Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance : A minimum 5-year follow-up study

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2007-09, Vol.32 (20), p.2189-2197
• Main Authors: KIM, Yongjung J, BRIDWELL, Keith H, LENKE, Lawrence G, CHEH, Gene, BALDUS, Christine
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cerebrospinal fluid. Meninges. Spinal cord; Diseases of the osteoarticular system; Diseases of the spine; Female; Follow-Up Studies; Humans; Kyphosis - complications; Kyphosis - diagnostic imaging; Kyphosis - physiopathology; Kyphosis - surgery; Lordosis - complications; Lordosis - diagnostic imaging; Lordosis - physiopathology; Lordosis - surgery; Low Back Pain - etiology; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Orthopedic surgery; Osteotomy - adverse effects; Osteotomy - methods; Pain Measurement; Patient Satisfaction; Postural Balance; Pseudarthrosis - etiology; Radiography; Recovery of Function; Retrospective Studies; Scoliosis - complications; Scoliosis - diagnostic imaging; Scoliosis - physiopathology; Scoliosis - surgery; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Time Factors; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e31814b8371

Retrospective study. To report results at a minimum 5 years after pedicle subtraction osteotomy for fixed sagittal imbalance. No one has reported results of pedicle subtraction osteotomies with a 5- to 8-year follow-up. Thirty-five consecutive patients with sagittal imbalance (29 females/6 males, average age at surgery, 53.1 years) treated with lumbar pedicle subtraction osteotomies (1 at L1, 13 at L2, 20 at L3, and 1 at L4) at 1 institution were analyzed (average follow-up, 5.8 years; range, 5-7.6 years). Radiographic and clinical outcomes analysis was performed. There were no significant regional radiographic changes between 2 years postoperative and the ultimate follow-up (proximal junctional change, P = 0.30; thoracic kyphosis, P = 0.38; and lumbar lordosis, P = 0.84), although many patients did demonstrate an increasingly anterior C7 sagittal plumb with time. Ten pseudarthroses (29%) occurred in 8 patients and were revised between 2 and 5 years postoperative. There were no pseudarthroses at the osteotomy level (9 at the thoracolumbar junction, 1 at the LS junction), but at the levels added to the previous fusions. There was no degradation in Oswestry and Scoliosis Research Society (SRS) outcome scores between 2 years postoperative and ultimate follow-up (P = 0.23 and 0.90, respectively). Patients reported very good satisfaction (87%), good self-image (76%), good function (69%), and fair pain subscales (66%) at ultimate follow-up. Sagittal vertical axis