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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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 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2111142941</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2111142941</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-4ca89a9bd85b73c47f3c47ecf1eb27bde542bbf2e39b373150019175624f52da3</originalsourceid><addsrcrecordid>eNp1kUtPJCEURolxou3jB7gxJG5mUzM8i2ZpjI4mJroY1wSoWy2mqmiBivrvh077SEyGBSw491y4H0InlPyihKjfmRC5bBtCl41UrWped9CCCs4aojnbRQuiBWlaRfU-Osj5iRAqNWn30D4nTDBJ1ALBfcw5uAFwb32JKWObc_TBFujwSyiPONtVKMUOeLSDHcJqGmEqOIGfU4LJA7Z9gYTX0AVfNXl2JVVViBOOuUAscXw7Qj96O2Q4fj8P0cPV5d-L6-b27s_Nxflt47lipRHeLrXVrltKp7gXqt9s4HsKjinXgRTMuZ4B144rTmX9kaZKtkz0knWWH6KfW-86xecZcjFjyB6GwU4Q52wYrUswLWhFz76hT3FOU33dhiJccy5kpeiW8qnOKUFv1imMNr0ZSswmA7PNwNQMzCYD81prTt_Nsxuh-6z4GHoF2BbI9WpaQfpq_X_rP4Iqk_U</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2110393345</pqid></control><display><type>article</type><title>Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Eichler, David ; Charles, Yann Philippe ; Baldairon, Florent ; Ntilikina, Yves ; Sauleau, Erik André ; Steib, Jean-Paul</creator><creatorcontrib>Eichler, David ; Charles, Yann Philippe ; Baldairon, Florent ; Ntilikina, Yves ; Sauleau, Erik André ; Steib, Jean-Paul</creatorcontrib><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
< 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° (
p
< 0.0001) and decreased to 49.7° (
p
= 0.0008). Pelvic tilt decreased from 29.2° to 16.5° (
p
< 0.0001) and increased to 22.5° (
p
< 0.0001). SVA C7 decreased from 105.1 to 35.5 mm (
p
< 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 > 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 & 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</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
< 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° (
p
< 0.0001) and decreased to 49.7° (
p
= 0.0008). Pelvic tilt decreased from 29.2° to 16.5° (
p
< 0.0001) and increased to 22.5° (
p
< 0.0001). SVA C7 decreased from 105.1 to 35.5 mm (
p
< 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 > 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><subject>Geriatrics</subject><subject>Humans</subject><subject>Kyphosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Osteotomy</subject><subject>Osteotomy - adverse effects</subject><subject>Osteotomy - methods</subject><subject>Osteotomy - statistics & numerical data</subject><subject>Radiography</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Sacrum</subject><subject>Spinal Curvatures - diagnostic imaging</subject><subject>Spinal Curvatures - pathology</subject><subject>Spinal Curvatures - surgery</subject><subject>Spine (lumbar)</subject><subject>Spine - diagnostic imaging</subject><subject>Spine - pathology</subject><subject>Spine - surgery</subject><subject>Surgical Orthopedics</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kUtPJCEURolxou3jB7gxJG5mUzM8i2ZpjI4mJroY1wSoWy2mqmiBivrvh077SEyGBSw491y4H0InlPyihKjfmRC5bBtCl41UrWped9CCCs4aojnbRQuiBWlaRfU-Osj5iRAqNWn30D4nTDBJ1ALBfcw5uAFwb32JKWObc_TBFujwSyiPONtVKMUOeLSDHcJqGmEqOIGfU4LJA7Z9gYTX0AVfNXl2JVVViBOOuUAscXw7Qj96O2Q4fj8P0cPV5d-L6-b27s_Nxflt47lipRHeLrXVrltKp7gXqt9s4HsKjinXgRTMuZ4B144rTmX9kaZKtkz0knWWH6KfW-86xecZcjFjyB6GwU4Q52wYrUswLWhFz76hT3FOU33dhiJccy5kpeiW8qnOKUFv1imMNr0ZSswmA7PNwNQMzCYD81prTt_Nsxuh-6z4GHoF2BbI9WpaQfpq_X_rP4Iqk_U</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Eichler, David</creator><creator>Charles, Yann Philippe</creator><creator>Baldairon, Florent</creator><creator>Ntilikina, Yves</creator><creator>Sauleau, Erik André</creator><creator>Steib, Jean-Paul</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0606-211X</orcidid></search><sort><creationdate>20190101</creationdate><title>Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy</title><author>Eichler, David ; Charles, Yann Philippe ; Baldairon, Florent ; Ntilikina, Yves ; Sauleau, Erik André ; Steib, Jean-Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-4ca89a9bd85b73c47f3c47ecf1eb27bde542bbf2e39b373150019175624f52da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Geriatrics</topic><topic>Humans</topic><topic>Kyphosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Osteotomy</topic><topic>Osteotomy - adverse effects</topic><topic>Osteotomy - methods</topic><topic>Osteotomy - statistics & numerical data</topic><topic>Radiography</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Sacrum</topic><topic>Spinal Curvatures - diagnostic imaging</topic><topic>Spinal Curvatures - pathology</topic><topic>Spinal Curvatures - surgery</topic><topic>Spine (lumbar)</topic><topic>Spine - diagnostic imaging</topic><topic>Spine - pathology</topic><topic>Spine - surgery</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eichler, David</au><au>Charles, Yann Philippe</au><au>Baldairon, Florent</au><au>Ntilikina, Yves</au><au>Sauleau, Erik André</au><au>Steib, Jean-Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>28</volume><issue>1</issue><spage>161</spage><epage>169</epage><pages>161-169</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>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
< 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° (
p
< 0.0001) and decreased to 49.7° (
p
= 0.0008). Pelvic tilt decreased from 29.2° to 16.5° (
p
< 0.0001) and increased to 22.5° (
p
< 0.0001). SVA C7 decreased from 105.1 to 35.5 mm (
p
< 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 > 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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