Neurologic complications of lumbar pedicle subtraction osteotomy : A 10-year assessment
Clinical, radiographic, and outcomes assessment focusing on neurologic complications in patients undergoing pedicle subtraction osteotomy (PSO). Clinical data were collected prospectively. Radiographic analysis was performed retrospectively. To evaluate intraoperative and postoperative neurologic de...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2007-09, Vol.32 (20), p.2245-2252 |
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| creator | BUCHOWSKI, Jacob M BRIDWELL, Keith H LENKE, Lawrence G KUHNS, Craig A LEHMAN, Ronald A KIM, Youngjung J STEWART, David BALDUS, Chris |
| description | Clinical, radiographic, and outcomes assessment focusing on neurologic complications in patients undergoing pedicle subtraction osteotomy (PSO). Clinical data were collected prospectively. Radiographic analysis was performed retrospectively.
To evaluate intraoperative and postoperative neurologic deficits following lumbar PSOs in order to determine risk factors, treatment strategies, and patient outcome.
Although technically demanding, PSOs have been increasingly used to restore lumbar lordosis and correct sagittal deformity. Although some reports have commented on various complications of the procedure, to our knowledge, there have been no studies focusing on neurologic complications of the osteotomy.
An analysis of 108 consecutive patients with an average age of 54.8 +/- 14.0 years and treated with a lumbar PSO at 1 institution over a 10-year period (1995-2005) was performed. Medical records, radiographs, and neuromonitoring data were analyzed. Clinical outcome was assessed using the Oswestry Disability Index and the Scoliosis Research Society (SRS)-24 instruments.
A total of 108 PSOs were performed. Following surgery, lumbar lordosis increased from -17.1 degrees +/- 19.3 degrees to -49.3 degrees +/- 14.7 degrees (P < 0.000), and sagittal balance improved from 131 +/- 73 mm to 23 +/- 48 mm (P < 0.000). Intraoperative and postoperative deficits (defined as motor loss of 2 grades or more or loss of bowel/bladder control) were seen in 12 patients (11.1%) and were permanent in 3 patients (2.8%). With time motor function improved by 1 grade in 2 patients and all 3 were able to ambulate. Intraoperative neuromonitoring did not detect the deficits. In 9 patients, additional surgical intervention consisted of central enlargement and further decompression. Deficits were thought to be due to a combination of subluxation, residual dorsal impingement, and dural buckling.
Intraoperative or postoperative neurologic deficits are relatively common following a PSO; however, in a majority of cases, deficits are not likely to be permanent. |
| doi_str_mv | 10.1097/BRS.0b013e31814b2d52 |
| format | Article |
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To evaluate intraoperative and postoperative neurologic deficits following lumbar PSOs in order to determine risk factors, treatment strategies, and patient outcome.
Although technically demanding, PSOs have been increasingly used to restore lumbar lordosis and correct sagittal deformity. Although some reports have commented on various complications of the procedure, to our knowledge, there have been no studies focusing on neurologic complications of the osteotomy.
An analysis of 108 consecutive patients with an average age of 54.8 +/- 14.0 years and treated with a lumbar PSO at 1 institution over a 10-year period (1995-2005) was performed. Medical records, radiographs, and neuromonitoring data were analyzed. Clinical outcome was assessed using the Oswestry Disability Index and the Scoliosis Research Society (SRS)-24 instruments.
A total of 108 PSOs were performed. Following surgery, lumbar lordosis increased from -17.1 degrees +/- 19.3 degrees to -49.3 degrees +/- 14.7 degrees (P < 0.000), and sagittal balance improved from 131 +/- 73 mm to 23 +/- 48 mm (P < 0.000). Intraoperative and postoperative deficits (defined as motor loss of 2 grades or more or loss of bowel/bladder control) were seen in 12 patients (11.1%) and were permanent in 3 patients (2.8%). With time motor function improved by 1 grade in 2 patients and all 3 were able to ambulate. Intraoperative neuromonitoring did not detect the deficits. In 9 patients, additional surgical intervention consisted of central enlargement and further decompression. Deficits were thought to be due to a combination of subluxation, residual dorsal impingement, and dural buckling.
