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  • Title: A pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report.
    Author: van Loon PJ, van Stralen G, van Loon CJ, van Susante JL.
    Journal: Spine J; 2006; 6(2):195-200. PubMed ID: 16517393.
    Abstract:
    BACKGROUND CONTEXT: A pedicle subtraction osteotomy can be considered as part of the surgical treatment of a symptomatic sagittal imbalance. The literature on the use of this technique is limited and thus far not applied to a rigid thoracolumbar hyperkyphosis. PURPOSE: To evaluate our preliminary results of a pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of thoracolumbar kyphotic deformities. STUDY DESIGN/SETTING: Case series METHODS: Eleven patients with a symptomatic kyphotic deformity were treated with a thoracolumbar pedicle subtraction osteotomy in combination with a multilevel correction. The mean follow-up was 42.8 months (range 26-105). The clinical outcome, radiographic correction, and perioperative complications were analyzed. The results in six more traditional indications (ankylosing spondylitis, kyphoscoliosis, congenital and posttraumatic deformity), were compared with the results in a subgroup of five cases with a rigid thoracolumbar hyperkyphosis. RESULTS: All patients had a kyphotic thoracolumbar junction. An average of 5.8 levels was involved in the corrective fusion. A pedicle subtraction was always performed between the level Th10 and L2 to correct the sagittal balance. A lordotic correction of 38.8 (range 25-49) degrees was established with this fusion. The osteotomy contributed 66% (26.9 degrees) of the correction, whereas the remaining correction came from multilevel facetectomies. The visual analogue scale for both pain and impairment improved significantly (p<.005) for the entire group. Statistical analysis on the results for both subgroups separately was inappropriate because of the small number of patients available; however, overall both subgroups appeared to do equally well. All patients were very satisfied with the result and would choose surgical treatment again. No major complications were encountered. CONCLUSIONS: A pedicle subtraction osteotomy is a technically demanding but well tolerated operative procedure for the correction of a kyphotic deformity. This technique can also be considered as an adjunctive tool in the surgical treatment of a rigid thoracolumbar (Scheuermann's) kyphosis.
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