L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyphosis deformity: a more than 2-year follow-up report

European spine journal

article

Hiroki Ushirozako¹  Tomohiko Hasegawa¹  Yu Yamato²  Go Yoshida¹  Tatsuya Yasuda³  Tomohiro Banno¹  Hideyuki Arima¹  Shin Oe²  Yuki Mihara¹  Tomohiro Yamada¹  Koichiro Ide¹  Yuh Watanabe¹  Keichi Nakai¹  Yukihiro Matsuyama¹ 

[1] Department of Orthopedic Surgery, Hamamatsu University School of Medicine;Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine;Department of Orthopaedic Surgery, Iwata City Hospital

关键词: Adult spinal deformity;    Correction surgery;    Pedicle subtraction osteotomy;    Complication;    Clinical outcome;   

DOI  :  10.1007/s00586-020-06616-z

来源: Springer

【 摘 要 】

L5 pedicle subtraction osteotomy (PSO) is a demanding technique; thus, PSOs are usually performed at the L3/L4 level to correct the lack of lumbar lordosis. Mid- to long-term improvements in clinical outcomes after L5 PSO are unknown. We aimed to determine the efficacy and safety of L5 PSO for rigid kyphosis deformities. We retrospectively reviewed the records of 57 patients with a rigid kyphosis deformity (mean age: 68 years) who underwent extensive corrective surgery incorporating PSO with a > 2-year follow-up. Radiographic parameters, postoperative complication rates, and the Oswestry Disability Index (ODI) scores were compared in the L5, L4, and L1-3 PSO groups preoperatively and at 1, 2, and 5 years postoperatively. There were 12, 25, and 20 patients in the L5, L4, and L1-3 PSO groups, respectively. Significant between-group differences were found in preoperative L4–S1 lordosis (L5:L4:L1-3 PSO groups =  − 8.9°:8.9°:16.2°, P < 0.001). The surgeries improved the postoperative spinopelvic alignment (similar in all groups). There was no significant between-group difference in the postoperative complication rate; no irreversible complications occurred. In the L5 PSO group, there was one case of a common iliac vein injury. The ODI scores improved postoperatively in all groups; this was maintained for 5 years postoperatively. L5 PSO for L4-5/L5 kyphosis deformities resulted in adequate correction and ODI improvement, which were maintained up to 5 years postoperatively. The surgical invasiveness, complication rates, and long-term prognosis associated with L5 PSO were similar to those of PSOs performed at other levels.

【 授权许可】

Unknown