients (86.6%), while in the 3CO group (N = 19), sagittal DAR was greater than 16.5 in 17 patients (89.4%). In the PCO group (N = 28), the T1-Pelvic angle (TPA) was less than 17° in 19 patients (67.8%), while in the 3CO group (N = 15), TPA was greater than 17° in 10 patients (66.6%). Five patients (10.2%) had recent-onset or progressive neurological alteration, all of them (100%) required 3CO. CONCLUSION An algorithm for kyphosis was developed based on the classification by Rajasekaran et al., preoperative analysis of the angularity and flexibility of the curve, global sagittal balance and neurological status of the patient, to aid in the choice of the appropriate corrective osteotomy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Julián Calcagni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina.
| | - Carlos A Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Lucas Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Rodrigo Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Juan Pablo Arispe
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
| | - Mariano Noel
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
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Akgün H, Albayrak A, Kargın D, Öner A, Akbulut D, Aydın A. Comparison of clinical and radiological outcomes of SRS-Schwab grade 3-4 and SRS-Schwab 5-6 osteotomies in congenital kyphosis and kyphoscoliosis patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025:10.1007/s00586-025-08670-x. [PMID: 39921713 DOI: 10.1007/s00586-025-08670-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 01/13/2025] [Indexed: 02/10/2025]
Abstract
PURPOSE This study aimed to evaluate the clinical and radiological outcomes of two patient groups with congenital kyphosis and kyphoscoliosis who underwent posterior surgical correction using Schwab grade 3-4 and Schwab grade 5-6 osteotomies. METHODS A retrospective analysis was conducted on 58 patients (35 females and 23 males; mean age: 16.2 yr). Radiological evaluations included preoperative,postoperative,and last follow-up measurements of segmental kyphosis, scoliosis, lumbar lordosis(LL), C7-central sacral vertical line[C7-CSVL] and sagittal vertical axis [SVA], and pelvic parameters (pelvic incidence [PI],pelvic tilt [PT], sacral slope [SS].Clinical evaluations included Scoliosis Research Society-22r (SRS-22r) scores and Oswestry Disability Index (ODI) scores at preoperative and last follow-up time points. RESULTS The mean deformity correction was 53.4%. Preoperative segmental kyphosis angles for Schwab grade 3-4 osteotomy (group 1) and Schwab grade 5-6 osteotomy (group 2) were 66.9° and 104.9°, respectively.The last follow-up angles were 33.1° and 48.2° (p < 0.001).No significant loss of correction was observed in either group (p > 0.05). SRS-22r scores improved significantly at the last follow-up (p < 0.001).Similarly, ODI scores improved significantly in both groups (p < 0.001).Neurological complications occurred in 14 (24.1%) patients,including dura injury, spinal nerve root injury, transient incomplete neurological deficits, and spinal cord compression.Mechanical complications were reported in 14 (24.1%) patients and included rod fractures, proximal junction kyphosis, pedicle screw malposition, and pedicle screw loosening. CONCLUSION Posterior surgical correction using Schwab grade 3-4 and Schwab grade 5-6 osteotomies yields satisfactory radiological and clinical outcomes in patients with congenital kyphosis and kyphoscoliosis. However, higher osteotomy grades, necessitated by greater deformity severity, are associated with increased complication rates.
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Affiliation(s)
- Hakan Akgün
- Tatvan Can Hospital, Bitlis, Turkey.
- Baltalimanı Kemik Hastalıkları Hastanesi, Istanbul, Turkey.
| | - Akif Albayrak
- Baltalimanı Kemik Hastalıkları Hastanesi, Istanbul, Turkey
- TC İstanbul Rumeli Üniversitesi, Istanbul, Turkey
| | - Deniz Kargın
- Baltalimanı Kemik Hastalıkları Hastanesi, Istanbul, Turkey
| | - Ali Öner
- Baltalimanı Kemik Hastalıkları Hastanesi, Istanbul, Turkey
| | - Deniz Akbulut
- Baltalimanı Kemik Hastalıkları Hastanesi, Istanbul, Turkey
- Van Akdamar Hospital, Van, Turkey
| | - Abdurrahman Aydın
- Baltalimanı Kemik Hastalıkları Hastanesi, Istanbul, Turkey
- Düzce Akçakoca Hospital, Düzce, Turkey
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De Salvatore S, Oggiano L, Brigato P, Palombi D, Sessa S, Curri C, Fumo C, Sangiovanni GM, Costici PF, Ruzzini L. One-stage posterior-only correction in severe and rigid scoliosis exceeding 90°: radiographic and surgical outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:65. [PMID: 39918694 DOI: 10.1007/s00590-025-04187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 01/25/2025] [Indexed: 02/09/2025]
Abstract
PURPOSE Scoliosis, if left untreated, can lead to severe curvatures exceeding 90°, causing devastating functional impairments. Various surgical methods exist, but the optimal approach is still debated. One-stage posterior spinal fusion (PSF)-only surgery is gaining favor for its comparable outcomes and reduced morbidity. This study, focusing on radiographic and surgical outcomes, evaluates the efficacy and safety of one-stage PSF for scoliosis curves over 90° in pediatric patients. METHODS Thirty-five pediatric patients with scoliosis (Cobb angle ≥ 90°) who underwent one-stage posterior spinal fusion (PSF)-only surgery from January 2020 to December 2023 were included. Patients with idiopathic, neuromuscular, or syndromic scoliosis were included. The primary outcome was the correction rate (CR) of scoliosis curves. Secondary outcomes included major postoperative complications, surgery duration, blood loss, and hospital stay length. Preoperative and postoperative radiographic and clinical data were analyzed. RESULTS The mean CR for major and minor curves was 65.2 ± 10.5% and 57.9 ± 12.8%, respectively. The mean preoperative and postoperative Cobb angle of major and minor curves was 102.6° and 35.6°, 68.6° and 28.8°, respectively. There were 13 recorded complications, with only one being life-threatening. Mean blood loss was 787 ± 437 ml. Total surgical time was roughly 5 h per case. The mean length of hospital stay (LOS) was 9 days. CONCLUSIONS PSF-only surgery for severe scoliosis over 90° is effective and safe. It supports using posterior-only methods as a viable alternative to combined approaches, suitable for patients with even more severe curves when their condition allows.
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Affiliation(s)
- Sergio De Salvatore
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma, Rome, Italy.
| | - Leonardo Oggiano
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Brigato
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma, Rome, Italy
| | - Davide Palombi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Sessa
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cloe Curri
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Caterina Fumo
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Laura Ruzzini
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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Frerich JM, Dibble CF, Park C, Bergin SM, Goodwin CR, Abd-El-Barr MM, Shaffrey CI, Than KD. Proximal Lumbar Anterior Column Realignment for Iatrogenic Sagittal Plane Adult Spinal Deformity Correction: A Retrospective Case Series. World Neurosurg 2025; 193:884-892. [PMID: 39489337 DOI: 10.1016/j.wneu.2024.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 10/24/2024] [Accepted: 10/25/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Anterior column realignment (ACR) is a powerful minimally invasive surgery technique to restore sagittal alignment in adult spinal deformity (ASD). This can accomplish similar segmental lordosis restoration as 3-column osteotomy with less blood loss and comparable complication rates. ACR can be performed at adjacent disease segments in the proximal lumbar spine in revision cases. However, two thirds of physiologic lordosis occurs between L4-S1, and concerns remain about altered lumbar morphology. We evaluated patients who underwent proximal lumbar ACR for iatrogenic flatback deformity. METHODS A total of 19 consecutive patients who underwent L1-2 or L2-3 ACR were retrospectively analyzed. All patients were treated with lateral minimally invasive surgery interbody technique, followed by posterior reconstruction with Smith-Peterson osteotomy. Preoperative and postoperative radiographic and clinical outcomes were obtained. RESULTS Mean follow-up was 19 months. All but 1 patient had a history of prior lumbar or lumbo-sacral fusion. Sagittal vertical axis and pelvic incidence-lumbar lordosis decreased from 11.9 cm to 6.1 cm (P < 0.0001) and 34.2° to 12.8° (P < 0.0001). Segmental lordosis increased from -2.7° to 21.9° (P < 0.0001). Proximal lumbar lordosis increased from -0.4° to 22.6° (P < 0.0001), and lordosis distribution index decreased from 79.5% to 48.9% (P < 0.0001). Mean Oswestry Disability Index and numeric pain rating scale back pain scores decreased from 58.0 to 36.2 (P = 0.0041) and 7.9 to 3.4 (P < 0.0001), respectively. Patient-Reported Outcomes Measurement Information System Physical and Mental Health T-scores increased from 34.1 to 43.3 (P = 0.0049) and 40.4 to 45.0 (P = 0.0993), respectively. Major complication rate was 15.8%. One patient required revision for mechanical failure. There were no permanent neurological or vascular injuries. CONCLUSIONS Proximal lumbar ACR plus Smith-Peterson osteotomy can achieve sagittal correction with low major complication rates in patients with ASD and prior distal fusion. Differentially increasing proximal lumbar lordosis and lowering lumbar distribution index did not have deleterious effects on radiographic or clinical outcomes. Further work is needed to understand the effect of proximal ACR in the surgical management of ASD.
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Affiliation(s)
- Jason M Frerich
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Christopher F Dibble
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine Park
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stephen M Bergin
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Khoi D Than
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
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Makineni PS, El-Abtah ME, Porto JR, Steinmetz MP, Benzel EC. Pedicle Subtraction Osteotomies for Surgical Correction of Fixed Sagittal Imbalance: A Meta-Analysis and Systematic Review. Neurosurgery 2024; 95:1223-1231. [PMID: 38904379 DOI: 10.1227/neu.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/29/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Disruption of the spine's sagittal balance is associated with significant negative impacts on quality of life. Compared with other spinal osteotomies, pedicle subtraction osteotomy (PSO), which can potentially offer greater correction, is considered technically challenging and performed at lower rates. The aim of this study was to review the use of PSO to correct fixed sagittal imbalance and assess its efficacy and associated perioperative complications. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, EBSCO host, MEDLINE, and Google Scholar databases were queried for full-text English manuscripts published from 1961 to 2022, exploring PSO for the management of fixed sagittal imbalance. Studies were included if they reported preoperative and postoperative radiographic measurements. The mean Methodological Index for Nonrandomized Studies (MINORS) for included articles was 9.6 ± 1.1. The outcomes of interest included etiology, operative time, blood loss, complications, radiographic outcomes, and patient-reported outcomes. Statistical analysis was performed using a random-effects, inverse variance-weighted meta-analysis of observational data. Pre and postoperative radiographic and clinical outcomes were compared using a Student t -test. RESULTS Fourteen studies with 595 patients were included. Meta-analysis showed that the mean operative time was 7.2 ± 2.0 hours, and the average blood loss was 2033 ± 629 mL. After PSO, there was a significant improvement in sagittal vertebral axis (12.41-3.92 cm, P = .0003), LL (13.35°-42.60°, P = .000002), PSO angle (5.11° to -26.91°, P = .0001), and Oswestry Disability Index (55.36-27.35, P = .02). Common complications include pseudarthrosis (8.1%), neurological deficits (7.8%), and proximal junctional failure (6.0%). CONCLUSION PSO offers significant correction of sagittal vertebral axis, lumbar lordosis, PSO angle, and Oswestry Disability Index scores despite its reduced utilization in recent years. Blood loss and high complication rates must be considered when evaluating the efficacy of this procedure; however, surgeon experience and operative techniques can be used to reduce morbidity.
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Affiliation(s)
- Pratheek S Makineni
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland , Ohio , USA
| | - Mohamed E El-Abtah
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland , Ohio , USA
| | - Joshua R Porto
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland , Ohio , USA
| | - Michael P Steinmetz
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland , Ohio , USA
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Yang X, Li R, Qi Q, Liu J, Zheng X, Shu J. Efficacy of intervertebral release combined with asymmetric osteotomy in rigid degenerative scoliosis. J Orthop Surg Res 2024; 19:751. [PMID: 39533392 PMCID: PMC11558811 DOI: 10.1186/s13018-024-05133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 09/28/2024] [Indexed: 11/16/2024] Open
Abstract
PURPOSE The aim of this study is to evaluate the clinical efficacy and safety of treating patients with rigid degenerative scoliosis by restoring intervertebral balance through a combination of interbody release and asymmetric grade 1 and 2 osteotomy. METHOD The medical collected clinical and radiographic data of patients with rigid degenerative scoliosis from our department between 2015 and 2022. A total of 60 patients were included in the study, comprising 20 males and 40 females, with an average follow-up period of 30.7 months. Data recorded included surgery duration, blood loss, number of fixed segments, hospital stay, complications, clinical scores, and radiographic parameters. RESULTS The sagittal vertical axis improved from 4.28 ± 1.48 cm preoperatively to 2.90 ± 1.18 cm postoperatively, while the coronal vertical axis improved from 3.29 ± 1.72 cm preoperatively to 1.12 ± 0.62 cm postoperatively. The preoperative coronal Cobb angle was 30.85 ± 7.33°, which improved to 4.14 ± 3.06°postoperatively. Additionally, lumbar lordosis increased from 24.50 ± 17.24°preoperatively to 30.35 ± 6.11°postoperatively. VAS scores for back pain and leg pain, ODI scores, and JOA scores showed varying degrees of improvement. CONCLUSION Interbody release combined with asymmetric Grade 1 and 2 osteotomy to restore intervertebral balance significantly improves spinal deformity and postoperative functional scores in patients with rigid degenerative scoliosis.
