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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Research article

Effectiveness of a two-stage posterior-anterior–posterior surgery using subcutaneously preserved autologous bone grafts for adult spinal deformity: a retrospective observational study

Authors: Atsushi Kimura, Yasuyuki Shiraishi, Hideaki Sawamura, Hirokazu Inoue, Katsushi Takeshita

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

To achieve optimal correction of rigid kyphoscoliosis, we developed a novel two-stage posterior-anterior–posterior (PAP) surgery using subcutaneously preserved autologous bone grafts. This study aimed to investigate the effectiveness of two-stage PAP surgery versus single-stage anterior–posterior (AP) surgery.

Methods

This was a retrospective analysis of patients undergoing combined anterior–posterior long-level fusion for adult spinal deformity (ASD) with a minimum 2-year follow-up. The indications for two-stage PAP surgery were rigid thoracolumbar deformity associated with hypertrophic facet arthritis and/or a large pelvic incidence–lumbar lordosis mismatch of > 25°. In the first stage of PAP surgery, pedicle screw insertion and multilevel Ponte osteotomies were performed. The resected local bone was embedded under sutured fascia. One week later, the embedded bone was retrieved in the right lateral position and used as an autograft for lateral lumbar interbody fusion. Final deformity correction was performed in the prone position.

Results

From January 2018 to April 2021, 12 and 16 patients with ASD underwent two-stage PAP surgery (PAP group) and single-stage AP surgery (AP group), respectively. Although PAP surgery was associated with a significantly longer operation time, the total blood loss volume was significantly less in the PAP group than the AP group. Compared with the AP group, the PAP group showed significantly larger postoperative changes in radiological parameters in the sagittal and coronal planes. The overall complication rate did not differ significantly between the two groups.

Conclusion

Two-stage PAP surgery provided effective correction of rigid kyphoscoliosis without increasing blood loss and postoperative complication rates.

Youssef JA, Orndorff DO, Patty CA, Scott MA, Price HL, Hamlin LF, Williams TL, Uribe JS, Deviren V. Current status of adult spinal deformity. Global Spine J. 2013;3:51–62.CrossRefPubMed

Beschloss A, Dicindio C, Lombardi J, Varthi A, Ozturk A, Lehman R, Lenke L, Saifi C. Marked increase in spinal deformity surgery throughout the United States. Spine (Phila Pa 1976). 2021;2021(46):1402–8.CrossRef

Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa1976). 2010;35:2224–31.CrossRef

Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V. Scoliosis research society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37:1077–82.CrossRefPubMed

Enercan M, Ozturk C, Kahraman S, Sarier M, Hamzaoglu A, Alanay A. Osteotomies/spinal column resections in adult deformity. Eur Spine J. 2013;22(Suppl 2):S254-264.CrossRefPubMed

Haddad S, Vila-Casademunt A, Yilgor C, Nunez-Pereira S, Ramirez M, Pizones J, Alanay A, Kleinstuck F, Obeid I, Perez-Grueso FJS, Pellise F. European Spine Study. Combined anterior-posterior versus all-posterior approaches for adult spinal deformity correction: a matched control study. Eur Spine J. 2022;31:1754–64.CrossRefPubMed

Yamato Y, Hasegawa T, Yoshida G, Yasuda T, Banno T, Oe S, Arima H, Mihara Y, Ushirozako H, Yamada T, Ide K, Watanabe Y, Matsuyama Y. Planned two-stage surgery using lateral lumbar interbody fusion and posterior corrective fusion: a retrospective study of perioperative complications. Eur Spine J. 2021;30:2368–76.CrossRefPubMed

Bae J, Theologis AA, Strom R, Tay B, Burch S, Berven S, Mummaneni PV, Chou D, Ames CP, Deviren V. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine. 2018;28:40–9.CrossRefPubMed

Hiyama A, Katoh H, Sakai D, Sato M, Tanaka M, Nukaga T, Watanabe M. Changes in spinal alignment following extreme lateral interbody fusion alone in patients with adult spinal deformity using computed tomography. Sci Rep. 2019;9:12039.CrossRefPubMedPubMedCentral

10.

