J Korean Neurosurg Soc.  2010 Feb;47(2):95-101. 10.3340/jkns.2010.47.2.95.

Clinical Outcomes and Complications after Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance Patients : A Long-Term Follow-Up Data

Affiliations
  • 1Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea.
  • 2Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. scrhim@amc.seoul.kr

Abstract


OBJECTIVE
Clinical, radiographic, and outcomes assessments, focusing on complications, were performed in patients who underwent pedicle subtraction osteotomy (PSO) to assess correction effectiveness, fusion stability, procedural safety, neurological outcomes, complication rates, and overall patient outcomes.
METHODS
We analyzed data obtained from 13 consecutive PSO-treated patients presenting with fixed sagittal imbalances from 1999 to 2006. A single spine surgeon performed all operations. The median follow-up period was 73 months (range 41-114 months). Events during perioperative course and complications were closely monitored and carefully reviewed. Radiographs were obtained and measurements were done before surgery, immediately after surgery, and at the most recent follow-up examinations. Clinical outcomes were assessed using the Oswestry Disability Index and subjective satisfaction evaluation.
RESULTS
Following surgery, lumbar lordosis increased from -14.1degrees +/- 20.5degrees to -46.3degrees +/- 12.8degrees (p < 0.0001), and the C7 plumb line improved from 115 +/- 43 mm to 32 +/- 38 mm (p < 0.0001). There were 16 surgery-related complications in 8 patients; 3 intraoperative, 3 perioperative, and 10 late-onset postoperative. The prevalence of proximal junctional kyphosis (PJK) was 23% (3 of 13 patients). However, clinical outcomes were not adversely affected by PJK. Intraoperative blood loss averaged 2,984 mL. The C7 plumb line values and postoperative complications were closely correlated with clinical results.
CONCLUSION
Intraoperative or postoperative complications are relatively common following PSO. Most late-onset complications in PSO patients were related to PJK and instrumentation failure. Correcting the C7 plumb line value with minimal operative complications seemed to lead to better clinical results.

Keyword

Sagittal imbalance; Pedicle subtraction osteotomy; Clinical outcome; Proximal junctional kyphosis; Complication

MeSH Terms

Animals
Follow-Up Studies
Humans
Kyphosis
Lordosis
Osteotomy
Outcome Assessment (Health Care)
Postoperative Complications
Prevalence
Spine
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