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Affiliation(s)
- Xueneng Yang
- Department of Traumatic Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ruijuan Li
- Department of Burn, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qiangqiang Qi
- Department of Traumatic Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - JunFei Liu
- Department of Traumatic Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaoyu Zheng
- Department of Traumatic Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jun Shu
- Department of Traumatic Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Lee SH, Kim DH, Park JH, Kang DH. Predictive Value of Bolster Supine X-Ray for the Correction of Segmental Deformity After Thoracolumbar Fusion Surgery. Neurosurgery 2024; 95:1046-1054. [PMID: 39007601 DOI: 10.1227/neu.0000000000003080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/17/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Assessment of thoracolumbar spine flexibility is crucial for determining which osteotomy to perform (posterior column osteotomy or 3-column osteotomy) to restore sagittal balance. Although preoperative bolster supine X-rays have been used to evaluate spine flexibility, their correlation with postoperative spinopelvic parameters has not been reported. We aimed to evaluate the predictive value of bolster X-ray for correcting sagittal deformities after thoracolumbar fusion surgery. METHODS We retrospectively evaluated patients who underwent bolster supine radiography before posterior thoracolumbar fusion. Demographic data, operative records, and radiographic parameters were also recorded. The segmental Cobb angle, defined as the angle between the upper endplate of the uppermost and lower endplates of the lowest instrumented vertebrae, was compared between bolster and postoperative X-ray to evaluate the correlation between them. The predictive value of bolster X-ray for postoperative deformity correction was measured using intraclass correlation coefficients (ICC). RESULTS Forty-two patients were included. The preoperative segmental Cobb angle (-1.4 ± 22.4) was significantly lower than the bolster segmental Cobb angle (23.2 ± 18.7, P < .001) and postoperative segmental Cobb angle (27.9 ± 22.3, P < .001); however, no significant difference was observed between the bolster and postoperative segmental Cobb angles ( P = .746). Bolster X-ray showed a very strong correlation with postoperative X-ray (r = 0.950, P < .001) for segmental Cobb angle. Bolster supine X-ray had good-to-excellent reliability for postoperative X-ray with an ICC of 0.913 (95% CI, 0.760-0.962, P < .001) for the segmental Cobb angle. CONCLUSION Bolster supine X-rays demonstrate good-to-excellent reliability with postoperative X-rays for segmental Cobb angles. These findings offer valuable insights into the selection of appropriate osteotomy techniques for clinical practice.
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Affiliation(s)
- Sang Hyub Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon , Republic of Korea
| | - Dong-Hwan Kim
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si , Gyeongsangnam-do , Republic of Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul , Republic of Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si , Gyeongsangnam-do , Republic of Korea
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10
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Ammanuel SG, Page PS, Greeneway GP, Ansari D, Stadler JA. Early clinical outcomes and medical complications following long segment fusion for adult spinal deformity with and without three column osteotomy. World Neurosurg X 2024; 24:100415. [PMID: 39399352 PMCID: PMC11470477 DOI: 10.1016/j.wnsx.2024.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/24/2024] [Indexed: 10/15/2024] Open
Abstract
Background Surgical treatment of adult spinal deformity (ASD) commonly involves long-segment fusion with or without three column osteotomies (3CO) to provide satisfactory correction of sagittal and coronal balance. While some clinical studies have implicated 3CO as a driver of high surgical complication rates, these prior investigations are limited by small sample size. Herein, we compare early outcomes and adverse events in patients undergoing long segment posterior spinal fusion for ASD with and without 3CO. Methods A multicenter administrative database was queried for patients undergoing elective posterior spinal fusion for ASD. Patients were stratified based upon long segment fusion with and without 3CO. Preoperative patient demographics, procedural characteristics, hospitalization events, and postoperative complication rates were evaluated. Student's t-test and Fisher's exact test were utilized where appropriate to compare differences between the two groups for continuous and categorical variables. Results 340 cases met the inclusion criteria, of which 156 involved 3CO. Patients who required 3CO had a lower rate of preoperative diabetes (22.3 % vs 10.3 %, p = 0.003), higher rates of non-home discharge (26.2 % vs 57.1 %, p < 0.001), longer operation time (245.62 ± 9.45 vs. 434.40 ± 11.65, p < 0.001), and longer length of stay (4.17 ± 0.66 vs. 7.76 ± 0.83, p < 0.001). In terms of complications, 3CO patients had higher rates of deep surgical site infection (0 % vs 3.2 %, p = 0.02), reintubation (0 % vs 4.5 %, p = 0.004), inability to wean off ventilator (0 % vs 2.6 %, p = 0.04), and perioperative blood transfusion (20.1 % vs 76.3 %, p < 0.001). Conclusions In this retrospective analysis, posterior 3CO was frequently undertaken but associated with higher risk for postoperative adverse events following spinal deformity correction.
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Affiliation(s)
- Simon G. Ammanuel
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, United States
| | - Paul S. Page
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, United States
| | - Garret P. Greeneway
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, United States
| | - Darius Ansari
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, United States
| | - James A. Stadler
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, United States
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11
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Corbett AN, Adeniyi B, Simonetta BA, Crandall DG, Chang MS. Complications and outcomes after three-column osteotomy: a 5-year follow-up. Spine J 2024; 24:1723-1731. [PMID: 38697559 DOI: 10.1016/j.spinee.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/12/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Three-column spinal osteotomies (3-CO) are powerful techniques used to correct spinal deformity. These surgeries are associated with an elevated risk of complications. While outcomes have been reported in the literature with 2 years follow-up, longer-term outcomes of three-column osteotomies remain understudied. OBJECTIVES This study aims to examine patient reported outcomes and complications for three-column osteotomies at 5 years. STUDY DESIGN Retrospective review of a prospectively collected spinal deformity cases database. PATIENT SAMPLE All consecutive adult patients at a single spine surgery center treated with either a pedicle subtraction osteotomy (PSO) or vertebral column resection (VCR) for spinal deformity, and with a minimum 5-year follow-up were included. OUTCOME MEASURES Visual-analog scale (VAS) for back pain score (0 to 10), Oswestry Disability Index (ODI) score (0 to 100), number of complications, revision rate, sagittal balance, lumbar lordosis at preoperative and at 5-year visit. METHODS Data was extracted from a prospectively collected spinal deformity surgery database continuously updated since 2002 with data from operative reports, patients' medical visit notes and patients' self-reported VAS and ODI questionnaires completed at each office visit. Radiographic measurements were performed on standing full-length spine radiographs taken at preop and 5-year visits. Descriptive statistics, comparison of means and proportions among groups, and a logistic regression analysis were conducted using the statistical software package SPSS version 28. Statistical significance was set at p<.05. RESULTS Of 127 consecutive adult patients with minimum of 5-year follow-up undergoing a 3-CO posterior spinal surgery for spinal deformity were identified and included in the study, 79 (62%) were treated with PSO, and 48 (38%) with VCR. Both PSO and VCR groups demonstrated significant improvements in VAS (PSO preop: 6.7, 5-year: 4.6, p<.001; VCR preop: 7.1, 5-year: 5.2, p<.001), and ODI (PSO preop: 52.9, 5-year: 45.4, p<.001; VCR preop: 57.5, 5-year 43.0, p<.001) that were maintained at 5 years. Major and minor complications occurring within 5 years were not statistically different between the PSO and VCR groups (major: 59.5% vs 56.3%, p=.85; minor: 45.6% vs 37.5%, p=.46). The rate of revision surgery within 5 years was 39.4% overall. Of the fifty patients requiring revision, 37.5% were for nonunion, 27.1% instrumentation failure, 14.6% proximal junctional kyphosis (PJK), 12.5% vertebral fracture, 6.3% motor weakness, and 2.1% infection. Improvements in lumbar lordosis were maintained at 5 years in both the PSO (29.9° vs 47.2°, p<.001) and VCR (34.6° vs 48.5°, p<.001) groups while sagittal balance maintained significant improvement in the VCR group (9.5 cm vs 6.3 cm, p=.008) but not the PSO (11.4 cm vs 9.3 cm, p=.065). CONCLUSION Patients undergoing three-column osteotomies had a major complication rate of 57.5% and a minor complication rate of 42.5% after 5 years. Improvements in lumbar lordosis were maintained at 5-year follow-up, but sagittal balance was only maintained in the VCR group. Despite these radiographic findings, both VCR and PSO groups maintained significant clinical improvements in both VAS and ODI scores at 5-year follow up.
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Affiliation(s)
- Andrew N Corbett
- Sonoran Spine in collaboration with HonorHealth, 1255 W. Rio Salado Parkway, Suite 107, Tempe, AZ 85281, USA; Florida Advanced Spine and Orthopedics, 2040 Short Ave, Odessa, FL 33556, USA
| | - Biodun Adeniyi
- Sonoran Spine in collaboration with HonorHealth, 1255 W. Rio Salado Parkway, Suite 107, Tempe, AZ 85281, USA; Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Brandon A Simonetta
- Sonoran Spine in collaboration with HonorHealth, 1255 W. Rio Salado Parkway, Suite 107, Tempe, AZ 85281, USA; The Orthopedic Clinic, 1075 Mason Ave, Daytona Beach, FL 32117, USA
| | - Dennis G Crandall
- Sonoran Spine in collaboration with HonorHealth, 1255 W. Rio Salado Parkway, Suite 107, Tempe, AZ 85281, USA
| | - Michael S Chang
- Sonoran Spine in collaboration with HonorHealth, 1255 W. Rio Salado Parkway, Suite 107, Tempe, AZ 85281, USA.
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12
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Singh M, Muhamad Ariffin MH, Tan JA, Sabri S, Baharuddin A. From Looking at the Floor to Looking Forward: A Case of Hyperkyphotic Spine in an Ankylosing Spondylitis Patient. Cureus 2024; 16:e70091. [PMID: 39449875 PMCID: PMC11500485 DOI: 10.7759/cureus.70091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2024] [Indexed: 10/26/2024] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disorder characterized by progressive spinal stiffness and deformity, primarily affecting the sacroiliac joints, spine, and pelvis. In advanced cases, untreated AS can lead to severe kyphosis, resulting in debilitating functional impairment and a significantly reduced quality of life. We present a case of a patient with a fixed thoracolumbar kyphotic deformity that severely affected his daily function. He underwent an L1 and L4 pedicle subtraction osteotomy (PSO) and posterior spinal instrumentation. This case highlights the challenges associated with correcting rigid spinal deformities in AS patients, where surgical intervention is often the only option to restore function and quality of life. Despite the high risk of complications, advancements in surgical techniques and implants have improved outcomes even in the most complex cases. Detailed preoperative planning, precise surgical execution, and cautious postoperative management are crucial for successful outcomes in such high-risk procedures.
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Affiliation(s)
- Malwin Singh
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | | | - Jin Aun Tan
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Suffian Sabri
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Azmi Baharuddin
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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13
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Farber SH, White MD, Guidry BS, Dugan RK, Shaffer KV, Ho JL, Kuttner NP, Morgan CD, Kupanoff KM, Uribe JS, Turner JD. Predicting Immediate Lordosis Restoration After Anterior Lumbar Interbody Fusion and the Effect of Posterior Column Osteotomies. World Neurosurg 2024:S1878-8750(24)01481-5. [PMID: 39216719 DOI: 10.1016/j.wneu.2024.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Anterior lumbar interbody fusion (ALIF) can be combined with posterior column osteotomies (PCOs) to maximize lordotic correction. This study compares radiographic changes in regional and segmental lordosis in patients undergoing ALIF with and without PCOs. METHODS Patients >18 years old who underwent ALIF at 1 or 2 segments at a single institution (January 2014-July 2020) were included. Preoperative and postoperative radiographic parameters were determined, and a propensity-matched analysis was performed. RESULTS Ninety-nine patients (53 [54%] men) underwent ALIF at 129 levels (mean [SD], 1.3 [0.46] levels; median [range] age, 61 [32-83] years). PCOs were performed in 13 (13%) patients at 19 (15%) segments. PCOs included 13 Schwab grade 1 and 6 grade 2 osteotomies. All measures, including lumbar lordosis, segmental lordosis, disc angle, and neural foramen height, increased significantly after surgery (P ≤ 0.003). In the propensity-matched analysis, PCO was associated with greater increases in lumbar lordosis (14.9° vs. 8.2°, P = 0.02), segmental lordosis (14.0° vs. 9.6°, P = 0.03), and disc angle (15.0° vs. 10.2°, P = 0.046). The change in disc angle more closely approximated the inherent lordosis of the cage when PCO was performed (94% vs. 62%, P = 0.004). CONCLUSIONS Performing PCOs and ALIFs significantly increased the radiographic correction of overall and segmental lordosis in the selected patient cohort. The disc angle achieved with ALIF without PCOs was approximately 60% of the cage lordosis. The addition of PCO allowed for greater segmental compression, enabling the disc angle to reach nearly 100% of the inherent interbody cage lordosis.
