Bridwell Keith H, Lewis Stephen J, Edwards Charles, Lenke Lawrence G, Iffrig Theresa M, Berra Annette, Baldus Christine, Blanke Kathy
Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO 63110, USA.
Spine (Phila Pa 1976). 2003 Sep 15;28(18):2093-101. doi: 10.1097/01.BRS.0000090891.60232.70.
Radiographic analysis, outcomes analysis (pain scale, Oswestry, SRS-24), and accumulation of complications. Outcomes and complications collected prospectively. Radiographic analysis performed retrospectively.
To assess the benefits and stress complications of pedicle subtraction osteotomies for patients with fixed sagittal imbalance.
Few reports on pedicle subtraction osteotomies exist in the peer-review literature for conditions other than trauma and ankylosing spondylitis.
Thirty-three consecutive patients with sagittal imbalance treated with lumbar pedicle subtraction osteotomy at one institution (minimum 2-year follow-up) were analyzed. Complications were also analyzed for the entire group of consecutive pedicle subtraction osteotomies done at our institution to date (n = 66).
For the 33 patients with minimum 2-year follow-up, there were significant improvements in the overall Oswestry score (P 0.0001) and pain score (P = 0.0001). Most patients reported improvement in pain and self-image and reported overall satisfaction based on ultimate SRS-24 questionnaire. There was one pseudarthrosis in the lumbar spine through an area of pedicle subtraction osteotomy (area of previous laminectomy and nonunion), and six patients had thoracic pseudarthroses (levels other than the osteotomy level) and one patient had a pseudarthrosis at L5-S1. Two patients had acute angular kyphosis at the thoracolumbar junction at the proximal end of the construct. Five patients who experienced transient neurologic deficits resolved their deficits after central canal enlargement.
The clinical result with pedicle subtraction osteotomy is reduced with pseudarthrosis in the thoracic or lumbar spine and subsequent breakdown adjacent to the fusion. For patients with a degenerative sagittal imbalance etiology the results were worse and the complications were higher. Central canal enlargement is critical.
影像学分析、结果分析（疼痛量表、奥斯维斯特功能障碍指数、SRS-24）以及并发症的累积情况。前瞻性收集结果和并发症。回顾性进行影像学分析。
评估椎弓根截骨术对固定矢状面失衡患者的益处及应激并发症。
除创伤和强直性脊柱炎外，同行评议文献中关于椎弓根截骨术的报道很少。
分析了在一家机构接受腰椎椎弓根截骨术治疗矢状面失衡的33例连续患者（至少随访2年）。还对截至目前在我们机构进行的连续椎弓根截骨术全组患者（n = 66）的并发症进行了分析。
对于33例至少随访2年的患者，总体奥斯维斯特功能障碍指数评分（P < 0.0001）和疼痛评分（P = 0.0001）有显著改善。大多数患者报告疼痛和自我形象有所改善，并根据最终的SRS-24问卷表示总体满意。腰椎有1例假关节形成于椎弓根截骨区域（既往椎板切除和不愈合区域），6例患者有胸椎假关节（截骨水平以外的节段），1例患者在L5-S1有假关节。2例患者在构建物近端的胸腰段交界处出现急性角状后凸。5例经历短暂神经功能缺损的患者在中央椎管扩大后缺损得到缓解。
胸椎或腰椎假关节形成以及融合相邻部位随后的破坏会降低椎弓根截骨术的临床效果。对于退行性矢状面失衡病因的患者，结果更差且并发症更高。中央椎管扩大至关重要。
