Abstract
Study Design Multicenter, retrospective radiographic analysis. Objectives To evaluate the impact that preoperative spinopelvic parameters have on postoperative sagittal vertical axis (SVA). The researchers hypothesized that patients with a large preoperative pelvic tilt (PT) would require more extensive lumbar pedicle subtraction osteotomy (LPSO) procedures to reestablish anatomic postoperative SVA than patients with normal preoperative PT. Summary of Background Data Restoration of anatomic sagittal spinal alignment has been demonstrated to improve clinical outcomes. However, the degree to which spinopelvic parameters contribute to sagittal spinal malalignment is poorly understood. Methods Multicenter, retrospective analysis of 183 consecutively enrolled adult spinal deformity patients treated with LPSO procedures for correction of sagittal malalignment. Preoperative and postoperative freestanding full-length sagittal X-rays were analyzed for regional curves, pelvic parameters, and global alignment. Only patients with a preoperative SVA greater than 10 cm and a postoperative SVA less than 5 cm were retained for analysis. Patients were divided into 2 groups according to preoperative PT (low PT, less than 30°; and high PT, ≥30°). Independent t test analysis was used to determine differences in correction required to achieve postoperative SVA less than 5 cm. Results A total of 55 patients were identified for analysis. Low PT (n = 30) had lower preoperative PT than high PT (n = 25; 25° vs. 42°, respectively; p <.001). Analysis of the osteotomy performed demonstrated that the high PT group required a larger osteotomy resection (30° vs. 23°; p =.039) and a larger correction of lumbar lordosis (-43° vs. -31°; p =.006) to achieve an acceptable postoperative SVA (less than 5 cm). Conclusions This study demonstrates that patients with high PT in conjunction with sagittal spinal malalignment require larger lumbar osteotomy procedures, including a greater osteotomy resection and larger lumbar lordosis correction, to obtain a satisfactory postoperative SVA. Surgeons performing LPSO procedures must evaluate preoperative spinopelvic parameters, including PT, to avoid undercorrection and residual deformity after complex sagittal realignment procedures.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 358-366 |
| Number of pages | 9 |
| Journal | Spine Deformity |
| Volume | 2 |
| Issue number | 5 |
| DOIs | |
| State | Published - 2014 |
Fingerprint
Keywords
- Osteotomy
- Pelvic tilt
- Preoperative planning
- Radiographic outcomes
- Sagittal malalignment
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
Cite this
Preoperative planning for pedicle subtraction osteotomy : Does pelvic tilt matter? / Lafage, Virginie; Blondel, Benjamin; Smith, Justin S.; Boachie-Adjei, Oheneba; Hostin, Richard A.; Burton, Douglas; Mundis, Gregory; Klineberg, Eric Otto; Ames, Christopher; Akbarnia, Behrooz; Bess, Shay; Schwab, Frank.
In: Spine Deformity, Vol. 2, No. 5, 2014, p. 358-366.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Preoperative planning for pedicle subtraction osteotomy
T2 - Does pelvic tilt matter?
AU - Lafage, Virginie
AU - Blondel, Benjamin
AU - Smith, Justin S.
AU - Boachie-Adjei, Oheneba
AU - Hostin, Richard A.