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Affiliation(s)
- S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael D White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Bradley S Guidry
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert K Dugan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kurt V Shaffer
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacquelyn L Ho
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicolas P Kuttner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kristina M Kupanoff
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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14
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Iwai C, Nozawa S, Fushimi K, Yamada K, Akiyama H. Surgical management of omega deformity in a patient with neurofibromatosis type 1: a case report. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2897-2903. [PMID: 38717496 DOI: 10.1007/s00586-024-08288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 03/17/2024] [Accepted: 04/19/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To describe the surgical treatment in a patient with a partial omega deformity in the thoracic spine with neurofibromatosis type 1. METHODS The patient was a 55-year-old man with an omega deformity, which is defined as a curvature in which the end vertebra is positioned at the level of, above, or below the apical vertebra (i.e., a horizontal line bisecting it). We performed halo gravity traction (HGT) for 7 weeks, followed by posterior spinal instrumented nearly equal in situ fusion from T2-L5 with three femoral head allografts and a local bone autograft. We avoided reconstruction of the thoracic anterior spine because of his severe pulmonary dysfunction. RESULTS HGT improved the % vital capacity from 32.5 to 43.5%, and improved the Cobb angle of the kyphosis from > 180° before traction to 144° after traction. The Cobb angle of kyphosis and scoliosis changed from > 180° preoperatively to 155° and 146°, respectively, postoperatively, and 167° and 156°, respectively, at final follow-up. His postoperative respiratory function deteriorated transiently due to bilateral pleural effusions and compressive atelectasis, which was successfully treated with a frequent change of position and nasal high flow for 1 week. At final follow-up, his pulmonary function improved from 0.86 to 1.04 L in VC, and from 32.5 to 37.9% in %VC. However, there was no overall improvement in preoperative distress following surgery, although his modified Borg scale improved from 3 preoperatively to 0.5 postoperatively. One month after discharge, he felt worsening respiratory distress (SpO2:75%) and was readmitted for pulmonary hypertension for 2 months. He was improved by non-invasive positive pressure ventilation (biphasic positive airway pressure) for 1 week, medication and daily lung physiotherapy. Thereafter, he has been receiving permanent daytime (0.5 L/min) and nighttime (2 L/min) oxygen therapy at home. A solid arthrodesis through the fusion area was confirmed on computed tomography. However, the kyphosis correction loss was 12° (i.e., 155°-167°), while the scoliosis correction loss was 10° (i.e., 146°-156°) at 2 years of recovery. CONCLUSIONS We suggest that nearly equal in situ fusion is a valid option for preventing further deformity deterioration and avoiding fatal complications.
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Affiliation(s)
- Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Satoshi Nozawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kazunari Fushimi
- Department of Orthopaedic Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kazunari Yamada
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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15
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Chi J, Zhang Y, Fontaine A, Zhang Z, Wang J, Labaran L, Li X. Pedicle Subtraction Osteotomy Versus Multilevel Anterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in the Treatment of Adult Spinal Deformity: Trends, Outcomes, and Cost. Clin Spine Surg 2024; 37:E192-E200. [PMID: 38158597 DOI: 10.1097/bsd.0000000000001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to compare the outcomes of pedicle subtraction osteotomy (PSO) with multilevel anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) in posterior long-segment fusion. BACKGROUND PSO and ALIF/LLIF are 2 techniques used to restore lumbar lordosis and correct sagittal alignment, with each holding its unique advantages and disadvantages. As there are situations where both techniques can be employed, it is important to compare the risks and benefits of both. PATIENTS AND METHODS Patients aged 18 years or older who underwent PSO or multilevel ALIF/LLIF with posterior fusion of 7-12 levels and pelvic fixation were identified. 1:1 propensity score was used to match PSO and ALIF/LLIF cohorts for age, sex, and relevant comorbidities, including smoking status. Logistic regression was used to compare medical and surgical outcomes. Trends and costs were generated for both groups as well. RESULTS ALIF/LLIF utilization in posterior long fusion has been steadily increasing since 2010, whereas PSO utilization has significantly dropped since 2017. PSO was associated with an increased risk of durotomy ( P < 0.001) and neurological injury ( P = 0.018). ALIF/LLIF was associated with increased rates of postoperative radiculopathy ( P = 0.005). Patients who underwent PSO had higher rates of pseudarthrosis within 1 and 2 years ( P = 0.015; P = 0.010), 1-year hardware failure ( P = 0.028), and 2-year reinsertion of instrumentation ( P = 0.009). Reoperation rates for both approaches were not statistically different at any time point throughout the 5-year period. In addition, there were no significant differences in both procedural and 90-day postoperative costs. CONCLUSIONS PSO was associated with higher rates of surgical complications compared with anterior approaches. However, there was no significant difference in overall reoperation rates. Spine surgeons should select the optimal technique for a given patient and the type of lordotic correction required.
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Affiliation(s)
- Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Yi Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Andrew Fontaine
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Jesse Wang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Lawal Labaran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Xudong Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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16
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Liu J, Zhang X, Zhang H, Zhang J, Wang Q, Li G. Prevalence, Features, and Predictive Factors of Spontaneous Spinal Arthrodesis in Posttraumatic Thoracolumbar Kyphosis. World Neurosurg 2024; 185:e676-e682. [PMID: 38417620 DOI: 10.1016/j.wneu.2024.02.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Spontaneous spinal arthrodesis (SSA) is a phenomenon of spontaneous fusion, and SSA is not rare in posttraumatic thoracolumbar kyphosis (PTK). However, few reports have focused on SSA in patients with PTK. The objective of this study was to investigate the prevalence, features, and predictive factors of SSA in patients with PTK. METHODS In this retrospective study, 70 patients with PTK were included. Data on the clinical and radiologic parameters were obtained and evaluated. According to whether there was SSA or not, patients were divided into an SSA group (n = 45) or a non-SSA group (n = 25). A binary logistic regression analysis was used to identify the predictive factors for SSA. RESULTS The incidence of SSA in PTK was 64%. Among 45 patients with PTK with SSA, SSA was present as a solid bridging anterior osteophyte along the vertebral bodies in 11 patients, posterior contiguous bony growth through the facet joints bilaterally in 13 patients, bony formation in both anterior and posterior elements in 18 patients, and direct contiguous bony formation from the injured vertebral body to the adjacent one in 3 patients. Patients with longer disease duration, larger local Cobb angle, and anterior wall height loss (AWHL) ratio of injured vertebral body, and less kyphosis flexibility index were significantly more likely to develop SSA. The parameter of AWHL remained significant in binary logistic regression analysis. CONCLUSIONS SSA in PTK was common, and the SSA sign presented in various patterns, which might have implications for surgical decisions. AWHL was the independent predictor for SSA.
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Affiliation(s)
- Jincheng Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Department of Orthopaedics, Xichang People's Hospital, Xichang, China
| | - Xiaofei Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Hamouda AM, Pennington Z, Astudillo Potes M, Mikula AL, Lakomkin N, Martini ML, Abode-Iyamah KO, Freedman BA, McClendon J, Nassr AN, Sebastian AS, Fogelson JL, Elder BD. The Predictors of Incidental Durotomy in Patients Undergoing Pedicle Subtraction Osteotomy for the Correction of Adult Spinal Deformity. J Clin Med 2024; 13:340. [PMID: 38256474 PMCID: PMC10816915 DOI: 10.3390/jcm13020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Pedicle subtraction osteotomy (PSO) is a powerful tool for sagittal plane correction in patients with rigid adult spinal deformity (ASD); however, it is associated with high intraoperative blood loss and the increased risk of durotomy. The objective of the present study was to identify intraoperative techniques and baseline patient factors capable of predicting intraoperative durotomy. Methods: A tri-institutional database was retrospectively queried for all patients who underwent PSO for ASD. Data on baseline comorbidities, surgical history, surgeon characteristics and intraoperative maneuvers were gathered. PSO aggressiveness was defined as conventional (Schwab 3 PSO) or an extended PSO (Schwab type 4). The primary outcome of the study was the occurrence of durotomy intraoperatively. Univariable analyses were performed with Mann-Whitney U tests, Chi-squared analyses, and Fisher's exact tests. Statistical significance was defined by p < 0.05. Results: One hundred and sixteen patients were identified (mean age 61.9 ± 12.6 yr; 44.8% male), of whom 51 (44.0%) experienced intraoperative durotomy. There were no significant differences in baseline comorbidities between those who did and did not experience durotomy, with the exception that baseline weight and body mass index were higher in patients who did not suffer durotomy. Prior surgery (OR 2.73; 95% CI [1.13, 6.58]; p = 0.03) and, more specifically, prior decompression at the PSO level (OR 4.23; 95% CI [1.92, 9.34]; p < 0.001) was predictive of durotomy. A comparison of surgeon training showed no statistically significant difference in durotomy rate between fellowship and non-fellowship trained surgeons, or between orthopedic surgeons and neurosurgeons. The PSO level, PSO aggressiveness, the presence of stenosis at the PSO level, nor the surgical instrument used predicted the odds of durotomy occurrence. Those experiencing durotomy had similar hospitalization durations, rates of reoperation and rates of nonroutine discharge. Conclusions: In this large multisite series, a history of prior decompression at the PSO level was associated with a four-fold increase in intraoperative durotomy risk. Notably the use of extended (versus) standard PSO, surgical technique, nor baseline patient characteristics predicted durotomy. Durotomies occurred in 44% of patients and may prolong operative times. Additional prospective investigations are merited.
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Affiliation(s)
- Abdelrahman M. Hamouda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | - Maria Astudillo Potes
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | - Anthony L. Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | - Michael L. Martini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | | | - Brett A. Freedman
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jamal McClendon
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA;
| | - Ahmad N. Nassr
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Arjun S. Sebastian
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jeremy L. Fogelson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
| | - Benjamin D. Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (A.M.H.); (M.A.P.)
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Zhao D, Wang F, Hu Z, Zhong R, Huang H, Zhang Z, Jiang D, Liang Y, Liang Y. A novel surgical strategy of three column osteotomy at non-lesioned area for correcting severe angular kyphosis due to Pott's disease: a retrospectively study. Sci Rep 2023; 13:21360. [PMID: 38049473 PMCID: PMC10695937 DOI: 10.1038/s41598-023-48891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
Severe sharp angular kyphosis resulting from Pott's disease typically necessitates surgical intervention. The deployment of three-column osteotomy within the lesion and apical regions has been validated as an effective modality for the amelioration of angular kyphosis. Nonetheless, a propensity for residual kyphosis persists, accompanied by a significant perioperative risk profile. In pursuit of optimizing correctional outcomes and diminishing complication rates, we proposed an innovative surgical approach, utilizing osteotomy in the non-lesioned zones for the rectification of severe angular kyphosis associated with Pott's disease. This retrospective investigation encompasses 16 subjects who underwent this novel surgical tactic, involving osteotomies in non-lesioned vertebral segments, at our institution from 2016 to 2018. Radiographic measures, encompassing kyphotic angle and sagittal vertical axis (SVA), were documented at baseline and during terminal follow-up. Neurological status was evaluated via the American Spinal Injury Association (ASIA) grading system. Operative duration, volume of hemorrhage, and perioperative complications were systematically recorded. The cohort included 6 males and 10 females with an average age of 30.7 ± 11.41 years. Follow-up intervals spanned 24 to 42 months. Mean operative time and blood loss were 492 ± 127.3 min and 1791 ± 788.8 ml, respectively. The kyphotic angle improved from 97.6 ± 14.6° to 28.8 ± 18.70°. In cases with lumbar afflictions, vertebral restoration was achieved (L1-L5 and L2-S1). Initial mean SVA of 6.7 ± 3.58 cm was reduced to 3.3 ± 1.57 cm at follow-up. Neurological function enhancement was observed in six patients, while ten maintained baseline status. Complication rates, including wound infection and rod fracture at 12 months, were observed in approximately 11.8% of cases. Our findings suggest that the surgical strategy is both effective and safe for addressing severe angular kyphosis due to Pott's disease, contingent upon the expertise of the surgical unit.
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Affiliation(s)
- Deng Zhao
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Fei Wang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Zhengjun Hu
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Rui Zhong
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Huaqiang Huang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Zhong Zhang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Dengxu Jiang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Beijing, China.
| | - Yijian Liang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China.
