L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyph
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ORIGINAL ARTICLE
L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyphosis deformity: a more than 2‑year follow‑up report Hiroki Ushirozako1 · Tomohiko Hasegawa1 · Yu Yamato2 · Go Yoshida1 · Tatsuya Yasuda3 · Tomohiro Banno1 · Hideyuki Arima1 · Shin Oe2 · Yuki Mihara1 · Tomohiro Yamada1 · Koichiro Ide1 · Yuh Watanabe1 · Keichi Nakai1 · Yukihiro Matsuyama1 Received: 27 April 2020 / Revised: 21 August 2020 / Accepted: 26 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose L5 pedicle subtraction osteotomy (PSO) is a demanding technique; thus, PSOs are usually performed at the L3/L4 level to correct the lack of lumbar lordosis. Mid- to long-term improvements in clinical outcomes after L5 PSO are unknown. We aimed to determine the efficacy and safety of L5 PSO for rigid kyphosis deformities. Methods We retrospectively reviewed the records of 57 patients with a rigid kyphosis deformity (mean age: 68 years) who underwent extensive corrective surgery incorporating PSO with a > 2-year follow-up. Radiographic parameters, postoperative complication rates, and the Oswestry Disability Index (ODI) scores were compared in the L5, L4, and L1-3 PSO groups preoperatively and at 1, 2, and 5 years postoperatively. Results There were 12, 25, and 20 patients in the L5, L4, and L1-3 PSO groups, respectively. Significant between-group differences were found in preoperative L4–S1 lordosis (L5:L4:L1-3 PSO groups = − 8.9°:8.9°:16.2°, P 20° in the coronal plane, C7 sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, and T5–T12 thoracic kyphosis (TK) > 60°. Altogether, 39 patients (68%) were followed-up over 5 years.
Variables, data sources, and bias Patient characteristics and medical and demographic details were obtained from medical records. Age, sex, body mass index, alcohol intake, smoking status, American Society of Anesthesiologists classification, presence of two-stage surgery, upper instrumented vertebra, number of fused vertebral segments, screw insertions, rods, posterior lumbar interbody fusion, length of surgery, and estimated blood loss (EBL) were recorded. We defined upper instrumented vertebra (UIV) levels as follows: T1 vertebral body = 1, T2 = 2, and T3 = 3…T12 = 12. The measured radiographic parameters were cervical lordosis (CL); TK; L1–S1 LL, and L4–S1 lordosis (in L4 PSO cases, the L4–S1 lordosis was measured between L3 caudal and S1 cranial endplates); sacral slope (SS); PT; pelvic incidence (PI); T1 slope; C7 sagittal vertical axis (SVA); T1 pelvic angle (TPA); proximal junctional sagittal angle; C7 plumb line and centre sacral vertical line (C7-CSVL); and Cobb angle preoperatively and at 6 months, 1, 2, and 5 years postoperatively. We evaluated in-hospital perioperative complications, including postoperative motor deficit, major vessel injury, surgical site infection (SSI), pneumonia, urinary tract infection, cardiac complications, postoperative haematoma, deep venous thrombosis (DVT),
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