Otani Kazuyuki, Shindo Shigeo, Mizuno Koichi, Kusano Kazuo, Miyake Norihiko, Taniyama Takashi, Nakai Osamu, Okawa Atsushi
Department of Orthopaedic Surgery, Kudanzaka Hospital, Tokyo, Japan.
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Spine Surg Relat Res. 2018 Mar 15;2(3):221-225. doi: 10.22603/ssrr.2017-0059. eCollection 2018.
Pedicle subtraction osteotomy (PSO) is performed to correct sagittal plane deformity. This procedure is useful with revision cases in which the number of intact discs for correction is limited.
Forty-four patients (10 male and 34 female) with minimum follow-up of 2 years were reviewed; all had undergone PSO revision surgery for kyphosis following previous lumbar fusion surgery. The average age at operation was 72.8 years (range 42-85 years), and the average follow-up period was 4.1 years (2-9 years). The average fusion level was 7.5 (4-13 level), and the average previously fused level was 2.4 (1-7 level).
The average operation time was 424 min, and average blood loss was 2880 g. The average JOA score of 14.0 before operation changed to 21.8 at 1-year follow-up and to 20.7 at final follow-up. The average recovery rate at final follow-up was 45.7%. Four patients underwent re-operations for proximal junctional kyphosis and 3 patients for rod fracture. The fusion rate was 88.6%, and 13 patients (29.5%) developed subsequent vertebral fracture. The average PI-LL (Pelvic incidence minus Lumbar lordosis) at pre-op of 52.9 degrees changed to 3.8 degrees at post-op, to 13.4 degrees at 1-year follow-up, and to 14.8 degrees at final follow-up. The average correction at the PSO site was 36.0 degrees at post-op, 36.7 degrees at 1-year follow-up, and 37.0 degrees at final follow-up. The average sagittal vertical axis at pre-op of 145.0 mm decreased to 51.2 mm at 1-year follow-up; however, it increased to 75.3 mm at final follow-up.
PSO for correction of kyphosis following previous lumbar fusion surgery was an effective procedure without correction loss at the local osteotomy site; however, its surgical invasiveness and complication rate were high. Subsequent vertebral fracture, adjacent segment degeneration, and rod fracture contribute to deterioration of outcome that is evident at long-term follow-up.
椎弓根截骨术（PSO）用于矫正矢状面畸形。该手术对于矫正时完整椎间盘数量有限的翻修病例很有用。
对44例患者（10例男性和34例女性）进行了回顾，其最短随访时间为2年；所有患者均在先前腰椎融合手术后因后凸畸形接受了PSO翻修手术。手术时的平均年龄为72.8岁（范围42 - 85岁），平均随访期为4.1年（2 - 9年）。平均融合节段为7.5个（4 - 13个节段），先前平均融合节段为2.4个（1 - 7个节段）。
平均手术时间为424分钟，平均失血量为2880克。术前平均日本骨科学会（JOA）评分为14.0分，1年随访时变为21.8分，最终随访时变为20.7分。最终随访时的平均恢复率为45.7%。4例患者因近端交界性后凸畸形接受了再次手术，3例患者因棒材骨折接受了再次手术。融合率为88.6%，13例患者（29.5%）发生了后续椎体骨折。术前平均骨盆入射角减去腰椎前凸角（PI - LL）为52.9度，术后变为3.8度，1年随访时变为13.4度，最终随访时变为14.8度。PSO部位的平均矫正角度术后为36.0度，1年随访时为36.7度，最终随访时为37.0度。术前矢状垂直轴平均为145.0毫米，1年随访时降至51.2毫米；然而，最终随访时又升至75.3毫米。
先前腰椎融合手术后用于矫正后凸畸形的PSO是一种有效的手术方法，局部截骨部位无矫正丢失；然而，其手术侵袭性和并发症发生率较高。后续椎体骨折、相邻节段退变和棒材骨折导致长期随访时预后恶化。