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Hua W, Ke W, Li S, Feng X, Wang K, Yin H, Wu X, Zhang Y, Gao Y, Ling L, Yang C. Sequential Correction versus Conventional Correction for Severe and Rigid Kyphoscoliosis: A Retrospective Case Control Study. Orthop Surg 2023; 15:3083-3091. [PMID: 37771124 PMCID: PMC10694008 DOI: 10.1111/os.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE Conventional correction techniques were challenging and of high risk of neurological complications for the correction of severe and rigid kyphoscoliosis. A new technical note we developed and named as sequential correction, was used to treat severe and rigid kyphoscoliosis. The present study was to compare the clinical outcomes of sequential correction versus conventional correction for the treatment of severe and rigid kyphoscoliosis. METHODS This is a respectively case-control study. Between January 2014 and December 2019, 36 adults underwent the surgical correction of severe and rigid kyphoscoliosis and were included in the present study. Among them, 20 adults underwent conventional correction, 16 adults underwent sequential correction. Major curve Cobb angle, kyphotic angle, coronal imbalance, and sagittal vertical axis were compared between two groups. The patient-reported health-related quality of life outcomes, including the Oswestry disability index score, and SRS-22 questionnaire, were recorded. Independent samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test, were used to compare the differences between two groups according to the results of normal distribution test. RESULTS In conventional correction group, the mean major curve Cobb angle was 122.50° preoperatively, 40.35° immediately after surgery, and 43.95° at final follow-up postoperatively; the mean kyphotic angle was 97.45° preoperatively, 34.45° immediately after surgery, and 38.30° at final follow-up postoperatively. In the sequential correction group, the mean major angle was 134.44° preoperatively, 44.56° immediately after surgery, and 46.25° at final follow-up postoperatively; the mean kyphotic angle was 112.31° preoperatively, 39.00° immediately after surgery, and 40.38° at final follow-up postoperatively. The mean major curve Cobb angle and kyphotic angle of both groups were improved significantly, while there were no significant differences between two groups (p > 0.001). Improved self-reported quality of life scores were achieved postoperatively and at final follow-up postoperatively, and there were no significant differences between the two groups. The total complication rate of the patients underwent conventional correction was 55%, and the total complication rate of the patients underwent sequential correction was 43.75%. The complication rate of the two groups showed no significant difference. CONCLUSIONS Sequential correction is an excellent and safe treatment for severe and rigid kyphoscoliosis in adults, with similar clinical outcomes with conventional correction. The total complication rate of the patients who underwent sequential correction was slightly lower than conventional correction.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Huipeng Yin
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Li Ling
- Department of VIP Clinic, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Van Halm-Lutterodt NI, Pan A, Al-Saidi NN, Ye Z, Zhang Y, Zhou L, Yang J, Liu T, Liu Y, Kim SS, Lonner B, Hai Y. Postoperative complications following Schwab-grade-I versus Schwab-grade-II PCO in treating severe rigid kyphoscoliosis patients: comparative matched-group outcomes with minimum 2-year follow-up. Spine J 2023; 23:1908-1919. [PMID: 37619870 DOI: 10.1016/j.spinee.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/05/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND CONTEXT Standard partial facetectomies, (Smith-Petersen Osteotomy, (SPO), (Schwab-grade-I) and complete facet resection also known as Ponte osteotomy, (PO), (Schwab-grade-II) are narrowly akin and collectively appreciated as posterior column shortening osteotomies (PCOs). The former is considered a gentler osteotomy grade than the latter. The spine literature provides very little information on their comparison regarding perioperative complications and major curve correction rate outcomes. PURPOSE To determine whether Schwab-grade-I PCO (SPO) and Schwab-grade-II PCO (PO) are comparably safe in the surgical management of severe rigid scoliosis or kyphoscoliosis patients. STUDY DESIGN/SETTING Retrospective single-center comparative clinical study. PATIENT SAMPLE A total of 38 patients with severe rigid scoliosis or kyphoscoliosis were propensity score matched in this study, (SPO-treated); n=21 (55.30%) and (PO-treated); n=17 (44.70%), who underwent primary spinal deformity corrective surgery, respectively. OUTCOME MEASURES Outcomes included demographics, baseline pulmonary functional outcomes, perioperative complications incidence, hospital costs, Oswestry disability index (ODI), and the Scoliosis Research Society-22 (SRS-22) questionnaire scores. METHODS Following approval by the Institutional Review Board (IRB) of Beijing Chaoyang Hospital-Affiliated Capital Medical University in Beijing, out of a total of 82 consecutive surgical patients with complete data demonstrating severe and/or rigid spinal deformity, a pool of 38 of the 82 (46.3%) propensity-matched adult (≥18 years) patients with severe rigid scoliosis or kyphoscoliosis defined with a preoperative major curve magnitude of ≥80° on anteroposterior plain radiographs, and flexibility of <25% on bending plain radiographs who underwent primary spinal deformity corrective surgery were retrospectively evaluated. The patients were dichotomized into two osteotomy groups: standard (partial) facetectomy (SPO-treated), n=21 with an average age of 24.67 years, (Schwab-grade-I PCO) and complete facet excision, (PO-treated), (ie, Schwab-grade-II PCO), n=17 with an average age of 23.12 years. The minimum follow-up period was 2 years. Primary outcomes included baseline demographics and clinical features. Secondary outcomes included perioperative [intraoperative, immediate, and 2-year postoperative] complication rates. Tertiary outcomes included perioperative ODI and SRS-22 scores. Statistical analyses were carried out by Student t-test and Pearson's Chi-square test (Fisher's Exact Test), through Python statistical software package. Statistical significance was set at (p<.05). RESULTS Of the 38 matched severe rigid scoliosis or kyphoscoliosis patients, 55.30% (n=21) were SPO-treated and 44.70% (n=17) were PO-treated patients, respectively. The overall average age of patients was 23.97 years, with a female incidence of 76.32%. Major curve correction rates were 49.19% and 57.40% in SPO-treated and PO-treated patients, respectively, (p>.05). Immediately following surgery, comparable overall complication rates of 28.57% (n=6/21) versus 29.41% (n=5/17) were observed in the SPO-treated and PO-treated patients, respectively, (p=.726). We observed incidences of 9.52%, (n=2/21) versus 5.88%, (n=1/17) for surgical intensive care unit (SICU) admission, and incidences of 4.76%, (n=1/21) versus 5.88%, (n=1/17) for cardiopulmonary events in SPO-treated versus PO-treated patients following corrective surgery, respectively, (p>.05). The incidences of neurological deficits in the SPO-treated and PO-treated patients were respectively, 14.29%, (n=3/21) versus 17.65%, (n=3/17) immediately following surgery, (p>.05), and 0.00%, (n=0/21) in SPO-treated versus 14.28%, (n=3/21) in PO-treated patients at ≥2 years postoperative, (p<.05). Among the three patients that reported neurological deficits in the PO-treated group at ≥2 years postoperative, two patients had pre-existing baseline neurological deficits. The ODI score in the PO-treated group was significantly inferior at a minimum 2-year follow-up, (p<.05). CONCLUSIONS In the current study, both SPO-treated and PO-treated patients demonstrated statistically comparable surgical complications immediately following corrective surgery. Severe rigid kyphoscoliosis patients with preexisting baseline neurological deficits were more inclined to sustain neurological morbidity following corrective surgery. PCO corrective techniques are warranted as safe options for treating patients with severe rigid spine deformity phenotypes.
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Affiliation(s)
- Nicholas Ishmael Van Halm-Lutterodt
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Orthopedics and Neurosurgery Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Orthopedics Surgery and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA; Department of Healthcare Leadership Program, School of Professional Studies, Brown University, Providence, RI, USA; Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Neil Nazar Al-Saidi
- Department of Medicine, Central Michigan University School of Medicine, Mount Pleasant, MI, USA
| | - Ziyang Ye
- Department of Orthopedics Surgery and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA; Department of Business Analytics, University of Chicago, Chicago, IL, USA
| | - Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tie Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sunny Sik Kim
- Department of Orthopedics Surgery and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
| | - Baron Lonner
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York City, NY, USA
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Park C, Agarwal N, Mummaneni PV, Berven SH. Spinopelvic Alignment: Importance in Spinal Pathologies and Realignment Strategies. Neurosurg Clin N Am 2023; 34:519-526. [PMID: 37718098 DOI: 10.1016/j.nec.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Sagittal spinal malalignment can lead to pain, decreased function, dynamic imbalance, and compromise of patient-reported health status. The goal of reconstructive spine surgery is to restore spinal alignment parameters, and an understanding of appropriate patient-specific alignment is important for surgical planning and approaches. Radiographic spinopelvic parameters are strongly correlated with pain and function. The relationship between spinopelvic parameters and disability in adult spinal deformity patients is well-established, and optimal correction of sagittal alignment results in improved outcomes regarding patient health status and mechanical complications of surgery.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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22
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Scheer JK, Clark AJ, Mitsunaga K, Tan LA, Theologis AA. Lumbar Pedicle Subtraction Osteotomy (PSO): A Novel Surgical Technique for Correction of Sagittal and Coronal Imbalance Using Laterally Based Satellite Rods. Clin Spine Surg 2023; 36:317-322. [PMID: 37482632 DOI: 10.1097/bsd.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
STUDY DESIGN Operative video and supplemental manuscript. OBJECTIVE To present a novel step-by-step approach to performing a lumbar pedicle subtraction osteotomy (PSO) using laterally based satellite rods. SUMMARY OF BACKGROUND DATA Multi-rod constructs have demonstrated paramount for decreasing rates of pseudarthrosis after PSOs. Multi-rods constructs can be achieved using either "satellite" rods (rods not connected to the primary rods) and/or "accessory rods" (rods connected to the primary rods). METHODS A step-by-step approach to performing a lumbar PSO using a laterally based satellite rod configuration is provided through a case example and surgical technique video. RESULTS Lateral satellite rods can be particularly useful from a surgical perspective, as they provide temporary stabilization while the PSO is being performed, facilitate closure of the osteotomy site (symmetric and/or asymmetric), and serve as the final fixation rods across the PSO without needing to be exchanged. CONCLUSIONS Use of laterally based satellite rods is a useful technique for lumbar PSOs, as they provide temporary stabilization while the PSO is being performed, facilitate closure of the osteotomy site, and serve as the final fixation rods across the PSO without needing to be exchanged.
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Affiliation(s)
- Justin K Scheer
- Department of Neurological Surgery, University of California-San Francisco (UCSF), San Francisco, CA
| | - Aaron J Clark
- Department of Neurological Surgery, University of California-San Francisco (UCSF), San Francisco, CA
| | - Kyle Mitsunaga
- The Queen's Medical Center Orthopedic Spine Center, Honolulu, HI
| | - Lee A Tan
- Department of Neurological Surgery, University of California-San Francisco (UCSF), San Francisco, CA
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23
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Joiner EF, Mummaneni PV, Shaffrey CI, Chan AK. Posterior-based Osteotomies for Deformity Correction. Neurosurg Clin N Am 2023; 34:555-566. [PMID: 37718102 DOI: 10.1016/j.nec.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused anterior column and non-focal sagittal deformity requiring modest correction in lordosis. When performed on multiple levels, posterior-column osteotomy may provide significant harmonious correction in patients who require more extensive correction. Pedicle subtraction osteotomy and vertebral column resection are appropriate for patients with a fused anterior column and more severe deformity, particularly focal and/or multiplanar deformity. The power of pedicle subtraction osteotomy and vertebral column resection to provide greater correction and to address multiplanar deformity comes at the cost of higher complication rates than posterior-column osteotomy.
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Affiliation(s)
- Evan F Joiner
- Department of Neurological Surgery, Columbia University-NewYork Presbyterian Hospital, 710 West 168th Street, 4th Floor, New York, NY 10032, USA. https://twitter.com/efjoiner
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA; Department of Orthopaedic Surgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Och Spine Hospital, 5141 Broadway, 3FW, New York, NY, USA.
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24
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Zhao D, Wang F, Hu Z, Zhong R, Liang Y. Pulmonary and clinical outcomes of patients with severe rigid scoliosis and type I respiratory failure treated with halo-pelvic distraction. J Orthop Surg Res 2023; 18:710. [PMID: 37735661 PMCID: PMC10512616 DOI: 10.1186/s13018-023-04212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The severe rigid scoliosis patients with type I respiratory failure could not tolerate complicated corrective surgery. Preoperative halo-pelvic distraction (HPD) is used to reduce the curve magnitude and improve the pulmonary function before surgery. The present study aimed to retrospectively analyze the pulmonary and clinical outcomes of preoperative HPD in severe rigid spinal deformity with type I respiratory failure. METHODS Eighteen cases of severe rigid scoliosis and type I respiratory failure treated with preoperative HPD and corrective surgery for spinal deformity between 2016 and 2018 were retrospectively reviewed. Patient demographics, major coronal curve and kyphosis, correction rates, heights, pulmonary function, distraction time, and postoperative neurological complications were recorded for all cases. RESULTS The averaged duration of distraction was 9.1 ± 2.3 months. The coronal curve was corrected from 168° ± 14° to 58° ± 11° at the end of HPD. The kyphosis curve reduced from 151° ± 29° to 65° ± 10°. Meanwhile, the mean stand body height increased by 23.9 ± 5.3 cm. Significantly increased mean FVC (1.52 ± 0.43 L vs. 0.95 ± 0.44 L) and improved percent-predicted values for FVC (37 ± 10% vs. 23 ± 9%) were observed after HPD. The pressure of oxygen (PaO2) increased from 54.5 ± 2.0 to 84.8 ± 4.7 mmHg. Scoliosis and kyphosis curve, respectively, averaged 48 ± 8°and 30 ± 14° after final fusion and instrumentation, with a mean correction of 71% and 80%, respectively. No severe complication occurred during the distraction. CONCLUSIONS HPD may be useful for severe rigid scoliosis patients with type I respiratory failure. Pulmonary functions in patients with severe rigid scoliosis can be significantly improved by HPD. They are then better able to tolerate complicated corrective surgery.
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Affiliation(s)
- Deng Zhao
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Fei Wang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Zhengjun Hu
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Rui Zhong
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yijian Liang
- Department of Orthopaedics, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China.