Intraoperative or postoperative neurologic deficits are relatively common following a PSO; however, in a majority of cases, deficits are not likely to be permanent.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e31814b2d52</identifier><identifier>PMID: 17873818</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Philadelphia, PA: Lippincott</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cerebrospinal fluid. Meninges. Spinal cord ; Disability Evaluation ; Diseases of the osteoarticular system ; Diseases of the spine ; Female ; Humans ; Incidence ; Lumbar Vertebrae - diagnostic imaging ; Lumbar Vertebrae - physiopathology ; Lumbar Vertebrae - surgery ; Male ; Medical sciences ; Middle Aged ; Motor Skills ; Nervous system (semeiology, syndromes) ; Neurology ; Odds Ratio ; Orthopedic surgery ; Osteotomy - adverse effects ; Osteotomy - methods ; Peripheral Nervous System Diseases - epidemiology ; Peripheral Nervous System Diseases - etiology ; Peripheral Nervous System Diseases - physiopathology ; Postural Balance ; Radiography ; Recovery of Function ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Spinal Diseases - diagnostic imaging ; Spinal Diseases - physiopathology ; Spinal Diseases - surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2007-09, Vol.32 (20), p.2245-2252</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c284t-5f86ed8f3aeb0f46a7de2bf4c085ae36ad6e5887e5ef30cbc5889ced972b572c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19084932$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17873818$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BUCHOWSKI, Jacob M</creatorcontrib><creatorcontrib>BRIDWELL, Keith H</creatorcontrib><creatorcontrib>LENKE, Lawrence G</creatorcontrib><creatorcontrib>KUHNS, Craig A</creatorcontrib><creatorcontrib>LEHMAN, Ronald A</creatorcontrib><creatorcontrib>KIM, Youngjung J</creatorcontrib><creatorcontrib>STEWART, David</creatorcontrib><creatorcontrib>BALDUS, Chris</creatorcontrib><title>Neurologic complications of lumbar pedicle subtraction osteotomy : A 10-year assessment</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>Clinical, radiographic, and outcomes assessment focusing on neurologic complications in patients undergoing pedicle subtraction osteotomy (PSO). Clinical data were collected prospectively. Radiographic analysis was performed retrospectively.
To evaluate intraoperative and postoperative neurologic deficits following lumbar PSOs in order to determine risk factors, treatment strategies, and patient outcome.
Although technically demanding, PSOs have been increasingly used to restore lumbar lordosis and correct sagittal deformity. Although some reports have commented on various complications of the procedure, to our knowledge, there have been no studies focusing on neurologic complications of the osteotomy.
An analysis of 108 consecutive patients with an average age of 54.8 +/- 14.0 years and treated with a lumbar PSO at 1 institution over a 10-year period (1995-2005) was performed. Medical records, radiographs, and neuromonitoring data were analyzed. Clinical outcome was assessed using the Oswestry Disability Index and the Scoliosis Research Society (SRS)-24 instruments.
A total of 108 PSOs were performed. Following surgery, lumbar lordosis increased from -17.1 degrees +/- 19.3 degrees to -49.3 degrees +/- 14.7 degrees (P < 0.000), and sagittal balance improved from 131 +/- 73 mm to 23 +/- 48 mm (P < 0.000). Intraoperative and postoperative deficits (defined as motor loss of 2 grades or more or loss of bowel/bladder control) were seen in 12 patients (11.1%) and were permanent in 3 patients (2.8%). With time motor function improved by 1 grade in 2 patients and all 3 were able to ambulate. Intraoperative neuromonitoring did not detect the deficits. In 9 patients, additional surgical intervention consisted of central enlargement and further decompression. Deficits were thought to be due to a combination of subluxation, residual dorsal impingement, and dural buckling.
