P152. Pedicle subtraction osteotomies vs anterior column reconstruction: Is there a difference in pseudarthrosis rates?

• Published in: The spine journal Vol. 24; no. 9; pp. S138 - S139
• Main Authors: Jakoi, Andre, McDermott, Michael, Barner, Kyle L, Patel, Ashish
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2024
• ISSN: 1529-9430
• DOI: 10.1016/j.spinee.2024.06.172

Restoring physiologic sagittal and segmental alignment is crucial for improving postoperative outcomes and preventing adjacent segment disease in patients with symptomatic spinal pathologies. Some patients require significant changes in regional alignment to achieve proper sagittal alignment. This can be accomplished through an anterior column reconstruction (ACR) or a pedicle subtraction osteotomy (PSO). PSOs are maximally invasive and require substantial bony removal to achieve the desired correction. On the other hand, ACR is minimally invasive and achieves correction through the placement of a hyperlordotic implant. Due to the instability that is created through the techniques, fusion may be difficult to achieve. To examine the rate of pseudarthrosis and other surgical parameters of ACR compared to PSO. Retrospective Cohort. Multicenter. The rate of pseudoarthrosis at two years. A retrospective review was conducted on patients who underwent an ACR or PSO at two centers. Preoperative and first postoperative radiographic films were collected, and Cobb angles were measured to assess the individual segmental changes with each technique. Surgical characteristics, including age, BMI, and estimated blood loss (EBL), were recorded for statistical analysis. Signs and symptoms of pseudoarthrosis were recorded, and the presence or absence was confirmed on CT imaging. A total of 44 patients were retrospectively included in the study, eighteen (18) of which underwent correction with an ACR, and twenty-six (26) had a PSO. Each patient had a single ACR or PSO as part of a multilevel construct, with a total of 317 instrumented levels. The average EBL was significantly lower for the ACR group (287 ± 365 ml) vs the PSO group (1451.2 ± 661 ml, p = <0.0001). There was no difference in length of stay between ACR (4.2 ± 2.5 days) and PSO (4.6 ± 1.3 days). The preoperative lumbar lordosis (LL) was 26.0° ± 11.6. Both ACR and PSO significantly increased the LL (24.7° ± 7.4° vs 23.3 ± 11.5° respectively), and there was no statistical difference in the LL increase between techniques (p = 0.65). The average follow-up for the cohort was 30.5 ± 8.7 months. 4% (1/26) of patients in the PSO group developed pseudarthrosis compared to 0% (0/18) in the ACR group, these rates were not statistically different (P = 0.41) ACR and PSO are viable options for sizeable sagittal spine correction. ACR is less invasive and has a lower estimated blood loss. There was no difference in lordosis correction or pseudarthrosis rates in this study. This abstract does not discuss or include any applicable devices or drugs.