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Hua W, Li S, Feng X, Wang K, Yin H, Wu X, Zhang Y, Gao Y, Ling L, Yang C. Sequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results. BMC Musculoskelet Disord 2023; 24:697. [PMID: 37653384 PMCID: PMC10469414 DOI: 10.1186/s12891-023-06736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE The present study is to evaluate the clinical outcomes of the sequential correction of severe and rigid kyphoscoliosis. METHODS Between January 2014 and December 2020, 27 adults with severe and rigid kyphoscoliosis underwent sequential correction combined with posterior grade 4 or grade 5 spinal osteotomy. Radiological parameters, including the major curve Cobb angle, kyphotic angle, coronal imbalance, and sagittal vertical axis (SVA), were compared. Patient self-reported health-related quality of life (HRQOL) scores were used to evaluate clinical outcomes. RESULTS The mean major curve Cobb angle improved from 134.30 ± 13.24° to 44.48 ± 9.34° immediately after surgery and to 46.11 ± 8.94° at the final follow-up. The mean kyphotic angle improved from 112.15 ± 20.28° to 38.63 ± 15.00° immediately after surgery and to 39.85 ± 14.92° at the final follow-up. The mean preoperative major curve Cobb angle of grade 5 spinal osteotomy group was higher than that of grade 4 spinal osteotomy group. Coronal imbalance and SVA slightly improved. The patient self-reported HRQOL scores improved postoperatively and at the final follow-up. Activity, appearance and total scores of the SRS-22 of the grade 5 spinal osteotomy group at the final follow-up were significantly better than those of the grade 4 spinal osteotomy group. CONCLUSIONS Sequential correction combined with posterior grade 4 or grade 5 spinal osteotomies is an excellent and safe treatment for severe and rigid kyphoscoliosis in adults. Sequential correction combined with posterior grade 5 spinal osteotomies can be used to correct severe and rigid kyphoscoliosis with higher major curve Cobb angle.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huipeng Yin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Ling
- Department of VIP Clinic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Zavras AG, Sullivan TB, Dandu N, An HS, DeWald CJ, Colman MW. Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy. Global Spine J 2023; 13:1342-1349. [PMID: 34263668 PMCID: PMC10416591 DOI: 10.1177/21925682211032563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. METHODS This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). RESULTS Significant correlations were found between PSO SAC and the postoperative increase in LL (r = 0.316, P = .021) and PT (r = 0.352, P = .010), and a decrease in TPA (r = -0.324, P = .018). PSO level significantly correlated with change in T1SPI (r = -0.305, P = .026) and SVA (r = -0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = -3.138, P = .009) and SVA (β = -29.030, P = .001), while larger PSO SAC (β = -0.375, P = .045) and a greater number of fusion levels (β = -1.427, P = .036) predicted a greater reduction in TPA. CONCLUSION This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.
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Affiliation(s)
- Athan G. Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - T. Barrett Sullivan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Howard S. An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Matthew W. Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Mills ES, Mertz K, Faye E, Bell JA, Ton AT, Wang JC, Alluri RK, Hah RJ. Complication Rates and Utilization Trends of 3-Level Posterior Column Osteotomy Compared to Single-Level Pedicle Subtraction Osteotomy. Neurospine 2023; 20:662-668. [PMID: 37401085 PMCID: PMC10323336 DOI: 10.14245/ns.2346222.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE The objective of this study is to assess differences in complication profiles between 3-level posterior column osteotomy (PCO) and single-level pedicle subtraction osteotomy (PSO) as both are reported to provide similar degrees of sagittal correction. METHODS The PearlDiver database was queried retrospectively using International Classification of Disease, 9th and 10th edition and Current Procedural Terminology codes to identify patients who underwent PCO or PSO for degenerative spine disease. Patients under age 18 or with history of spinal malignancy, infection, or trauma were excluded. Patients were separated into 2 cohorts, 3-level PCO or single-level PSO, matched at a 1:1 ratio based on age, sex, Elixhauser comorbidity index, and number of fused posterior segments. Thirtyday systemic and procedure-related complications were compared. RESULTS Matching resulted in 631 patients for each cohort. PCO patients had decreased odds of respiratory (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.43-0.82; p = 0.001) and renal complications (OR, 0.59; 95% CI, 0.40-0.88; p = 0.009) compared to PSO patients. There was no significant difference in cardiac complications, sepsis, pressure ulcer, dural tear, delirium, neurologic injuries, postoperative hematoma, postoperative anemia, or overall complications. CONCLUSION Patients who undergo 3-level PCO have decreased respiratory and renal complications compared to single-level PSO. No differences were found in the other complications studied. Considering both procedures achieve similar sagittal correction, surgeons should be aware that 3-level PCO offers an improved safety profile compared to single-level PSO.
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Affiliation(s)
- Emily S. Mills
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Kevin Mertz
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Ethan Faye
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Jennifer A. Bell
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Andy T. Ton
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Raymond J. Hah
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
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Joaquim AF, de Oliveira SA, Appenzeller S, Patel AA. Spine Surgery and Ankylosing Spondylitis: Optimizing Perioperative Management. Clin Spine Surg 2023; 36:8-14. [PMID: 35249972 DOI: 10.1097/bsd.0000000000001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/02/2022] [Indexed: 02/07/2023]
Abstract
Ankylosing spondylitis (AS) is a common form of axial spondyloarthritis, characterized by inflammatory back pain, radiographic sacroiliitis, excess spinal bone formation, and a high prevalence of HLA-B27. Commonly, AS patients require spinal surgery for kyphotic deformities, spinal trauma, and spinal infections. For preoperative management, proper interruption considering each specific half-lives of disease-modifying antirheumatic drugs are necessary to avoid complications, such as infections. When feasible, bone quality assessment before surgery is mandatory. For intraoperative measurements, airway management should be carefully evaluated, especially in patients with severe cervical deformities. Cardiac, renal, and pulmonary assessment should be made considering specific pathologic characteristics involved in AS patients, such as pulmonary restrictive disease and chronic anti-inflammatory drugs use. Multimodal neurophysiological intraoperative monitoring is recommended once these patients had a high risk for neurological deterioration. At the postoperative period, early oral intake, early mobilization, and aggressive pain control may decrease complications and enhance recovery. AS presents several unique challenges that require specific attention around spine surgery. This includes handling preoperative and postoperative pharmacotherapeutics, intraoperative airway management, and the mitigation of postoperative complications. In this paper, we provide a literature review of optimal strategies for the perioperative management for patients with AS.
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Affiliation(s)
| | | | - Simone Appenzeller
- Department of Orthopedics, Rheumatology, and Traumatology, School of Medical Science, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Alpesh A Patel
- Department of Orthopaedic Surgery & Neurosurgery, Northwestern Spine Health, Northwestern University School of Medicine, Chicago, IL
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Menezes CM, Lacerda GC, Lamarca S. Sagittal Alignment Concepts and Spinopelvic Parameters. Rev Bras Ortop 2023; 58:1-8. [PMID: 36969787 PMCID: PMC10038727 DOI: 10.1055/s-0042-1742602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 11/22/2021] [Indexed: 10/18/2022] Open
Abstract
Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.
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Affiliation(s)
- Cristiano Magalhães Menezes
- Serviço de Cirurgia da Coluna, Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Serviço de Cirurgia da Coluna, Hospital Vila da Serra, Belo Horizonte, MG, Brasil
| | - Gabriel Carvalho Lacerda
- Serviço de Cirurgia da Coluna, Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Serviço de Cirurgia da Coluna, Hospital Vila da Serra, Belo Horizonte, MG, Brasil
| | - Santiago Lamarca
- Serviço de Cirurgia da Coluna, Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Serviço de Cirurgia da Coluna, Hospital Vila da Serra, Belo Horizonte, MG, Brasil
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Yuan H, Xie Y, Zheng J, Yang Y. Novel intervertebral space release for the treatment of moderate and severe degenerative scoliosis. Medicine (Baltimore) 2023; 102:e32445. [PMID: 36701724 PMCID: PMC9857351 DOI: 10.1097/md.0000000000032445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To investigate the clinical effectiveness and feasibility of novel intervertebral space release without Smith-Petersen osteotomy/pedicle subtraction osteotomy/Ponte osteotomy in the treatment of adults with moderate to severe degenerative scoliosis. The data of 49 patients with moderate to severe degenerative scoliosis treated with a novel intervertebral space release and balance correction technique from January 2010 to January 2016 and followed up until January 2021 were collected based upon pre-designated inclusive and exclusive criteria for retrospective analyses. The Japanese Orthopaedic Association score and coronal Cobb angle were employed for the assessment of clinical symptoms and scoliosis correction improvements. Forty-nine patients were followed for a median time of 5.2 (1-11) years. The Japanese Orthopaedic Association score was significantly increased from 9.45 ± 3.33 preoperatively to 19.65 ± 4.58 postoperatively (P < .001), and the coronal Cobb angle was significantly improved from 39.95º ± 9.04º preoperatively to 8.28º ± 4.21º (P < .001) after 1 year. There were no major complications occurred in patients. The novel intervertebral space release and balance correction at the original lesion and maximal unbalance site without vertebral osteotomy showed a promising clinical profile and may be considered as an alternative for the treatment of moderate to severe degenerative scoliosis.
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Affiliation(s)
- Hang Yuan
- Department of Orthopedics (III), Zhejiang Hospital, No.12 Lingyin Road, Hangzhou 310013, China
| | - Yaming Xie
- Department of Orthopedics (III), Zhejiang Hospital, No.12 Lingyin Road, Hangzhou 310013, China
| | - Jie Zheng
- Department of Orthopedics (I), 903RD Hospital of PLA, No.14 Lingyin Road, Hangzhou 310013, China
| | - Yonghong Yang
- Department of Orthopedics (III), Zhejiang Hospital, No.12 Lingyin Road, Hangzhou 310013, China
- Department of Orthopedics (I), 903RD Hospital of PLA, No.14 Lingyin Road, Hangzhou 310013, China
- * Correspondence: Yonghong Yang, Department of Orthopedics (III), Zhejiang Hospital, No.12 Lingyin Road, Hangzhou 310013, China (e-mail: )
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Ma S, Zhou Z, Ge Z, Wang Y, Wan W, Zhou R, Yang C, Cao K. Global realignment after posterior vertebral column resection in severe thoracolumbar post-tubercular kyphosis: correlation with patient-reported outcomes. INTERNATIONAL ORTHOPAEDICS 2023; 47:201-208. [PMID: 36326896 DOI: 10.1007/s00264-022-05620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate spinal realignment in patients with severe post-tubercular kyphosis (PTK) who underwent posterior vertebral column resection (PVCR) and its correlation with patient-reported outcomes (PROs). METHODS Eighty-two patients were included in this study. Spinopelvic parameters (focal scoliosis (FS), coronal balance (CB), sagittal vertical axis (SVA), focal kyphosis (FK), C2-7 lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and pelvic incidence minus lumbar lordosis (PI-LL)) and PROs (Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)) were analyzed. The correlation between spinopelvic parameters and PROs was evaluated. RESULTS FK, FS, CL, TK, LL, and PI-LL significantly changed after surgery. FK decreased from pre-operative 108.5 ± 16.4° to 31.8 ± 4.5° at three months after surgery and increased to 38.7 ± 6.6° at final follow-up (P < 0.001). FS decreased from pre-operative 20.9 ± 2.2° to 5.1 ± 2.2° at final follow-up (P < 0.001). CL decreased from pre-operative 7.2 ± 7.3° to 3.3 ± 8.3° at final follow-up (P = 0.002). TK improved from pre-operative - 5.6 ± 7.1° to 12.9 ± 8.2° at final follow-up (P < 0.001). LL decreased from pre-operative 75.5 ± 12.6° to 45.5 ± 7.9° at final follow-up (P < 0.001). PI-LL improved from pre-operative - 24.8 ± 13.4° to 4.8 ± 9.9° at final follow-up (P < 0.001). The improvement of PROs was found to be significantly correlated with the variations of FK, CL, TK, LL, and PI-LL. The multiple regression analysis revealed that FK was an independent predictor for the improvement of VAS and ODI. CONCLUSIONS PVCR is effective in treating severe PTK, which can significantly improve patients' clinical and radiographic outcomes. Spine surgeons should pay more attention to reducing the residual kyphosis.
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Affiliation(s)
- Shengbiao Ma
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, #1519 Dongyue Avenue, Nanchang, 330209, Jiangxi, China
| | - Zhenhai Zhou
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, #1519 Dongyue Avenue, Nanchang, 330209, Jiangxi, China
| | - Zhaohui Ge
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yingsong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenbing Wan
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rongping Zhou
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, #1519 Dongyue Avenue, Nanchang, 330209, Jiangxi, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Cao
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, #1519 Dongyue Avenue, Nanchang, 330209, Jiangxi, China.
