Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy

Purpose This retrospective study investigates sagittal alignment after pedicle subtraction osteotomy (PSO). The purpose was to investigate factors associated with malalignment recurrence. Methods Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measu...

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Veröffentlicht in:European spine journal 2019-01, Vol.28 (1), p.161-169
Hauptverfasser: Eichler, David, Charles, Yann Philippe, Baldairon, Florent, Ntilikina, Yves, Sauleau, Erik André, Steib, Jean-Paul
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container_title European spine journal
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creator Eichler, David
Charles, Yann Philippe
Baldairon, Florent
Ntilikina, Yves
Sauleau, Erik André
Steib, Jean-Paul
description Purpose This retrospective study investigates sagittal alignment after pedicle subtraction osteotomy (PSO). The purpose was to investigate factors associated with malalignment recurrence. Methods Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2–C7 lordosis, T4–T12 kyphosis, L1–S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints. Results PSO lordosis increased from 11.8° to 40.8° ( p  
doi_str_mv 10.1007/s00586-018-5767-x
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The purpose was to investigate factors associated with malalignment recurrence. Methods Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2–C7 lordosis, T4–T12 kyphosis, L1–S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints. Results PSO lordosis increased from 11.8° to 40.8° ( p  &lt; 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° ( p  &lt; 0.0001) and decreased to 49.7° ( p  = 0.0008). Pelvic tilt decreased from 29.2° to 16.5° ( p  &lt; 0.0001) and increased to 22.5° ( p  &lt; 0.0001). SVA C7 decreased from 105.1 to 35.5 mm ( p  &lt; 0.0001) and increased to 64.8 mm ( p  = 0.0005). Twenty-eight patients (42%) had an SVA C7 increase of more than 70 mm in the postoperative course: recurrence group. These patients were older: 62.8 years versus 52.3 years ( p  = 0.0031). Loss of lordosis was 11.9° (recurrence group) versus 5.0° (non-recurrence group). Eleven patients (17%) had pseudarthrosis. Pelvic incidence increased by 9.3° (recurrence group) versus 3.8° (non-recurrence group). In 23 patients (35%), pelvic incidence increased &gt; 10°. Gas was evidenced in sacroiliac joints in 22 patients (33%). Conclusion Postoperative anterior malalignment recurrence may occur after PSO. Elderly patients were at risk of recurrence. Loss of lumbar lordosis linked to pseudarthrosis represented another factor. With malalignment recurrence, anterior trunk rotation and pelvic retroversion might additionally have augmented moments across sacroiliac joints with subsequent ligament laxity and pelvic incidence increase. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-018-5767-x</identifier><identifier>PMID: 30242507</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Geriatrics ; Humans ; Kyphosis ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Neurosurgery ; Original Article ; Osteotomy ; Osteotomy - adverse effects ; Osteotomy - methods ; Osteotomy - statistics &amp; numerical data ; Radiography ; Recurrence ; Retrospective Studies ; Sacrum ; Spinal Curvatures - diagnostic imaging ; Spinal Curvatures - pathology ; Spinal Curvatures - surgery ; Spine (lumbar) ; Spine - diagnostic imaging ; Spine - pathology ; Spine - surgery ; Surgical Orthopedics</subject><ispartof>European spine journal, 2019-01, Vol.28 (1), p.161-169</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>European Spine Journal is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-4ca89a9bd85b73c47f3c47ecf1eb27bde542bbf2e39b373150019175624f52da3</citedby><cites>FETCH-LOGICAL-c372t-4ca89a9bd85b73c47f3c47ecf1eb27bde542bbf2e39b373150019175624f52da3</cites><orcidid>0000-0002-0606-211X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-018-5767-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-018-5767-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30242507$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eichler, David</creatorcontrib><creatorcontrib>Charles, Yann