AU - Burton, Douglas
AU - Mundis, Gregory
AU - Klineberg, Eric Otto
AU - Ames, Christopher
AU - Akbarnia, Behrooz
AU - Bess, Shay
AU - Schwab, Frank
PY - 2014
Y1 - 2014
N2 - Study Design Multicenter, retrospective radiographic analysis. Objectives To evaluate the impact that preoperative spinopelvic parameters have on postoperative sagittal vertical axis (SVA). The researchers hypothesized that patients with a large preoperative pelvic tilt (PT) would require more extensive lumbar pedicle subtraction osteotomy (LPSO) procedures to reestablish anatomic postoperative SVA than patients with normal preoperative PT. Summary of Background Data Restoration of anatomic sagittal spinal alignment has been demonstrated to improve clinical outcomes. However, the degree to which spinopelvic parameters contribute to sagittal spinal malalignment is poorly understood. Methods Multicenter, retrospective analysis of 183 consecutively enrolled adult spinal deformity patients treated with LPSO procedures for correction of sagittal malalignment. Preoperative and postoperative freestanding full-length sagittal X-rays were analyzed for regional curves, pelvic parameters, and global alignment. Only patients with a preoperative SVA greater than 10 cm and a postoperative SVA less than 5 cm were retained for analysis. Patients were divided into 2 groups according to preoperative PT (low PT, less than 30°; and high PT, ≥30°). Independent t test analysis was used to determine differences in correction required to achieve postoperative SVA less than 5 cm. Results A total of 55 patients were identified for analysis. Low PT (n = 30) had lower preoperative PT than high PT (n = 25; 25° vs. 42°, respectively; p <.001). Analysis of the osteotomy performed demonstrated that the high PT group required a larger osteotomy resection (30° vs. 23°; p =.039) and a larger correction of lumbar lordosis (-43° vs. -31°; p =.006) to achieve an acceptable postoperative SVA (less than 5 cm). Conclusions This study demonstrates that patients with high PT in conjunction with sagittal spinal malalignment require larger lumbar osteotomy procedures, including a greater osteotomy resection and larger lumbar lordosis correction, to obtain a satisfactory postoperative SVA. Surgeons performing LPSO procedures must evaluate preoperative spinopelvic parameters, including PT, to avoid undercorrection and residual deformity after complex sagittal realignment procedures.
AB - Study Design Multicenter, retrospective radiographic analysis. Objectives To evaluate the impact that preoperative spinopelvic parameters have on postoperative sagittal vertical axis (SVA). The researchers hypothesized that patients with a large preoperative pelvic tilt (PT) would require more extensive lumbar pedicle subtraction osteotomy (LPSO) procedures to reestablish anatomic postoperative SVA than patients with normal preoperative PT. Summary of Background Data Restoration of anatomic sagittal spinal alignment has been demonstrated to improve clinical outcomes. However, the degree to which spinopelvic parameters contribute to sagittal spinal malalignment is poorly understood. Methods Multicenter, retrospective analysis of 183 consecutively enrolled adult spinal deformity patients treated with LPSO procedures for correction of sagittal malalignment. Preoperative and postoperative freestanding full-length sagittal X-rays were analyzed for regional curves, pelvic parameters, and global alignment. Only patients with a preoperative SVA greater than 10 cm and a postoperative SVA less than 5 cm were retained for analysis. Patients were divided into 2 groups according to preoperative PT (low PT, less than 30°; and high PT, ≥30°). Independent t test analysis was used to determine differences in correction required to achieve postoperative SVA less than 5 cm. Results A total of 55 patients were identified for analysis. Low PT (n = 30) had lower preoperative PT than high PT (n = 25; 25° vs. 42°, respectively; p <.001). Analysis of the osteotomy performed demonstrated that the high PT group required a larger osteotomy resection (30° vs. 23°; p =.039) and a larger correction of lumbar lordosis (-43° vs. -31°; p =.006) to achieve an acceptable postoperative SVA (less than 5 cm). Conclusions This study demonstrates that patients with high PT in conjunction with sagittal spinal malalignment require larger lumbar osteotomy procedures, including a greater osteotomy resection and larger lumbar lordosis correction, to obtain a satisfactory postoperative SVA. Surgeons performing LPSO procedures must evaluate preoperative spinopelvic parameters, including PT, to avoid undercorrection and residual deformity after complex sagittal realignment procedures.
KW - Osteotomy
KW - Pelvic tilt
KW - Preoperative planning
KW - Radiographic outcomes
KW - Sagittal malalignment
UR - http://www.scopus.com/inward/record.url?scp=84906833824&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84906833824&partnerID=8YFLogxK
U2 - 10.1016/j.jspd.2014.05.006
DO - 10.1016/j.jspd.2014.05.006
M3 - Article
AN - SCOPUS:84906833824
VL - 2
SP - 358
EP - 366
JO - Spine Deformity
JF - Spine Deformity
SN - 2212-134X
IS - 5
ER -