Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California.
Oper Neurosurg (Hagerstown). 2021 Mar 15;20(4):343-354. doi: 10.1093/ons/opaa419.
Rigid and ankylosed thoracolumbar spinal deformities require three-column osteotomy (3CO) to achieve adequate correction. For severe and multiregional deformities, multilevel 3CO is required but its use and outcomes are rarely reported.
To describe the use of multilevel pedicle subtraction osteotomy (PSO) in adult spinal deformity (ASD) patients with severe, rigid, and ankylosed multiregional deformity.
Retrospective review of 5 ASD patients who underwent multilevel PSO for the correction of severe fixed deformity and review the literature regarding the use of multilevel PSO.
Five patients presented with spinal imbalance secondary to regional and multiregional spinal deformities involving the thoracolumbar spine. All patients underwent a single-stage two-level noncontiguous PSO, and 2 of the patients underwent a staged third PSO to treat deformity involving a separate spinal region. Significant radiographic correction was achieved with normalization of spinal alignment and parameters. Two-level PSO was able to provide greater than 80 degrees of sagittal plane correction in both the lumbar and thoracic spine. Two patients experienced new postoperative weakness which recovered to preoperative baseline at 3 to 6 mo follow-up. At most recent follow-up, 4 of the 5 patients gained significant pain relief and had improved functionality.
Noncontiguous multilevel PSO is a formidable surgical technique. Additional risk (compared to single-level 3CO) comes in the form of greater blood loss and higher risk for postoperative weakness. Nonetheless, multilevel PSO is feasible and effective for correcting severe multiplanar and multiregional ASD, and patients gain significant benefits in increased functionality and pain relief.
僵硬性胸腰椎脊柱畸形需要三柱截骨术（3CO）才能获得充分矫正。对于严重和多节段畸形，需要进行多节段 3CO，但很少有关于其使用和结果的报道。
描述多节段经椎弓根楔形截骨术（PSO）在严重、僵硬和固定性多节段畸形的成人脊柱畸形（ASD）患者中的应用。
回顾性分析 5 例 ASD 患者，这些患者因严重固定性畸形而行多节段 PSO 矫正，同时回顾关于多节段 PSO 使用的文献。
5 例患者均因胸腰椎区域性和多节段脊柱畸形导致脊柱失衡。所有患者均接受了一期双节段非连续性 PSO，其中 2 例患者分期进行了第 3 次 PSO，以治疗涉及单独脊柱区域的畸形。通过纠正脊柱排列和参数，实现了显著的影像学矫正。双节段 PSO 能够在腰椎和胸椎提供超过 80°的矢状面矫正。2 例患者术后出现新的肌无力，在 3 至 6 个月的随访中恢复到术前基线水平。在最近的随访中，5 例患者中有 4 例获得了显著的疼痛缓解和改善的功能。
非连续性多节段 PSO 是一种强大的手术技术。与单节段 3CO 相比，其额外风险表现为出血量更大和术后肌无力风险更高。尽管如此，多节段 PSO 对于矫正严重多平面和多节段 ASD 是可行且有效的，患者在增加功能和缓解疼痛方面获益显著。