Kim HJ, Iyer S. Proximal junctional kyphosis. J Am Acad Orthop Surg. 2016;24:318–26.CrossRefPubMed

11.

Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am. 2003;85:2089–92.CrossRefPubMed

12.

Scheer JK, Lafage R, Schwab FJ, Liabaud B, Smith JS, Mundis GM, Hostin R, Shaffrey CI, Burton DC, Hart RA, Kim HJ, Bess S, Gupta M, Lafage V, Ames CP. International Spine Study G. Under correction of sagittal deformities based on age-adjusted alignment thresholds leads to worse health-related quality of life whereas over correction provides no additional benefit. Spine (Phila Pa 1976). 2018;43:388–93.CrossRefPubMed

13.

Yu HH, Asuma MP, Wallace CS, Kelly MP, Kang DG. Should surgery for adult degenerative lumbar deformity be staged? Clin Spine Surg. 2019;32:269–71.CrossRefPubMed

14.

Rhee JM, Bridwell KH, Lenke LG, Baldus C, Blanke K, Edwards C, Berra A. Staged posterior surgery for severe adult spinal deformity. Spine (Phila Pa 1976). 2003;28:2116–21.CrossRefPubMed

15.

Spivak JM, Neuwirth MG, Giordano CP, Bloom N. The perioperative course of combined anterior and posterior spinal fusion. Spine (Phila Pa 1976). 1994;19:520–5.CrossRefPubMed

16.

Passias PG, Ma Y, Chiu YL, Mazumdar M, Girardi FP, Memtsoudis SG. Comparative safety of simultaneous and staged anterior and posterior spinal surgery. Spine (Phila Pa 1976). 2012;37:247–55.CrossRefPubMed

17.

Mitrophanov AY, Szlam F, Sniecinski RM, Levy JH, Reifman J. Controlled multifactorial coagulopathy: effects of dilution, hypothermia, and acidosis on thrombin generation in vitro. Anesth Analg. 2020;130:1063–76.CrossRefPubMed

18.

Aebi M. The adult scoliosis. Eur Spine J. 2005;14:925–48.CrossRefPubMed

19.

Kim YH, Ha KY, Kim KT, Chang DG, Park HY, Yoon EJ, Kim SI. Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion. Sci Rep. 2021;11:20149.CrossRefPubMedPubMedCentral

20.

Satake K, Kanemura T, Yamaguchi H, Segi N, Ouchida J. Predisposing factors for intraoperative endplate injury of extreme lateral interbody fusion. Asian Spine J. 2016;10:907–14.CrossRefPubMedPubMedCentral

21.

Schwartz CE, Martha JF, Kowalski P, Wang DA, Bode R, Li L, Kim DH. Prospective evaluation of chronic pain associated with posterior autologous iliac crest bone graft harvest and its effect on postoperative outcome. Health Qual Life Outcomes. 2009;7:49.CrossRefPubMedPubMedCentral

22.

Buser Z, Brodke DS, Youssef JA, Meisel HJ, Myhre SL, Hashimoto R, Park JB, Tim Yoon S, Wang JC. Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review. J Neurosurg Spine. 2016;25:509–16.CrossRefPubMed

23.

Singla N, Parkinson Singh S, Gupta SK, Karthigeyan M, Radotra BD. Histopathology of subcutaneously preserved autologous bone flap after decompressive craniectomy: a prospective study. Acta Neurochir (Wien). 2014;156:1369–73.CrossRefPubMed

24.

Baldo S, Tacconi L. Effectiveness and safety of subcutaneous abdominal preservation of autologous bone flap after decompressive craniectomy: a prospective pilot study. World Neurosurg. 2010;73:552–6.CrossRefPubMed

Title: Effectiveness of a two-stage posterior-anterior–posterior surgery using subcutaneously preserved autologous bone grafts for adult spinal deformity: a retrospective observational study
Authors: Atsushi Kimura
Yasuyuki Shiraishi
Hideaki Sawamura
Hirokazu Inoue
Katsushi Takeshita
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04572-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of a two-stage posterior-anterior–posterior surgery using subcutaneously preserved autologous bone grafts for adult spinal deformity: a retrospective observational study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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