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

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

Research output: Contribution to journalArticle

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Abstract

Object. Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods. In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results. Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). Conclusions. The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

Original languageEnglish (US)
Pages (from-to)184-191
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume14
Issue number2
DOIs
StatePublished - Feb 2011

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Osteotomy
Lordosis
Kyphosis
Thorax
Multicenter Studies
Spine
Retrospective Studies

Keywords

  • Adult deformity
  • Imbalance
  • Pedicle subtraction osteotomy
  • Pelvic tilt
  • Sagittal alignment

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? Clinical article. / Lafage, Virginie; Schwab, Frank; Vira, Shaleen; Hart, Robert; Burton, Douglas; Smith, Justin S.; Boachie-Adjie, Oheneba; Shelokov, Alexis; Hostin, Richard; Shaffrey, Christopher I.; Gupta, Munish; Akbarnia, Behrooz A.; Bess, Shay; Farcy, Jean Pierre.

In: Journal of Neurosurgery: Spine, Vol. 14, No. 2, 02.2011, p. 184-191.

Research output: Contribution to journalArticle

Lafage, V, Schwab, F, Vira, S, Hart, R, Burton, D, Smith, JS, Boachie-Adjie, O, Shelokov, A, Hostin, R, Shaffrey, CI, Gupta, M, Akbarnia, BA, Bess, S & Farcy, JP 2011, 'Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? Clinical article', Journal of Neurosurgery: Spine, vol. 14, no. 2, pp. 184-191. https://doi.org/10.3171/2010.9.SPINE10129
Lafage, Virginie ; Schwab, Frank ; Vira, Shaleen ; Hart, Robert ; Burton, Douglas ; Smith, Justin S. ; Boachie-Adjie, Oheneba ; Shelokov, Alexis ; Hostin, Richard ; Shaffrey, Christopher I. ; Gupta, Munish ; Akbarnia, Behrooz A. ; Bess, Shay ; Farcy, Jean Pierre. / Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? Clinical article. In: Journal of Neurosurgery: Spine. 2011 ; Vol. 14, No. 2. pp. 184-191.
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title = "Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?: Clinical article",
abstract = "Object. Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods. In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results. Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). Conclusions. The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.",
keywords = "Adult deformity, Imbalance, Pedicle subtraction osteotomy, Pelvic tilt, Sagittal alignment",
author = "Virginie Lafage and Frank Schwab and Shaleen Vira and Robert Hart and Douglas Burton and Smith, {Justin S.} and Oheneba Boachie-Adjie and Alexis Shelokov and Richard Hostin and Shaffrey, {Christopher I.} and Munish Gupta and Akbarnia, {Behrooz A.} and Shay Bess and Farcy, {Jean Pierre}",
year = "2011",
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doi = "10.3171/2010.9.SPINE10129",
language = "English (US)",
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pages = "184--191",
journal = "Journal of neurosurgery. Spine",
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T1 - Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

T2 - Clinical article

AU - Lafage, Virginie

AU - Schwab, Frank

AU - Vira, Shaleen

AU - Hart, Robert

AU - Burton, Douglas

AU - Smith, Justin S.

AU - Boachie-Adjie, Oheneba

AU - Shelokov, Alexis

AU - Hostin, Richard

AU - Shaffrey, Christopher I.

AU - Gupta, Munish

AU - Akbarnia, Behrooz A.

AU - Bess, Shay

AU - Farcy, Jean Pierre

PY - 2011/2

Y1 - 2011/2

N2 - Object. Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods. In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results. Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). Conclusions. The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

AB - Object. Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods. In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results. Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to -4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = -0.358, p < 0.005). Conclusions. The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

KW - Adult deformity

KW - Imbalance

KW - Pedicle subtraction osteotomy

KW - Pelvic tilt

KW - Sagittal alignment

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