Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.

Background data: Pedicle subtraction osteotomy is used for treatment of sagittal deformities. It has the advantages of being accomplished completely through a posterior approach. Neurological deficits that accompany the procedure are believed to be the result of a combination of subluxation, residua...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Mohamed wafa, Ahmed El-Badrawi, Fady Michael
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2012
Materias:	pedicle subtraction osteotomy PSO kyphosis sagittal deformity Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/b888c40feb5d4d92baebb784f1f45ac3
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:b888c40feb5d4d92baebb784f1f45ac3
record_format	dspace
spelling	oai:doaj.org-article:b888c40feb5d4d92baebb784f1f45ac32021-12-02T00:39:53ZPartial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.DOI:10.21608/ESJ.2012.37552314-89502314-8969https://doaj.org/article/b888c40feb5d4d92baebb784f1f45ac32012-01-01T00:00:00Zhttp://esj.journals.ekb.eg/article_3755.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background data: Pedicle subtraction osteotomy is used for treatment of sagittal deformities. It has the advantages of being accomplished completely through a posterior approach. Neurological deficits that accompany the procedure are believed to be the result of a combination of subluxation, residual dorsal impingement, and dural buckling. Purpose: To introduce a new modification of the traditional pedicle subtraction osteotomy, in which we perform partial pedicle osteotomy; preserving the inferior third of the pedicle. This allows more smooth correction of the deformity, minimizes the injury or irritation of the nerve root below this pedicle, and decreases the incidence of subluxation and dorsal impingement. Since the correction occurs with theoretically smaller wedges, better closure and union of the osteotomy site is expected. Study design: Our retrospective study included 33 patients with sagittal plan deformity (16 cases of ankylosing spondylitis, 8 cases of old fractures, 5 cases of congenital kyphosis and 4 cases of postlaminectomy kyphosis after cord tumour resection). Methods: All patients were treated by our modifications of the pedicle subtraction osteotomy technique. Radiographic analysis included assessment of kyphosis by regional Cobb angle, and the CV7 sagittal plumb line in pre and post plain radiographs. Clinically, the patients are assessed by the Oswestry functional score. Results: Our series included 23 male and 10 females. The age was of a mean 42.3 years. The vertical plumb line distance from the first sacral segment improved to 3.4 cm compared to a mean of 9.3 preoperatively. The degree of correction for single osteotomy was of a mean of 22.4°. The intervertebral foramen below the osteotomised pedicle showed unchanged vertical dimension after the osteotomy. The complications included 4 cases of dural tears, 1 case of massive bleeding (2500 ml), 3 cases of superficial wound infection, and 1 case developed transient postoperative paraparesis. There was no single case of root injury. The follow-up of the patients was of mean 27.4 months. At the end of follow up, radiologically, there was a loss of correction of mean of 2 degrees with no case of pseudoarthrosis or metal failure. According to Oswestry disability score, 88% of patients were able to return to their normal to moderate daily activities with good self image and overall satisfaction. Conclusion: Although our new technique is technically demanding, it has lower rate of neurological complication with better chances of union than the traditional osteotomy. Mohamed wafaAhmed El-Badrawi Fady MichaelEgyptian Spine Associationarticlepedicle subtraction osteotomyPSOkyphosissagittaldeformityNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 1, Iss 1, Pp 6-12 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	pedicle subtraction osteotomy PSO kyphosis sagittal deformity Neurology. Diseases of the nervous system RC346-429
spellingShingle	pedicle subtraction osteotomy PSO kyphosis sagittal deformity Neurology. Diseases of the nervous system RC346-429 Mohamed wafa Ahmed El-Badrawi Fady Michael Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.
description	Background data: Pedicle subtraction osteotomy is used for treatment of sagittal deformities. It has the advantages of being accomplished completely through a posterior approach. Neurological deficits that accompany the procedure are believed to be the result of a combination of subluxation, residual dorsal impingement, and dural buckling. Purpose: To introduce a new modification of the traditional pedicle subtraction osteotomy, in which we perform partial pedicle osteotomy; preserving the inferior third of the pedicle. This allows more smooth correction of the deformity, minimizes the injury or irritation of the nerve root below this pedicle, and decreases the incidence of subluxation and dorsal impingement. Since the correction occurs with theoretically smaller wedges, better closure and union of the osteotomy site is expected. Study design: Our retrospective study included 33 patients with sagittal plan deformity (16 cases of ankylosing spondylitis, 8 cases of old fractures, 5 cases of congenital kyphosis and 4 cases of postlaminectomy kyphosis after cord tumour resection). Methods: All patients were treated by our modifications of the pedicle subtraction osteotomy technique. Radiographic analysis included assessment of kyphosis by regional Cobb angle, and the CV7 sagittal plumb line in pre and post plain radiographs. Clinically, the patients are assessed by the Oswestry functional score. Results: Our series included 23 male and 10 females. The age was of a mean 42.3 years. The vertical plumb line distance from the first sacral segment improved to 3.4 cm compared to a mean of 9.3 preoperatively. The degree of correction for single osteotomy was of a mean of 22.4°. The intervertebral foramen below the osteotomised pedicle showed unchanged vertical dimension after the osteotomy. The complications included 4 cases of dural tears, 1 case of massive bleeding (2500 ml), 3 cases of superficial wound infection, and 1 case developed transient postoperative paraparesis. There was no single case of root injury. The follow-up of the patients was of mean 27.4 months. At the end of follow up, radiologically, there was a loss of correction of mean of 2 degrees with no case of pseudoarthrosis or metal failure. According to Oswestry disability score, 88% of patients were able to return to their normal to moderate daily activities with good self image and overall satisfaction. Conclusion: Although our new technique is technically demanding, it has lower rate of neurological complication with better chances of union than the traditional osteotomy.
format	article
author	Mohamed wafa Ahmed El-Badrawi Fady Michael
author_facet	Mohamed wafa Ahmed El-Badrawi Fady Michael
author_sort	Mohamed wafa
title	Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.
title_short	Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.
title_full	Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.
title_fullStr	Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.
title_full_unstemmed	Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.
title_sort	partial pedicle subtraction osteotomy (ppso): a modification for pso in treatment of sagittal deformities.
publisher	Egyptian Spine Association
publishDate	2012
url	https://doaj.org/article/b888c40feb5d4d92baebb784f1f45ac3
work_keys_str_mv	AT mohamedwafa partialpediclesubtractionosteotomyppsoamodificationforpsointreatmentofsagittaldeformities AT ahmedelbadrawi partialpediclesubtractionosteotomyppsoamodificationforpsointreatmentofsagittaldeformities AT fadymichael partialpediclesubtractionosteotomyppsoamodificationforpsointreatmentofsagittaldeformities
_version_	1718403578181189632

Partial pedicle subtraction osteotomy (PPSO): A modification for PSO in treatment of sagittal deformities.

Ejemplares similares