Carballo Cuello César, Flores-Milan Gabriel, Screven Ryan, Pressman Elliot, Kumar Jay I, Clampitt Bryan, Noureldine Mohammad Hassan A, Hidalgo Adolfo Viloria, Sabahi Mohammadmahdi, Hayman Erik, Greenberg Mark, Alikhani Puya
1Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa.
2University of South Florida, Morsani College of Medicine, Tampa; and.
J Neurosurg Spine. 2025 Jun 13;43(3):313-323. doi: 10.3171/2025.2.SPINE241128. Print 2025 Sep 1.
Intradiscal osteotomy (IDO), which is used for the treatment of spinal deformities, involves a three-column release that creates lordosis. It is believed to be as effective as pedicle subtraction osteotomy (PSO). The authors of this study compared the two techniques in restoring sagittal balance and evaluated their safety profiles.
They conducted a retrospective database review of patients who had undergone long construct fusions from 2016 to 2022. Long construct fusions were defined as having an upper instrumented vertebra of L2 or higher and a lower instrumented vertebra of S1 or the pelvis. The study included only those patients with lumbar degenerative disease, evidence of fusion at the treatment level on preoperative imaging, and 2 years of follow-up.
Fifty-three patients met the study inclusion criteria, of whom 28 had undergone IDO and 25 had undergone PSO. The IDO cohort had a 3.6% frequency of proximal junctional kyphosis (PJK), 17.9% frequency of hardware failure (HF), 10.7% frequency of deep vein thrombosis (DVT), 3.6% frequency of wound infection, and 10.7% frequency of pseudarthrosis. The PSO cohort had a 4.0% incidence of PJK, 28.0% incidence of HF, 16.0% incidence of DVT, 4.0% incidence of wound infection, and 12.0% incidence of pseudarthrosis. The average postoperative sagittal vertical axis (SVA) for the PSO group was 7 cm, whereas the average for the IDO group was 5 cm (p = 0.01). Patients who had undergone IDO reported less back pain on their visual analog scale assessments at 3 months postoperatively (p = 0.01). The IDO cohort had an average operative time (OT) of 7 hours and estimated blood loss (EBL) of 800 ml, whereas the PSO group had an OT of 8.5 hours (p = 0.01) and EBL of 1400 ml (p = 0.01).
IDO can be as effective as PSO in lordosis restoration and is a powerful technique for SVA correction (p = 0.01), significantly improving postoperative back pain, as compared with PSO (p = 0.01), while maintaining a similar risk profile.
用于治疗脊柱畸形的椎间盘内截骨术（IDO）涉及三柱松解以形成前凸。据信其与经椎弓根截骨术（PSO）效果相当。本研究的作者比较了这两种技术在恢复矢状面平衡方面的效果，并评估了它们的安全性。
他们对2016年至2022年期间接受长节段融合手术的患者进行了回顾性数据库分析。长节段融合手术定义为上位固定椎体为L2或更高，下位固定椎体为S1或骨盆。该研究仅纳入那些患有腰椎退行性疾病、术前影像学显示治疗节段有融合证据且有2年随访资料的患者。
53例患者符合研究纳入标准，其中28例行IDO，25例行PSO。IDO组近端交界性后凸（PJK）发生率为3.6%，内固定失败（HF）发生率为17.9%，深静脉血栓形成（DVT）发生率为10.7%，伤口感染发生率为3.6%，假关节形成发生率为10.7%。PSO组PJK发生率为4.0%，HF发生率为28.0%，DVT发生率为16.0%，伤口感染发生率为4.0%，假关节形成发生率为12.0%。PSO组术后矢状面垂直轴（SVA）平均为7 cm，而IDO组平均为5 cm（p = 0.01）。接受IDO的患者在术后3个月的视觉模拟评分评估中报告的背痛较轻（p = 0.01）。IDO组平均手术时间（OT）为7小时，估计失血量（EBL）为800 ml，而PSO组OT为8.5小时（p = 0.01），EBL为1400 ml（p = 0.01）。
IDO在恢复前凸方面与PSO效果相当，是一种矫正SVA的有效技术（p = 0.01），与PSO相比，能显著改善术后背痛（p = 0.01），同时保持相似的风险状况。