Intraoperative or postoperative neurologic deficits are relatively common following a PSO; however, in a majority of cases, deficits are not likely to be permanent.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Disability Evaluation</subject><subject>Diseases of the osteoarticular system</subject><subject>Diseases of the spine</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Lumbar Vertebrae - physiopathology</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Motor Skills</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Odds Ratio</subject><subject>Orthopedic surgery</subject><subject>Osteotomy - adverse effects</subject><subject>Osteotomy - methods</subject><subject>Peripheral Nervous System Diseases - epidemiology</subject><subject>Peripheral Nervous System Diseases - etiology</subject><subject>Peripheral Nervous System Diseases - physiopathology</subject><subject>Postural Balance</subject><subject>Radiography</subject><subject>Recovery of Function</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Spinal Diseases - diagnostic imaging</subject><subject>Spinal Diseases - physiopathology</subject><subject>Spinal Diseases - surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surveys and Questionnaires</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkEtLw0AUhQdRbK3-A5HZ6C51Hplk4q4WX1AUfOAyzEzuSCTp1LnJov_elAYEV5fD_c5ZfIScczbnrMivb1_f5swyLkFyzVMrKiUOyJQroRPOVXFIpkxmIhGpzCbkBPGbMZZJXhyTCc91LjXXU_L5DH0MTfiqHXWh3TS1M10d1kiDp03fWhPpBqraNUCxt100bvemATsIXWi39IYuKGfJFgbSIAJiC-vulBx50yCcjXdGPu7v3pePyerl4Wm5WCVO6LRLlNcZVNpLA5b5NDN5BcL61DGtDMjMVBkorXNQ4CVz1g2hcFAVubAqF07OyNV-dxPDTw_YlW2NDprGrCH0WGZa6MGRGsB0D7oYECP4chPr1sRtyVm5E1oOQsv_Qofaxbjf2xaqv9JocAAuR8CgM42PZu1q_OMKptNCCvkLwKqA_g</recordid><startdate>20070915</startdate><enddate>20070915</enddate><creator>BUCHOWSKI, Jacob M</creator><creator>BRIDWELL, Keith H</creator><creator>LENKE, Lawrence G</creator><creator>KUHNS, Craig A</creator><creator>LEHMAN, Ronald A</creator><creator>KIM, Youngjung J</creator><creator>STEWART, David</creator><creator>BALDUS, Chris</creator><general>Lippincott</general><scope>IQODW</scope><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>7X8</scope></search><sort><creationdate>20070915</creationdate><title>Neurologic complications of lumbar pedicle subtraction osteotomy : A 10-year assessment</title><author>BUCHOWSKI, Jacob M ; BRIDWELL, Keith H ; LENKE, Lawrence G ; KUHNS, Craig A ; LEHMAN, Ronald A ; KIM, Youngjung J ; STEWART, David ; BALDUS, Chris</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c284t-5f86ed8f3aeb0f46a7de2bf4c085ae36ad6e5887e5ef30cbc5889ced972b572c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Disability Evaluation</topic><topic>Diseases of the osteoarticular system</topic><topic>Diseases of the spine</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Lumbar Vertebrae - physiopathology</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Motor Skills</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Odds Ratio</topic><topic>Orthopedic surgery</topic><topic>Osteotomy - adverse effects</topic><topic>Osteotomy - methods</topic><topic>Peripheral Nervous System Diseases - epidemiology</topic><topic>Peripheral Nervous System Diseases - etiology</topic><topic>Peripheral Nervous System Diseases - physiopathology</topic><topic>Postural Balance</topic><topic>Radiography</topic><topic>Recovery of Function</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Spinal Diseases - diagnostic imaging</topic><topic>Spinal Diseases - physiopathology</topic><topic>Spinal Diseases - surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surveys and Questionnaires</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BUCHOWSKI, Jacob M</creatorcontrib><creatorcontrib>BRIDWELL, Keith H</creatorcontrib><creatorcontrib>LENKE, Lawrence G</creatorcontrib><creatorcontrib>KUHNS, Craig A</creatorcontrib><creatorcontrib>LEHMAN, Ronald A</creatorcontrib><creatorcontrib>KIM, Youngjung J</creatorcontrib><creatorcontrib>STEWART, David</creatorcontrib><creatorcontrib>BALDUS, Chris</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BUCHOWSKI, Jacob M</au><au>BRIDWELL, Keith H</au><au>LENKE, Lawrence G</au><au>KUHNS, Craig A</au><au>LEHMAN, Ronald A</au><au>KIM, Youngjung J</au><au>STEWART, David</au><au>BALDUS, Chris</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurologic complications of lumbar pedicle subtraction osteotomy : A 10-year assessment</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2007-09-15</date><risdate>2007</risdate><volume>32</volume><issue>20</issue><spage>2245</spage><epage>2252</epage><pages>2245-2252</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>Clinical, radiographic, and outcomes assessment focusing on neurologic complications in patients undergoing pedicle subtraction osteotomy (PSO). Clinical data were collected prospectively. Radiographic analysis was performed retrospectively.