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Liang Y, Hu Z, Zhao D, Wang F, Zhong R. Vertebral column resection (VCR) at the subapical vertebra for correction of angular kyphosis associated with neurofibromatosis type 1(NF1): a case report. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3736-3742. [PMID: 35526187 DOI: 10.1007/s00586-022-07230-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 02/14/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the process and outcome of vertebral column resection (VCR) at the subapical vertebra for correction of angular kyphosis associated with neurofibromatosis type 1(NF1). METHODS A review and summary of the medical history, radiographs, operative procedure, and complications of a 16-year-old male presenting with severe angular kyphosis associated with NF1 with dyspnea. RESULTS A 16-year-old male presented with severe angular kyphosis associated with NF1 with dyspnea. Preoperative radiographs demonstrated multiple vertebrae were rotated in the vicinity of the apical vertebra, with a wedge-shaped deformity, dysplasia, T10-T12 kyphotic angle of 160°, and T2-L2 kyphotic angle of 95°. VCR at the L1 vertebra (distal end of the apical vertebra) with bone grafting and internal fixation was performed. Postoperative imaging revealed that the T2-L2 Cobb angle was 20°, denoting a correction rate of 79%. The patient's height increased from 130 to 150 cm. The position of internal fixation was not displaced, and the correction angle was maintained at 2-year follow-up. CONCLUSIONS The novel strategy of performing VCR at the subapical vertebra, with posterior displacement of the distal end, and remodeling of the spinal canal is potentially a safe and efficacious option to correct sharp angular kyphosis.
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Affiliation(s)
- Yijian Liang
- Orthopaedic Department, Chengdu Third People's Hospital, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, 82 Qinglong Street, Chengdu, 610031, Sichuan, China.
| | - Zhengjun Hu
- Orthopaedic Department, Chengdu Third People's Hospital, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, 82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Deng Zhao
- Orthopaedic Department, Chengdu Third People's Hospital, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, 82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Fei Wang
- Orthopaedic Department, Chengdu Third People's Hospital, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, 82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Rui Zhong
- Orthopaedic Department, Chengdu Third People's Hospital, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, 82 Qinglong Street, Chengdu, 610031, Sichuan, China
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Elmorsy SEH, Abulnasr HA, Hassan Y, Samra M, Eissa EM. Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively: a prospective study. Chin Neurosurg J 2022; 8:35. [PMID: 36434653 PMCID: PMC9700965 DOI: 10.1186/s41016-022-00303-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Prospective study objectives. A sagittal balance is a good tool to improve the functional outcome of spine spondylolisthesis surgeries, primarily noted that it has a good impact in deformity surgery and then applied to every spine surgery and the aim of this study is to evaluate its functional outcome when considered in preoperative planning for non-dysplastic low- and mid-grade spondylolisthesis surgeries. METHOD Forty patients diagnosed as low- or mid-grade non-dysplastic spondylolisthesis had undergone surgery at Cairo University after failed medical treatment had been evaluated preoperatively by measuring the sagittal balance parameters which include SVA, spinopelvic angles, lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence and then measure it along a follow-up period of 1 year postoperatively started from February 2018 and correlate it with functional outcome using Oswestry score (ODI)and VAS. Correction of parameters has been estimated preoperatively by manual estimation and Surgimap application then applied during the operation. RESULTS All patients were treated by surgical treatment through posterior transpedicular screw fixation with conventional or reduction screws and fusion ± TLIF cages. The mean of lumbar lordosis and mean spinopelvic angles were increased in a statistically significant manner. Pelvis tilt was decreased in a statistically insignificant manner. The mean of pelvic incidence was not changed and statistically insignificant, and this is matching the fact that pelvic incidence is a constant parameter. The sacral slope was increased in a statistically insignificant manner. Final results showed that 37 had a statistically significant improvement in their ODI >20% at the last visit. Three patients had a poor clinical outcome with ODI scorFinal results showed that 37 had a statistically significant improvement in their ODI >20% at the last visit. Three patients had a poor clinical outcome with ODI score of >20% improvement, and we noticed that the level of pathology was at the level of L4L5, SVA was positive and worsen postoperatively, and also, it is accompanied by decreased lumbar lordosis. Change in ODI means statistically significant improvement when considering sagittal parameters preoperation and during operation. CONCLUSION Sagittal balance parameters should be considered in the surgical management of low-grade spondylolisthesis cases to improve their functional outcome.
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Affiliation(s)
| | | | - Yousry Hassan
- grid.7776.10000 0004 0639 9286Neurosurgery Cairo University, Cairo, Egypt
| | - Magdy Samra
- grid.7776.10000 0004 0639 9286Neurosurgery Cairo University, Cairo, Egypt
| | - Ehab Mohamed Eissa
- grid.7776.10000 0004 0639 9286Neurosurgery Cairo University, Cairo, Egypt
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Zhong XL, Qian BP, Huang JC, Li Y, Bao HD, Qiu Y. Remodeling morphology of the subluxated osteotomy vertebra in closing-opening wedge osteotomy in ankylosing spondylitis: would the anterior bony beak blunt? Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04695-9. [PMID: 36372808 DOI: 10.1007/s00402-022-04695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To investigate the remodeling morphology of subluxated osteotomy vertebra in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis after single-level closing-opening wedge osteotomy (COWO). MATERIALS AND METHODS Standing lateral radiographs were taken to evaluate sagittal parameters including lumbar lordosis (LL), C7 sagittal vertical axis (SVA), global kyphosis (GK), sacral slope (SS), and pelvic tilt (PT). Radiographic parameters of the osteotomy vertebra included osteotomized vertebra angle (OVA), sagittal translation (ST), anterior height (AH), posterior height (PH), and middle height (MH) of the osteotomy vertebrae. Furthermore, lateral projection area of the vertebral body was also measured to evaluate the remodeling of the osteotomy vertebrae. RESULTS Sixty AS patients who underwent single-level lumbar COWO with a minimal 2-year follow-up were included. The cohort consisted of 54 males and 6 females with an average age of 36.6 years. All patients were divided into two groups according to the development of vertebral subluxation (VS): 15 in VS group (ST ≥ 5 mm), 45 in non-VS group (ST < 5 mm). There was significant difference in the correction of GK, SVA, and the loss of correction of SVA between AS patients with and without VS. Significant difference in vertebra-related parameters regarding AH and OVA was found between VS group and non-VS group (P < 0.05). CONCLUSIONS After COWO, new bone formation narrowing the gap and adaptive resorption of the anterior bony beak at the osteotomy level during follow-up was surprisingly favorable. However, the ability of spinal canal remodeling is limited in patients complicated with VS.
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Affiliation(s)
- Xiao-Lin Zhong
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
- Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Ji-Chen Huang
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
- Medical School of Nanjing University, Nanjing, China
| | - Yao Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
- Medical School of Nanjing University, Nanjing, China
| | - Hong-da Bao
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
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Kim HJ, Yang JH, Chang DG, Lenke LG, Suh SW, Nam Y, Park SC, Suk SI. Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions. Asian Spine J 2022; 16:776-788. [PMID: 36274246 PMCID: PMC9633249 DOI: 10.31616/asj.2022.0376] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Corresponding author: Dong-Gune Chang Spine Center and Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1284, Fax: +82-2-950-1287, E-mail:
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, Columbia University, New York, NY, USA
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yunjin Nam
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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Xu HF, Li C, Ma ZS, Wu ZX, Sha J, Diwu WL, Yan YB, Liu ZC, Fan ZZ, Huang LY. Closing-opening wedge osteotomy for the treatment of congenital kyphosis in children. J Orthop Surg (Hong Kong) 2022; 30:10225536221118600. [PMID: 36120861 DOI: 10.1177/10225536221118600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To evaluate the safety and effectiveness of posterior closed-open wedge osteotomy for treatment of congenital kyphosis in children. METHODS Imaging and clinical data from January 2010 to December 2019 of posterior closed-open wedge osteotomy of congenital kyphosis with at least 2-year follow up was analyzed retrospectively. Perioperative indicators such as operation time, osteotomy site, osteotomy method and occurrence of complications, and imaging indicators were observed. The 3D printed models were used to measure the expanded distance of anterior edge vertebra and closed length of spinal canal line. The clinical effect was evaluated through SRS-22 questionnaires. RESULTS There were 15 CK patients in this study. The osteotomy segments and details are as follows: 1 case each for T6-9 and L2, 2 cases at T11, 3 cases at T12, and 6 cases at L1. The average operation time was 314 min, the average blood loss was 970 mL, the average fusion range was 6.3 segments, and the average time of follow up was 70.5 months. The Cobb angle of local kyphosis was corrected from 65.6 ± 18.8° to 11.3 ± 7.1°(p < .001). The range of kyphosis correction was 40-90°, and average correction rate was 83.2% (67.7-95.7%). The correction was stable in follow-up, and the kyphotic angle was 11.0 ± 7.6 (p = .68). The preoperative SVA was 31.5 ± 21.8 mm, and the postoperative recovery was 18.0 ± 15.5, while the last follow-up was 9.1 ± 7.9. The p values were 0.02 and 0.07 respectively. By using 3D printed models, the expanded distance of anterior edge vertebra and closed length of spinal canal line were 14.5 ± 7.5 mm and 24.5 ± 8.0 mm respectively. Self-image and satisfaction in SRS-22 improved significantly. There was no recurrence of deformity and junctional kyphosis. CONCLUSIONS The posterior closing-opening wedge osteotom for treatment of congenital kyphosis in children is satisfactory, if selected appropriately. During the longitudinal follow-up, the patients could achieve solid fusion and the correction could be well maintained.Evidence of Confidence: IVa.
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Affiliation(s)
- Hui-Fa Xu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Chao Li
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zhen-Sheng Ma
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zi-Xiang Wu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jia Sha
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Wei-Long Diwu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Ya-Bo Yan
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zhi-Chen Liu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zong-Zhi Fan
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lu-Yu Huang
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
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Cho W, Lenke LG, Bridwell KH, Nessim A, Dorward IG, Zebala LP, Pahys JM, Cho SK, Kang MM, Koester LA. Geometric analysis of pedicle subtraction osteotomy (PSO) for Kyphosis correction: anterior lengthening may occur at the osteotomized body as well as at the discs above and below. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2415-2422. [PMID: 35831481 DOI: 10.1007/s00586-022-07312-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/22/2021] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To validate the authors kyphosis correction formula for pedicle subtraction osteotomy (PSO) cases. Additionally, to use the formula to evaluate the safety of PSO by determining if there is anterior lengthening. METHODS Twenty-two patients with primarily kyphosis corrected by PSO and with clear landmarks on preoperative and postoperative x-rays were selected. Several anatomical lines and angle measurements were utilized as depicted previously in the Vertebral Column Resection formula (see below). Two approximations were calculated: the geometric approximation (G) = (tanG°*2 + 1)*15° and the rough approximation (R) which is about the same amount of actual shortening (x), if parallel length (y) ≥ 40; twice of x, if y < 40. For each patient, the change of segmental kyphosis angle (K°) was measured and compared with G° and R°, and the correlation between each value was analyzed. RESULTS The absolute Mean ± SE for K - G and K - R was 2.33° ± 0.34 and 6.09° ± 0.58, respectively. K - G is < 3° (p = 0.03). K - R is < 8° (p = 0.001). In other words, K was close to G and R and thus can be predicted by these approximations. Average posterior shortening, anterior shortening, and kyphosis correction at each level were 20.8 ± 2.0 mm, - 3.64 ± 1.5 mm (which equates to anterior lengthening), and 31.05° ± 2.0, respectively. Anterior lengthening occurred in 13 cases (in 4 cases, both at the body as well as at the disc above and below.) The correlation between posterior and anterior shortening was 0.03 (p = 0.88). There were 3 cage insertion cases: 1 had anterior lengthening, while 2 had anterior shortening even with the cage. CONCLUSION This study validated the geometric and rough approximations originally used in PVCR patients, for PSO patients. Additionally, this study found that anterior lengthening may occur in PSOs usually at the discs, but occasionally at the osteotomized body.
