L5 pedicle subtraction osteotomy: indication, surgical technique and specificities

• Published in: European spine journal Vol. 27; no. 3; pp. 644 - 651
• Main Authors: Alzakri, Abdulmajeed, Boissière, Louis, Cawley, Derek T., Bourghli, Anouar, Pointillart, Vincent, Gille, Olivier, Vital, Jean-Marc, Obeid, Ibrahim
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2018; Springer Nature B.V
• Subjects: Adult; Aged; Cohort Studies; Female; Humans; Lordosis - surgery; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Osteotomy; Osteotomy - methods; Radiography; Retrospective Studies; Surgery; Surgical Orthopedics; Flat back; L4–S1 lower lumbar lordosis; Sagittal and coronal malalignment; L5 Pedicle Subtraction Osteotomy; L1–S1 lumbar lordosis
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-017-5403-1

Purpose To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. Methods A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected. Results All surgeries were revision surgeries. The mean lumbar lordosis before surgery was − 22.5° (range, 8° to − 33°) and improved to − 58.5° (range, − 40° to − 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage. Conclusions PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.