To evaluate intraoperative and postoperative neurologic deficits following lumbar PSOs in order to determine risk factors, treatment strategies, and patient outcome.
Although technically demanding, PSOs have been increasingly used to restore lumbar lordosis and correct sagittal deformity. Although some reports have commented on various complications of the procedure, to our knowledge, there have been no studies focusing on neurologic complications of the osteotomy.
An analysis of 108 consecutive patients with an average age of 54.8 +/- 14.0 years and treated with a lumbar PSO at 1 institution over a 10-year period (1995-2005) was performed. Medical records, radiographs, and neuromonitoring data were analyzed. Clinical outcome was assessed using the Oswestry Disability Index and the Scoliosis Research Society (SRS)-24 instruments.
A total of 108 PSOs were performed. Following surgery, lumbar lordosis increased from -17.1 degrees +/- 19.3 degrees to -49.3 degrees +/- 14.7 degrees (P < 0.000), and sagittal balance improved from 131 +/- 73 mm to 23 +/- 48 mm (P < 0.000). Intraoperative and postoperative deficits (defined as motor loss of 2 grades or more or loss of bowel/bladder control) were seen in 12 patients (11.1%) and were permanent in 3 patients (2.8%). With time motor function improved by 1 grade in 2 patients and all 3 were able to ambulate. Intraoperative neuromonitoring did not detect the deficits. In 9 patients, additional surgical intervention consisted of central enlargement and further decompression. Deficits were thought to be due to a combination of subluxation, residual dorsal impingement, and dural buckling.
Intraoperative or postoperative neurologic deficits are relatively common following a PSO; however, in a majority of cases, deficits are not likely to be permanent.</abstract><cop>Philadelphia, PA</cop><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>17873818</pmid><doi>10.1097/BRS.0b013e31814b2d52</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0362-2436 |
| ispartof | Spine (Philadelphia, Pa. 1976), 2007-09, Vol.32 (20), p.2245-2252 |
| issn | 0362-2436 1528-1159 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Aged Biological and medical sciences Cerebrospinal fluid. Meninges. Spinal cord Disability Evaluation Diseases of the osteoarticular system Diseases of the spine Female Humans Incidence Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - physiopathology Lumbar Vertebrae - surgery Male Medical sciences Middle Aged Motor Skills Nervous system (semeiology, syndromes) Neurology Odds Ratio Orthopedic surgery Osteotomy - adverse effects Osteotomy - methods Peripheral Nervous System Diseases - epidemiology Peripheral Nervous System Diseases - etiology Peripheral Nervous System Diseases - physiopathology Postural Balance Radiography Recovery of Function Reoperation Retrospective Studies Risk Assessment Risk Factors Severity of Illness Index Spinal Diseases - diagnostic imaging Spinal Diseases - physiopathology Spinal Diseases - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surveys and Questionnaires Time Factors Treatment Outcome |
| title | Neurologic complications of lumbar pedicle subtraction osteotomy : A 10-year assessment |
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