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Affiliation(s)
- Woojin Cho
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 6th Fl., Bronx, NY, 10467, USA.
| | - Lawrence G Lenke
- The Daniel and Jane Och Spine Hospital, New York-Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Keith H Bridwell
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Adam Nessim
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 6th Fl., Bronx, NY, 10467, USA
| | - Ian G Dorward
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lukas P Zebala
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew M Kang
- Department of Neurosurgery, Regions Hospital, 640 Jackson Street, St. Paul, MN, 55101, USA
| | - Linda A Koester
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Tang ZL, Qian BP, Qiu Y, Liu ZJ, Zhao SZ, Huang JC. Does the Level of Pedicle Subtraction Osteotomy Affect the Surgical Outcomes in Ankylosing Spondylitis-Related Thoracolumbar Kyphosis With the Same Curve Pattern? Global Spine J 2022; 12:1392-1399. [PMID: 33648363 PMCID: PMC9393979 DOI: 10.1177/2192568220980716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To investigate the effect of pedicle subtraction osteotomy (PSO) level on the surgical outcomes in ankylosing spondylitis-related thoracolumbar kyphosis with the same curve pattern. METHODS ankylosing spondylitis (AS) patients with thoracolumbar kyphosis, who underwent 1-level lumbar PSO between March 2006 and June 2017, were retrospectively reviewed. Criteria for curve-matched thoracolumbar kyphosis were: (1) have same level of preoperative apex (pre-apex); (2) have similar global kyphosis (GK, the angle between the superior/inferior endplate of the maximally tilted upper and lower end vertebra) (the difference of GK less than 15˚). The radiographic parameters measured were sagittal vertical axis (SVA, the horizontal distance between the C7 plumb line and the posterosuperior corner of the S1), GK, thoracic kyphosis (TK, the angle between the T5 superior endplate and the T12 inferior endplate), lumbar lordosis (LL, the angle between the L1 and S1 superior endplate), sacral slope (SS, the angle between the sacral endplate and the horizontal line), pelvic tilt (PT, the angle between the vertical and the line joining the midpoint of the sacral plate and hip axis), and pelvic incidence (PI, the angle between the line vertical to the superior margin of S1 and the line connecting the sacral plate midpoint with the hip joint axis). All of these parameters and health-related quality of life (HRQoL, evaluated by preoperative and the last follow-up questionnaires including ODI and VAS) scores were collected before surgery and at the last follow-up. According to their osteotomy level, patients were devided into 2 sub-groups (L1 group and L2 group), and differences of these mentioned parameters between 2 groups were compared. RESULTS 26 curve-matched patients were recruited with a mean follow-up of 37.2 months. All patients improved significantly after surgery in HRQoL scores (VAS 1.6 vs 5.4, P < 0.001; ODI 11.9 vs 26.4, P < 0.001). Except for TK and PI, those radiographic parameters were also observed to be significantly changed after surgery. Compared to L2 group, PSO at L1 may have larger correction of TK (ΔTK -6.8 vs -0.3°, P = 0.164), PI (ΔPI -7.4 vs -0.7°, P = 0.364) and smaller correction of SVA (ΔSVA -105.3 vs -128.5 mm, P = 0.096), LL (ΔLL -31.1 vs -43.0°, P = 0.307) and SS (ΔSS 6.9 vs 12.2°, P = 0.279) but had no statistical significance. CONCLUSION The results of this investigation showed that in AS-related thoracolumbar kyphosis patients with the same curve pattern, the different levels of osteotomy had little effect on the improvement of surgical outcomes. However, osteotomy at L2 is more likely to obtain a larger correction of SVA compared to osteotomy at L1.
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Affiliation(s)
- Zou-li Tang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China,Medical School of Nanjing University, Nanjing, China
| | - Bang-ping Qian
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China,Bang-ping Qian, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing 210008, China.
| | - Yong Qiu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhuo-jie Liu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shi-zhou Zhao
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ji-chen Huang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Diniz SE, Cordeiro F, Ribau A, Vale J, Rodrigues-Pinto R. Postoperative impact of rod bending in the lumbar spine fusion surgery with polyaxial screws - Validation of a study. J Orthop 2022; 33:112-116. [PMID: 35958980 PMCID: PMC9357705 DOI: 10.1016/j.jor.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction In 2019, Moufid and Gille published a study in which they proposed certain radiological parameters that may justify the mismatch between the lordosis of the lumbar segment and the lordosis of the rod bar using polyaxial screws. The aim of this study is to reproduce the measurements performed by Moufid and Gille and try to validate their findings. Material and methods A retrospective study was performed including patients submitted to L3-L5 posterior fusion with or without interbody devices using polyaxial screws and titanium rods, for degenerative disease. Radiological parameters were analysed:the distance between the posterior wall and the rod for each vertebra(the standard deviation of the three distances was called Alpha); the angle between the screw and the rod for each screw(mean of the three was called Theta); the angle between screws and superior endplate for each instrumented vertebra(mean of the three was called Lambda). The difference between post-operative segmental lordosis and the lordosis of the rod was called DiffL. Results A total of 58 cases were included. The most frequent fusion surgery was posterolateral fusion(77.6%). The mean value of lumbar lordosis, fused segmental lordosis, pelvic incidence, Alpha, Theta, Lambda and DiffL were 48.7 ± 12.7°, 28.4 ± 9.2°, 60.7 ± 11.9°, 3.4 ± 1.6 mm, 90.5 ± 1.8°, 3.9 ± 1.8° e 9.9 ± 9.5° respectively. The mean value of rod lordosis was 20.5 ± 8.1°. DiffL varied between 0.1° (practically no mismatch) and 30.5° of mismatch. DiffL didn't correlate with gender, fusion type, age, PI and Alpha, Theta or Lambda. There was a significant positive correlation between lumbar lordosis and DiffL(ρ = 0.28; p = 0.03). No correlation was found between the radiological parameters for the cut-off point proposed by Moufid and Gille(Alpha 4.7 mm, Theta 86°, Lambda 2.8°) and the DiffL value. Conclusion No significant factors were identified in this study to aid in achieving an ideal match between rod and segmental spine lordosis, therefore not validating the study by Moufid and Gille.
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Affiliation(s)
- Sara Elisa Diniz
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Cordeiro
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Ana Ribau
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - João Vale
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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Liu C, Hu F, Hu W, Zhang Z, Zheng G, Song K, Li F, Zhang X. Clinical Results of Utilizing the Satellite Rod Technique in Treating Ankylosing Spondylitis Kyphosis. Orthop Surg 2022; 14:2180-2187. [PMID: 35946438 PMCID: PMC9483082 DOI: 10.1111/os.13427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 12/01/2022] Open
Abstract
Objective According to the literature, there are no clinical reports documenting the use of the satellite rod technique in the treatment of ankylosing spondylitis kyphosis. The purpose of this retrospective study was to compare the clinical outcome of patients with ankylosing spondylitis kyphosis who adopted satellite rods versus those who did not. Methods Patients with ankylosing spondylitis kyphosis who underwent one or two‐level pedicle subtraction osteotomy (PSO) were reviewed, and total of 119 patients (112 males and seven females, average age 39.89 ± 6.61 years) were eligible and included in this present study. Anterior–posterior and lateral full‐length spine X‐ray films were performed preoperatively and at the two‐year follow‐up visit. Global kyphosis (GK), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), and osteotomy angle (OA) were measured. The complications of every group of patients were collected. Pre‐ and postoperative health‐related quality of life instruments, including the Bath Ankylosing Spondylitis Functional Index (Basfi) and Scoliosis Research Society outcomes instrument‐22 (SRS‐22), were recorded. The patients were divided into three groups based on features of their osteotomy including PSO levels and whether the satellite rod technique was applied. Patients who underwent one‐level PSO without the satellite rod technique were categorized in the one‐level group. Patients who underwent one‐level PSO with the satellite rod technique were classified in the satellite rod group. Patients who underwent two‐level PSO without the satellite rod technique were included in the two‐level group. The paired sample t test was used to compare pre‐ and postoperative parameters. One‐way ANOVA was performed for multiple group comparisons. Results The average follow‐up time is 29.31 ± 3.66 months. The patients' GK were significantly improved from 46.84 ± 20.37 degree to 3.31 ± 15.09 degree. OS achieved through each osteotomy segment of one‐level group (39.78 ± 12.29 degree) and satellite rods group (42.23 ± 9.82 degree), was larger than that of two‐level group (34.73 ± 7.54 and 28.85 ± 7.26 degree). There was no significant difference between the one‐level group and the satellite rod group in achieving the OS. Thirteen patients experienced different complications (10.92%). Three patients experienced rod fracture in the one‐level group. There was no rod fracture or screw failure in the satellite rod group or the two‐level group. Conclusion The satellite rod technique is also recommended for patients who undergo PSO osteotomy to correct ankylosing spondylitis kyphosis deformities.
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Affiliation(s)
- Chao Liu
- Department of Orthopaedics, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Fanqi Hu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Wenhao Hu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Zhen Zhang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Guoquan Zheng
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Kai Song
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
| | - Fangcai Li
- Department of Orthopaedics, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xuesong Zhang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China
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Safaee MM, Scheer JK, Lau D, Fury M, Deviren V, Ames CP. Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature. Oper Neurosurg (Hagerstown) 2022; 23:e84-e90. [PMID: 35838456 DOI: 10.1227/ons.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/24/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Lumbosacral deformities are caused by high-grade spondylolisthesis, fractures, iatrogenic flat back, and other etiologies. The S1 pedicle subtraction osteotomy (PSO) can facilitate reduction of spondylolisthesis and lower the pelvic incidence. There are limited reports on the indications and outcomes of this technique. OBJECTIVE To present a technical description and literature review of the S1 PSO with video summary. METHODS This was a retrospective review of a single case to highlight the use of S1 PSO for the treatment of high-grade spondylolisthesis. A literature review was performed in accordance with STROBE guidelines. RESULTS A 47-year-old woman presented with back and right leg pain related to grade 4 spondylolisthesis at L5-S1 with sagittal imbalance and lumbosacral kyphosis. She was taken for an L2-pelvis instrumented fusion with S1 PSO. Three days later, she was taken for an L4-5 and L5-S1 anterior lumbar interbody fusion with the L5-S1 segmental plate. Her postoperative course was notable for right foot drop that resolved in 6 weeks. Postoperative x-rays showed successful reduction of spondylolisthesis with normal alignment and sagittal balance. Based on 6 studies involving 22 true sacral PSOs in the literature, the procedure carries a 27% risk of neurological deficit, typically in the form of L5 palsy. CONCLUSION The S1 PSO is a technically challenging operation that has a unique role in the treatment of high-grade spondylolisthesis. It carries a significant risk of L5 palsy and should be reserved for surgeons with experience performing complex 3-column osteotomies.
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Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Darryl Lau
- Department of Neurological Surgery, New York University, New York, New York, USA
| | - Marissa Fury
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA.,Department of Orthopedic Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA
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Zheng GB, Hong Z, Wang Z, Zheng B. A novel technique of transpedicular opening-wedge osteotomy for treatment of rigid kyphosis in patients with ankylosing spondylitis. BMC Surg 2022; 22:155. [PMID: 35501784 PMCID: PMC9063357 DOI: 10.1186/s12893-022-01610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effectiveness and feasibility of a novel vertebral osteotomy technique, transpedicular opening-wedge osteotomy (TOWO) was used to correct rigid thoracolumbar kyphotic deformities in patients with ankylosing spondylitis (AS). METHODS Eighteen AS patients underwent TOWO to correct rigid thoracolumbar kyphosis. Radiographic parameters were compared before surgery, 1 week after surgery and at the last follow-up. The SRS-22 questionnaire was given before surgery and at the last follow-up to evaluate clinical improvement. The operating time, estimated blood loss and complications were analyzed. RESULTS The mean operating time and estimated blood loss were 236 min and 595 ml, respectively. The mean preoperative sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT) and thoracolumbar kyphosis (TLK) were 158.97 mm, 51.24 mm, 43.63 mm and 41.74 mm, respectively, and decreased to 66.72 mm, 35.96 mm, 27.21 mm and 8.67 mm at the last follow-up. The mean preoperative lumbar lordosis (LL) and sacral slope (SS) were 8.30 ± 24.43 mm and 19.67 ± 9.40 mm, respectively, which increased to 38.23 mm and 28.13 mm at the last follow-up. The mean height of the anterior column of osteotomized vertebrae increased significantly from 25.17 mm preoperatively to 37.59 mm at the last follow, but the height of the middle column did not change significantly. SRS-22 scores were improved significantly at the last follow-up compared with preoperatively. Solid bone union was achieved in all patients after 12 months of follow-up, and no screw loosening, screw removal or rod breakage was noticed at the last follow-up. CONCLUSIONS TOWO could achieve satisfactory kyphosis correction by opening the anterior column instead of vertebral body decancellation and posterior column closing, thus simplifying the osteotomy procedure and improving surgical efficacy.
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Affiliation(s)
- Guang Bin Zheng
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China
| | - Zhenghua Hong
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China.
| | - Zhangfu Wang
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China
| | - Binbin Zheng
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China
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Yilgor C, Kindan P, Yucekul A, Zulemyan T, Alanay A. Osteotomies for the Treatment of Adult Spinal Deformities: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202205000-00010. [PMID: 35613311 DOI: 10.2106/jbjs.rvw.21.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications. » The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions. » Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques. » There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.
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Affiliation(s)
- Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Peri Kindan
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Sorour I, Elhabashy AM, Fayed AA. Safety and efficacy of posterior vertebral column resection in complex pediatric deformities. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vertebral column resection (VCR) is a well-known technique used for correction of complex spinal deformities. VCR could be done through a posterior only approach (Pvcr), or a combined anteroposterior approach, with almost comparable results. Early studies of Pvcr have reported high rates of complications, while subsequent studies have reported a reasonable complication rate. In this study, the authors represent and evaluate the initial results of using the Pvcr technique to correct complex pediatric deformities.
Objective
To evaluate the safety and efficacy of performing Pvcr to correct complex pediatric deformities.
Methods
Retrospective cohort study of data was collected from the database of pediatric deformity patients who were operated for correction of their deformities using posterior instrumentation and Pvcr at a single institution from 2015 to 2019.
