Preoperative planning for pedicle subtraction osteotomy: Does pelvic tilt matter?

Virginie Lafage, Benjamin Blondel, Justin S. Smith, Oheneba Boachie-Adjei, Richard A. Hostin, Douglas Burton, Gregory Mundis, Eric Otto Klineberg, Christopher Ames, Behrooz Akbarnia, Shay Bess, Frank Schwab

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)358-366
Number of pages9
JournalSpine Deformity
Volume2
Issue number5
DOIs
StatePublished - 2014

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Osteotomy
Lordosis
Multicenter Studies
Research Personnel
X-Rays

Keywords

  • Osteotomy
  • Pelvic tilt
  • Preoperative planning
  • Radiographic outcomes
  • Sagittal malalignment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Lafage, V., Blondel, B., Smith, J. S., Boachie-Adjei, O., Hostin, R. A., Burton, D., ... Schwab, F. (2014). Preoperative planning for pedicle subtraction osteotomy: Does pelvic tilt matter? Spine Deformity, 2(5), 358-366. https://doi.org/10.1016/j.jspd.2014.05.006

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 journalArticle

Lafage, V, Blondel, B, Smith, JS, Boachie-Adjei, O, Hostin, RA, Burton, D, Mundis, G, Klineberg, EO, Ames, C, Akbarnia, B, Bess, S & Schwab, F 2014, 'Preoperative planning for pedicle subtraction osteotomy: Does pelvic tilt matter?', Spine Deformity, vol. 2, no. 5, pp. 358-366. https://doi.org/10.1016/j.jspd.2014.05.006
Lafage V, Blondel B, Smith JS, Boachie-Adjei O, Hostin RA, Burton D et al. Preoperative planning for pedicle subtraction osteotomy: Does pelvic tilt matter? Spine Deformity. 2014;2(5):358-366. https://doi.org/10.1016/j.jspd.2014.05.006
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. / Preoperative planning for pedicle subtraction osteotomy : Does pelvic tilt matter?. In: Spine Deformity. 2014 ; Vol. 2, No. 5. pp. 358-366.
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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.",
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author = "Virginie Lafage and Benjamin Blondel and Smith, {Justin S.} and Oheneba Boachie-Adjei and Hostin, {Richard A.} and Douglas Burton and Gregory Mundis and Klineberg, {Eric Otto} and Christopher Ames and Behrooz Akbarnia and Shay Bess and Frank Schwab",
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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

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