Berjano Pedro, Pejrona Matteo, Damilano Marco, Cecchinato Riccardo, Aguirre Maryem-Fama Ismael, Lamartina Claudio
IVth Spine Surgery Division, IRCSS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy,
Eur Spine J. 2015 Jan;24 Suppl 1:58-65. doi: 10.1007/s00586-014-3618-y. Epub 2014 Oct 16.
Sagittal imbalance is a spine deformity with multifactorial etiology, associated with severe low back pain and gait disturbance that worsen deeply patients' quality of life. The amount of correction achievable through PSO is limited by the height of the resection of the posterior wall, causing a ceiling of segmental correction of 30-35°. The aim of this study is to describe and preliminarily evaluate the results of an alternative technique, corner osteotomy (CO), that can increase the amount of correction.
From March 2012, every patient examined in our Division, diagnosed with sagittal imbalance to be treated with PSO, underwent CO and fusion. This technique consists in removing the posterior vertebral arch, the pedicle and the posterior-superior corner of the vertebral body; the inferior endplate of the vertebra above is prepared and the superior adjacent disc removed to obtain, when closing the osteotomy, a direct interbody fusion. Ten patients undergoing CO were compared with 20 patients undergoing PSO regarding spinopelvic parameters, operative variables, complications and degree of correction.
Patients undergoing CO obtained higher lordotic angle at the osteotomy than patients undergoing PSO (36.6° ± 8.2° vs 16.5° ± 9.5°, p < 0.001) and had lower postoperative PT and SVA and higher average increase in lordosis. Complications were similar between groups. A trend toward longer surgical time, greater bleeding and higher transfusion rate was observed in the CO group, though this finding could be related to higher complexity of cases or incidence of associated anterior approach.
Corner osteotomy technique was more effective than the PSO in increasing segmental and lumbar lordosis with modest increase in blood loss and similar complication rate. The CO technique, in addition, proved a good reproducibility. Further studies with larger populations should confirm these preliminary results.
矢状面失平衡是一种病因多因素的脊柱畸形，与严重的腰背痛和步态障碍相关，会严重恶化患者的生活质量。经椎弓根椎体截骨术（PSO）可实现的矫正量受后壁切除高度的限制，导致节段性矫正上限为30 - 35°。本研究的目的是描述并初步评估一种可增加矫正量的替代技术——角状截骨术（CO）的结果。
从2012年3月起，在我们科室接受检查、被诊断为矢状面失平衡且拟行PSO治疗的每位患者，均接受了CO及融合术。该技术包括切除椎体的后弓、椎弓根和后上角；准备上方椎体的下终板并切除相邻的上位椎间盘，以便在截骨闭合时实现直接椎间融合。将10例行CO的患者与20例行PSO的患者在脊柱骨盆参数、手术变量、并发症及矫正程度方面进行比较。
行CO的患者在截骨时获得的前凸角高于行PSO的患者（36.6°±8.2°对16.5°±9.5°，p<0.001），术后骨盆倾斜角（PT）和矢状面垂直轴（SVA）更低，前凸平均增加量更高。两组并发症相似。虽然这一发现可能与病例的更高复杂性或联合前路手术的发生率有关，但在CO组中观察到手术时间更长、出血量更大和输血率更高的趋势。
角状截骨术在增加节段性和腰椎前凸方面比PSO更有效，失血量适度增加，并发症发生率相似。此外，CO技术具有良好的可重复性。更大样本量的进一步研究应证实这些初步结果。
