Nishizawa Mitsuhiro, Ohya Junichi, Ishikawa Yuki, Nakajima Soichiro, Zhongyuan Sun, Rosenfeld Marika G, Onishi Yuki, Kunogi Junichi, Kawamura Naohiro
1Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and.
2Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, California.
J Neurosurg Spine. 2025 Sep 5:1-9. doi: 10.3171/2025.4.SPINE241232.
The objective of this study was to introduce and evaluate foraminoplastic inferior pedicle subtraction osteotomy (FiPSO), a novel technique that involves downward resection of the pedicle and vertebral body, aimed at addressing rigid lower lumbar kyphosis.
The clinical records were reviewed of the patients who underwent corrective surgery from January 2012 through December 2021 for adult spinal deformity using a combination of procedures: pedicle subtraction osteotomy (PSO) at the lumbar level and spinopelvic fixation. Inclusion criteria included patients older than 40 years with sagittal imbalance symptoms and significant radiographic findings: sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI) minus lumbar lordosis (LL) > 10°. Patients were categorized into three groups: L1-3 PSO, L4-S1 PSO, and FiPSO. The authors assessed thoracic kyphosis, LL, lower LL (LLL), PI, PT, sacral slope, SVA, global tilt (GT), and Global Alignment and Proportion (GAP) score preoperatively, postoperatively, and at the last follow-up. Complications were also analyzed.
A total of 65 patients were included in the final analysis: 25 in the L1-3 PSO group, 29 in the L4-S1 PSO group, and 11 in the FiPSO group. The FiPSO group showed significantly larger postoperative LLL (39.2° ± 7.7° vs 29.7° ± 10.7°, p < 0.05) and smaller PI-LL mismatch (9.6° ± 10.3° vs 24.6° ± 13.4°, p < 0.01) compared to the L4-S1 PSO groups. At the last follow-up, the FiPSO group maintained larger LLL (38.3° ± 8.9° vs 27.1° ± 10.0°, p < 0.05), lower PT (23.1° ± 9.9° vs 33.3° ± 10.7°, p < 0.05), and good global sagittal alignment (SVA, 64.0 ± 43.8 mm vs 106.8 ± 55.7 mm, p < 0.05; GT, 28.7° ± 13.9° vs 43.5° ± 15.5°, p < 0.05) compared to the L4-S1 PSO group. The FiPSO group had higher nerve deficits (45%) but lower proximal junctional kyphosis (18%) and revision surgery rates (9.1%) than the L1-3 or L4-S1 PSO groups. However, the differences were not statistically significant.
FiPSO provides effective lower lumbar correction and long-term sagittal alignment with comparable complication rates, offering a valuable option for overcoming the challenges associated with PSO in the lower lumbar spine.
本研究的目的是介绍并评估椎间孔成形下椎弓根截骨术（FiPSO），这是一种涉及向下切除椎弓根和椎体的新技术，旨在解决僵硬的下腰椎后凸畸形。
回顾了2012年1月至2021年12月期间接受成人脊柱畸形矫正手术患者的临床记录，这些手术采用了多种手术方法联合：腰椎水平的椎弓根截骨术（PSO）和脊柱骨盆固定术。纳入标准包括年龄大于40岁、有矢状面失衡症状且有显著影像学表现的患者：矢状垂直轴（SVA）>50mm、骨盆倾斜（PT）>25°或骨盆入射角（PI）减去腰椎前凸（LL）>10°。患者分为三组：L1-3 PSO组、L4-S1 PSO组和FiPSO组。作者在术前、术后及最后一次随访时评估了胸椎后凸、LL、下腰椎前凸（LLL）、PI、PT、骶骨倾斜度、SVA、整体倾斜度（GT）以及整体对线与比例（GAP）评分。还对并发症进行了分析。
最终分析共纳入65例患者：L1-3 PSO组25例，L4-S1 PSO组29例，FiPSO组11例。与L4-S1 PSO组相比，FiPSO组术后LLL显著更大（39.2°±7.7°对29.7°±10.7°，p<0.05），PI-LL不匹配度更小（9.6°±10.3°对24.6°±13.4°，p<0.01）。在最后一次随访时，与L4-S1 PSO组相比，FiPSO组维持了更大的LLL（38.3°±8.9°对27.1°±10.0°，p<0.05）、更低的PT（23.1°±9.9°对33.3°±10.7°，p<0.05）以及良好的整体矢状面排列（SVA，64.0±43.8mm对106.8±55.7mm，p<0.05；GT，28.7°±13.9°对43.5°±15.5°，p<0.05）。FiPSO组神经功能缺损发生率更高（45%），但近端交界性后凸发生率更低（18%），翻修手术率更低（9.1%），低于L1-3或L4-S1 PSO组。然而，这些差异无统计学意义。
FiPSO能有效矫正下腰椎并长期维持矢状面排列，并发症发生率相当，为克服下腰椎PSO相关挑战提供了一个有价值的选择。