Philippe</creatorcontrib><creatorcontrib>Baldairon, Florent</creatorcontrib><creatorcontrib>Ntilikina, Yves</creatorcontrib><creatorcontrib>Sauleau, Erik André</creatorcontrib><creatorcontrib>Steib, Jean-Paul</creatorcontrib><title>Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose This retrospective study investigates sagittal alignment after pedicle subtraction osteotomy (PSO). The purpose was to investigate factors associated with malalignment recurrence. Methods Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2–C7 lordosis, T4–T12 kyphosis, L1–S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints. Results PSO lordosis increased from 11.8° to 40.8° ( p  &lt; 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° ( p  &lt; 0.0001) and decreased to 49.7° ( p  = 0.0008). Pelvic tilt decreased from 29.2° to 16.5° ( p  &lt; 0.0001) and increased to 22.5° ( p  &lt; 0.0001). SVA C7 decreased from 105.1 to 35.5 mm ( p  &lt; 0.0001) and increased to 64.8 mm ( p  = 0.0005). Twenty-eight patients (42%) had an SVA C7 increase of more than 70 mm in the postoperative course: recurrence group. These patients were older: 62.8 years versus 52.3 years ( p  = 0.0031). Loss of lordosis was 11.9° (recurrence group) versus 5.0° (non-recurrence group). Eleven patients (17%) had pseudarthrosis. Pelvic incidence increased by 9.3° (recurrence group) versus 3.8° (non-recurrence group). In 23 patients (35%), pelvic incidence increased &gt; 10°. Gas was evidenced in sacroiliac joints in 22 patients (33%). Conclusion Postoperative anterior malalignment recurrence may occur after PSO. Elderly patients were at risk of recurrence. Loss of lumbar lordosis linked to pseudarthrosis represented another factor. With malalignment recurrence, anterior trunk rotation and pelvic retroversion might additionally have augmented moments across sacroiliac joints with subsequent ligament laxity and pelvic incidence increase. 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The purpose was to investigate factors associated with malalignment recurrence. Methods Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2–C7 lordosis, T4–T12 kyphosis, L1–S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints. Results PSO lordosis increased from 11.8° to 40.8° ( p  &lt; 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° ( p  &lt; 0.0001) and decreased to 49.7° ( p  = 0.0008). Pelvic tilt decreased from 29.2° to 16.5° ( p  &lt; 0.0001) and increased to 22.5° ( p  &lt; 0.0001). SVA C7 decreased from 105.1 to 35.5 mm ( p  &lt; 0.0001) and increased to 64.8 mm ( p  = 0.0005). Twenty-eight patients (42%) had an SVA C7 increase of more than 70 mm in the postoperative course: recurrence group. These patients were older: 62.8 years versus 52.3 years ( p  = 0.0031). Loss of lordosis was 11.9° (recurrence group) versus 5.0° (non-recurrence group). Eleven patients (17%) had pseudarthrosis. Pelvic incidence increased by 9.3° (recurrence group) versus 3.8° (non-recurrence group). In 23 patients (35%), pelvic incidence increased &gt; 10°. Gas was evidenced in sacroiliac joints in 22 patients (33%). Conclusion Postoperative anterior malalignment recurrence may occur after PSO. Elderly patients were at risk of recurrence. Loss of lumbar lordosis linked to pseudarthrosis represented another factor. With malalignment recurrence, anterior trunk rotation and pelvic retroversion might additionally have augmented moments across sacroiliac joints with subsequent ligament laxity and pelvic incidence increase. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30242507</pmid><doi>10.1007/s00586-018-5767-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0606-211X</orcidid></addata></record>
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subjects Geriatrics
Humans
Kyphosis
Medicine
Medicine & Public Health
Middle Aged
Neurosurgery
Original Article
Osteotomy
Osteotomy - adverse effects
Osteotomy - methods
Osteotomy - statistics & numerical data
Radiography
Recurrence
Retrospective Studies
Sacrum
Spinal Curvatures - diagnostic imaging
Spinal Curvatures - pathology
Spinal Curvatures - surgery
Spine (lumbar)
Spine - diagnostic imaging
Spine - pathology
Spine - surgery
Surgical Orthopedics
title Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy
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