Results
Twenty-one pediatric patients with a mean age 15.2 ± 3.5 years were enrolled in this study. The mean follow-up period was 26.3 ± 3.1 months. The mean Cobb angle has been decreased significantly from 82.9 ± 23.9 degrees to 28.8 ± 14.2 immediately after correction (correction rate 66.9 ± 10.8%, p < 0.001) with slight increase to 30.2 ± 14.9 after 24 months of follow-up (correction loss 4.3 ± 3.1%). The mean kyphotic angle has decreased significantly from 74.1 ± 15.9 to 25.4 ± 4.5 immediately after correction (correction rate 65.4 ± 2.9%, p < 0.001) with slight increase to 26.7 ± 5.2 after 24 months of follow-up (correction loss 4.8 ± 3.5%). The mean estimated blood loss was 2816.7 ± 1441.5 ml. The mean operative time was 339 ± 84.3 min. Self-image domain (part of SRS-22 questionnaire) has significantly improved from a mean preoperative of 2.3 ± 0.5 to a mean postoperative of 3.9 ± 0.4 after 24 months of correction (p < 0.001). As regards complications, chest tubes were inserted in 17 cases (81%), one case (4.8%) had suffered from deep wound infection and temporary respiratory failure, while 3 cases (14.3%) had neurological deficits.
Conclusion
Posterior vertebral column resection is considered a highly effective release procedure that aids in the correction of almost any type of complex pediatric deformities with a correction rate reaching 66.9 ± 10.8%. However, Pvcr is a challenging procedure with high estimated blood loss and risk of neurological deficits, so it must be done only by experienced spine surgeons in the presence of good anesthesia and neuromonitoring teams.
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Li S, Mao S, Ma Y, Zhu Z, Liu Z, Shi B, Qiao J, Qiu Y. Posterior 3-Column Osteotomy for Treatment of Congenital Kyphosis with Multiple Thoracolumbar/Lumbar Anterior Unsegmented Vertebrae: A Comparison Between Patients with Increasing Number of Anterior Unsegmented Vertebrae. World Neurosurg 2022; 159:e172-e183. [PMID: 34906751 DOI: 10.1016/j.wneu.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A 3-column osteotomy is sometimes challenging in congenital kyphosis (CK) with many anterior unsegmented vertebrae (AUVs). This study compared surgical outcomes of single-level 3-column osteotomy and associated complications in CK with increasing number of AUVs. METHODS We retrospectively reviewed 25 consecutive patients with AUVs in CK who underwent surgery at a mean age of 16.2 ± 10.3 years. Patients were stratified into 2 groups according to the number of AUVs: 3 AUVs and ≥4 AUVs. Osteotomy types, surgical outcomes, and related complications were analyzed and compared between groups. RESULTS The 3 AUVs group comprised 13 patients, and the ≥4 AUVs group comprised 12 patients. Pedicle subtraction osteotomy, grade 4 osteotomy, vertebral column resection, and vertebral column decancellation accounted for 15.4%, 38.5%, 46.1%, and 0% of procedures in the 3 AUVs group and 8.3%, 0%, 83.3%, and 8.3% of procedures in the ≥4 AUVs group. Preoperative focal kyphosis, which was significantly higher in the ≥4 AUVs group (82.9° ± 28° vs. 59.7° ± 9.4°, P = 0.010), was corrected in both groups postoperatively. The ≥4 AUVs group had significantly higher remaining kyphosis (33.6° ± 13.4° vs. 15.1° ± 9.1°, P < 0.001) with a significantly lower correction rate (61.2% ± 13.6% vs. 75.0% ± 15.6%, P = 0.001). The complication rate, mainly involving vertebral subluxation and proximal junctional kyphosis, was significantly higher in the ≥4 AUVs group than the 3 AUVs group (8/12 vs. 1/13, P = 0.004). CONCLUSIONS Posterior single-level 3-column osteotomy can achieve satisfactory kyphosis correction in CK with 3 AUVs. Decreasing kyphosis correction and increasing surgery-related complications are prone to develop when treating CK with ≥4 AUVs.
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Affiliation(s)
- Song Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Saihu Mao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Yanyu Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Benlong Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Qiao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Lyu Q, Lau D, Haddad AF, Deviren V, Ames CP. Multiple-rod constructs and use of bone morphogenetic protein-2 in relation to lower rod fracture rates in 141 patients with adult spinal deformity who underwent lumbar pedicle subtraction osteotomy. J Neurosurg Spine 2022; 36:235-245. [PMID: 34560633 DOI: 10.3171/2021.3.spine201968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to compare rod fracture (RF) rates among three types of rod constructs (RCs) following lumbar pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD). METHODS A retrospective review of consecutive patients with adult spinal deformity who were treated with lumbar PSO between 2007 and 2017 was performed. The minimum follow-up was 2 years. Three RCs were compared: standard (2 main rods), satellite (2 main rods with satellite rod), and nested (2 main rods and 2 short rods spanning osteotomy). Outcomes examined included RF rate, time to RF, pseudarthrosis, and reoperation. Multivariate analysis was used. RESULTS A total of 141 patients were included 55 with standard, 23 with satellite, and 63 with nested RCs. The mean age was 65.2 years and 34.8% of patients were male. Radiographic preoperative and postoperative results were as follows: sagittal vertical axis (11.0 vs 3.9 cm), lumbar lordosis (28.5° vs 57.1°), pelvic tilt (30.6° vs 21.0°), pelvic incidence (61.5° vs 60.0°), distance between central sacral vertical line and C7 plumb line (2.2 vs 1.5 cm), and scoliosis (18.9° vs 11.3°). The average time to RF was 12.4 months. Overall RF, bilateral RF, pseudarthrosis, and reoperation rates were 22.7%, 5.0%, 20.6%, and 17.7%, respectively. Standard RCs had a significantly higher RF (36.4% vs 13.0% vs 14.3%, p = 0.008), bilateral RF (35.0% vs 0.0% vs 0.0%, p = 0.021), pseudarthrosis (34.5% vs 8.7% vs 12.7%, p = 0.004), and reoperation (30.9% vs 4.3% vs 11.1%, p = 0.004) rates. Satellite RCs (OR 0.21, p = 0.015), nested RCs (OR 0.24, p = 0.003), and bone morphogenetic protein-2 (OR 0.28, p = 0.005) were independently associated with lower odds of RF. CONCLUSIONS Use of multiple rods in the satellite RC and nested RC groups was associated with lower rates of RF, pseudarthrosis, and reoperations following lumbar PSO. Bone morphogenetic protein-2 was associated with a reduction in RF rate as well.
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Affiliation(s)
- Qiunan Lyu
- 1Department of Orthopedic Surgery, The First Peoples' Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- 2Department of Neurological Surgery, University of California, San Francisco; and
| | - Darryl Lau
- 2Department of Neurological Surgery, University of California, San Francisco; and
| | - Alexander F Haddad
- 2Department of Neurological Surgery, University of California, San Francisco; and
| | - Vedat Deviren
- 3Department of Orthopedic Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 2Department of Neurological Surgery, University of California, San Francisco; and
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Han N, Pratt N, Usmani MF, Hayman E, Jones S, Johnsen P, Thomson AE, Ye I, Chryssikos T, Sharma A, Olexa J, Cavanaugh DL, Koh EY, Buraimoh K, Ludwig S, Sansur C. Anterior longitudinal ligament release from a posterior approach: an alternative to three-column osteotomy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2196-2203. [PMID: 34978600 DOI: 10.1007/s00586-021-07100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Expansion of the anterior column and compression of the posterior column restores lordosis and sagittal imbalance. Anterior longitudinal ligament (ALL) release has been described from lateral and anterior approaches as a technique to improve lumbar lordosis; however, posterior approach to release the ALL has not been adequately assessed. METHODS We demonstrate a case series of ALL release using a posterior approach performed in conjunction with posterior column osteotomy (PCO), with or without transforaminal lumbar interbody fusion (TLIF) for spinal deformity. Eleven cases were identified from billing records between 2010 and 2019. Retrospective review was conducted for perioperative complications and revision surgery. Overall and segmental lumbar lordosis (LL) correction was measured from pre- and postoperative imaging. RESULTS Eleven patients underwent ALL release with a PCO. Kyphosis, scoliosis, and flat back syndrome were the most common spinal deformities. On average, patients had 9 ± 3 levels fused and a single level ALL release. ALL release was most commonly performed at L1-L2 and L2-L3 levels. An overall LL correction of 28.6° ± 19.8o was achieved; ALL release introduced 16.7° ± 11.9° of lordotic correction and accounted for 49.2 ± 30.4% of the overall lordotic correction. Average blood loss was 1030 ± 573 mL. CONCLUSIONS ALL release as an adjunct to PCO and TLIF is a viable technique for providing increased deformity correction without subjecting the patient to a more invasive three-column osteotomy. While this approach may not be appropriate for all patients, it represents a useful option in spinal deformity correction while limiting blood loss and additional anterior surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nathan Han
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA.
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Erik Hayman
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Salazar Jones
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Parker Johnsen
- Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Alexandra E Thomson
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ivan Ye
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Ashish Sharma
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Daniel L Cavanaugh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Y Koh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kendall Buraimoh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven Ludwig
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
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Penalosa BS, Ramos O, Patel SS, Cheng WK, Danisa OA. Pedicle subtraction osteotomy in adult spinal deformity correction: Clinical and radiographic risk factors for early instrumentation failure. J Clin Neurosci 2021; 94:266-270. [PMID: 34863449 DOI: 10.1016/j.jocn.2021.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/07/2021] [Accepted: 08/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Early instrumentation failure (EIF) after pedicle subtraction osteotomy (PSO) is a known complication of adult spine deformity (ASD) correction. In contrast to the more common failure that occurs secondary to pseudarthrosis, early instrumentation failure (<6 months after surgery) and its risk factors are not as well understood. OBJECTIVE To identify risk factors for EIF in patients undergoing PSO for ASD correction. METHODS Patients with ASD who underwent correction with PSO from 2013 to 2018 were retrospectively reviewed. Demographic characteristics, number of rods, spinopelvic parameters, bone density derived from computed tomography (CT) attenuation in Hounsfield units (HU), Global Alignment and Proportion (GAP) score, and type of instrumentation failure were evaluated. Potential risk factors for EIF were analyzed. RESULTS 9 out of 46 (19.5%) patients who underwent PSO had EIF. All 9 patients with EIF had 2-rod constructs and failed secondary to rod fracture. The number of rods used in the EIF group was significantly lower than the non-EIF group (2.00 ± 0.00 vs 2.81 ± 0.995, p = .000. The EIF group demonstrated a significantly higher pre-op PI (77.33 ± 13.23), p = .022, pre-op PT (37.22 ± 6.46),p = .012, and post-op SVA (89.96 ± 23.85), p = .028 compared to the non-EIF group. CONCLUSION High pre-op PI, pre-op PT, and post-op SVA were significant risk factors associated with EIF after PSO. Use of multiple rod constructs are protective and may help mitigate risk of EIF in these patients.
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Affiliation(s)
- Bryan S Penalosa
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Omar Ramos
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Shalin S Patel
- Department of Orthopaedic Surgery, George Washington University, Washington, D.C., USA
| | - Wayne K Cheng
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, CA, USA; Department of Orthopedic Surgery, VA Medical Center - Loma Linda, CA, USA.
| | - Olumide A Danisa
- Departments of Orthopedic Surgery and Neurosurgery, Loma Linda University Health, Loma Linda, CA, USA
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Liao H, Xie P, Zheng G, Miao H, Li N, Li X, Du S. Evaluation of parallel endplate osteotomy for severe rigid spinal deformities: a retrospective analysis of 36 cases with a minimum 2-year follow-up. BMC Musculoskelet Disord 2021; 22:1011. [PMID: 34861856 PMCID: PMC8641201 DOI: 10.1186/s12891-021-04877-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background To report on the technique and results of parallel endplate osteotomy (PEO) for severe rigid spinal deformity. Methods We retrospectively reviewed the clinical data of 36 patients with severe rigid spinal deformities who underwent PEO between July 2016 and December 2018 and who were followed up for at least 24 months. Results Following PEO, the kyphosis and scoliosis correction rates reached 77.4 ± 14.0% and 72.2 ± 18.2%, respectively. The median intraoperative estimated blood loss was 1500 mL and the median operative time was 6.8 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 62 ± 28, 51 ± 26, 49 ± 29, 35 ± 30, 53 ± 28, 45 ± 30, 32 ± 34 and 54 ± 18 at baseline to 81 ± 16, 66 ± 41, 72 ± 40, 64 ± 44, 75 ± 25, 71 ± 46, 66 ± 34 and 76 ± 28 at 12 months postoperatively, 82 ± 32, 67 ± 42, 81 ± 30, 71 ± 41, 80 ± 30, 74 ± 36, 68 ± 35 and 85 ± 33 at 18 months postoperatively, and 86 ± 21, 83 ± 33, 88 ± 26, 79 ± 39, 86 ± 36, 86 ± 48, 80 ± 47 and 91 ± 39 at 24 months postoperatively, respectively. Conclusions PEO is an effective technique for successful correction of spinal deformities. At the two-year follow-up visit, all patients achieved better clinical results based on the SF-36 scores.
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Affiliation(s)
- Hang Liao
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China
| | - Peng Xie
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China
| | - Guizhou Zheng
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China
| | - Houguang Miao
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China
| | - Ningdao Li
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China
| | - Xuedong Li
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China
| | - Shixin Du
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, 518000, PR, China.
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Simultaneous Anterior and Posterior Release in Lateral Decubitus Position for Rigid Adult Spinal Deformity: A Technical Note and 2 Case Reports. World Neurosurg 2021; 159:40-47. [DOI: 10.1016/j.wneu.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
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