TY - JOUR

T1 - Geometric analysis of pedicle subtraction osteotomy (PSO) for Kyphosis correction

T2 - anterior lengthening may occur at the osteotomized body as well as at the discs above and below

AU - Cho, Woojin

AU - Lenke, Lawrence G.

AU - Bridwell, Keith H.

AU - Nessim, Adam

AU - Dorward, Ian G.

AU - Zebala, Lukas P.

AU - Pahys, Joshua M.

AU - Cho, Samuel K.

AU - Kang, Matthew M.

AU - Koester, Linda A.

N1 - Funding Information:
No funds, grants, or other support was received.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2022/9

Y1 - 2022/9

N2 - Objective: To validate the authors kyphosis correction formula for pedicle subtraction osteotomy (PSO) cases. Additionally, to use the formula to evaluate the safety of PSO by determining if there is anterior lengthening. Methods: Twenty-two patients with primarily kyphosis corrected by PSO and with clear landmarks on preoperative and postoperative x-rays were selected. Several anatomical lines and angle measurements were utilized as depicted previously in the Vertebral Column Resection formula (see below). Two approximations were calculated: the geometric approximation (G) = (tanG°*2 + 1)*15° and the rough approximation (R) which is about the same amount of actual shortening (x), if parallel length (y) ≥ 40; twice of x, if y < 40. For each patient, the change of segmental kyphosis angle (K°) was measured and compared with G° and R°, and the correlation between each value was analyzed. Results: The absolute Mean ± SE for K − G and K − R was 2.33° ± 0.34 and 6.09° ± 0.58, respectively. K − G is < 3° (p = 0.03). K − R is < 8° (p = 0.001). In other words, K was close to G and R and thus can be predicted by these approximations. Average posterior shortening, anterior shortening, and kyphosis correction at each level were 20.8 ± 2.0 mm, − 3.64 ± 1.5 mm (which equates to anterior lengthening), and 31.05° ± 2.0, respectively. Anterior lengthening occurred in 13 cases (in 4 cases, both at the body as well as at the disc above and below.) The correlation between posterior and anterior shortening was 0.03 (p = 0.88). There were 3 cage insertion cases: 1 had anterior lengthening, while 2 had anterior shortening even with the cage. Conclusion: This study validated the geometric and rough approximations originally used in PVCR patients, for PSO patients. Additionally, this study found that anterior lengthening may occur in PSOs usually at the discs, but occasionally at the osteotomized body.

AB - Objective: To validate the authors kyphosis correction formula for pedicle subtraction osteotomy (PSO) cases. Additionally, to use the formula to evaluate the safety of PSO by determining if there is anterior lengthening. Methods: Twenty-two patients with primarily kyphosis corrected by PSO and with clear landmarks on preoperative and postoperative x-rays were selected. Several anatomical lines and angle measurements were utilized as depicted previously in the Vertebral Column Resection formula (see below). Two approximations were calculated: the geometric approximation (G) = (tanG°*2 + 1)*15° and the rough approximation (R) which is about the same amount of actual shortening (x), if parallel length (y) ≥ 40; twice of x, if y < 40. For each patient, the change of segmental kyphosis angle (K°) was measured and compared with G° and R°, and the correlation between each value was analyzed. Results: The absolute Mean ± SE for K − G and K − R was 2.33° ± 0.34 and 6.09° ± 0.58, respectively. K − G is < 3° (p = 0.03). K − R is < 8° (p = 0.001). In other words, K was close to G and R and thus can be predicted by these approximations. Average posterior shortening, anterior shortening, and kyphosis correction at each level were 20.8 ± 2.0 mm, − 3.64 ± 1.5 mm (which equates to anterior lengthening), and 31.05° ± 2.0, respectively. Anterior lengthening occurred in 13 cases (in 4 cases, both at the body as well as at the disc above and below.) The correlation between posterior and anterior shortening was 0.03 (p = 0.88). There were 3 cage insertion cases: 1 had anterior lengthening, while 2 had anterior shortening even with the cage. Conclusion: This study validated the geometric and rough approximations originally used in PVCR patients, for PSO patients. Additionally, this study found that anterior lengthening may occur in PSOs usually at the discs, but occasionally at the osteotomized body.

KW - Deformity

KW - Geometric analysis

KW - Pedicle subtraction osteotomy

UR - http://www.scopus.com/inward/record.url?scp=85134357185&partnerID=8YFLogxK

U2 - 10.1007/s00586-022-07312-w

DO - 10.1007/s00586-022-07312-w

M3 - Article

C2 - 35831481

AN - SCOPUS:85134357185

SN - 0940-6719

VL - 31

SP - 2415

EP - 2422

JO - European Spine Journal

JF - European Spine Journal

IS - 9

ER -