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European Spine Journal

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01-01-2015 | Review Article

Osteotomy of the spine for multifocal deformities

Authors: Ibrahim Obeid, Louis Boissière, Jean-Marc Vital, Anouar Bourghli

Published in: European Spine Journal | Special Issue 1/2015

Abstract

Introduction

When a deformity involves more than one area of the spine, it becomes a multifocal deformity; such a deformity could either be extending on two adjacent segments, or be two separated deformities on two non-adjacent segments.

Materials and methods

The surgical management of multifocal spinal deformities is challenging and must be done through a thorough preoperative planning where spinal and pelvic parameters should accurately be determined. Different strategies should be applied depending on the type of the multifocal deformity, the area involved, the angulation and stiffness of the spine in that area, and the presence of either a pure sagittal malalignment or a combined coronal and sagittal malalignment. This paper discusses these strategies and gives guidelines regarding the use of the different osteotomy techniques depending on each different situation that the deformity spine surgeon may encounter. For instance, where is the ideal level to perform a pedicle subtraction osteotomy (PSO) in a multifocal deformity? How does one take advantage of the remaining high discs to increase the correction without the need for a second PSO? When and where does one perform an asymmetrical PSO? When and where does one perform two PSOs? How does navigation help the spine surgeon to push the surgical limits further in these complex cases?

Conclusion

All these questions about the management of multifocal deformities will be discussed and answered with technical details and concrete examples of the different situations that may be encountered.

Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685PubMedCentralPubMedCrossRef

Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85:454–463PubMed

Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86(Suppl 1):44–50PubMed

Obeid I, Bourghli A, Boissiere L, Vital JM, Barrey C (2014) Complex osteotomies vertebral column resection and decancellation. Eur J Orthop Surg Traumatol 24(Suppl 1):S49–S57PubMedCrossRef

Wang Y, Lenke LG (2011) Vertebral column decancellation for the management of sharp angular spinal deformity. Eur Spine J 20:1703–1710PubMedCentralPubMedCrossRef

Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37:1198–1210CrossRef

Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I et al (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36:E18PubMedCrossRef

Barrey C, Perrin G, Michel F, Vital JM, Obeid I (2014) Pedicle subtraction osteotomy in the lumbar spine: indications, technical aspects, results and complications. Eur J Orthop Surg Traumatol 24(Suppl 1):S21–S30PubMedCrossRef

Elgafy H, Bransford RJ, McGuire RA, Dettori JR, Fischer D (2010) Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine (Phila Pa 1976) 35:S47–S56CrossRef

10.

Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA Jr, Kim YJ et al (2007) Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976) 32:2245–2252CrossRef

11.

Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS et al (2011) Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine 14:184–191PubMedCrossRef

12.

Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353CrossRef

13.

Hovorka I, Rousseau P, Bronsard N, Chalali M, Julia M, Carles M et al (2008) Extension reserve of the hip in relation to the spine: comparative study of two radiographic methods. Rev Chir Orthop Reparatrice Appar Mot 94:771–776PubMedCrossRef

14.

Chang KW, Leng X, Zhao W, Ching-Wei C, Chen TC, Chang KI et al (2011) Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976) 36:E186–E197CrossRef

15.

O’Shaughnessy BA, Kuklo TR, Hsieh PC, Yang BP, Koski TR, Ondra SL (2009) Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity. Spine (Phila Pa 1976) 34:2893–2899CrossRef

16.

Pellise F, Vila-Casademunt A, European Spine Study G (2014) Posterior thoracic osteotomies. Eur J Orthop Surg Traumatol 24(1):S39–S48PubMedCrossRef

17.

Cui G, Wang Y, Kao TH, Zhang Y, Liu Z, Liu B et al (2012) Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976) 37:891–900CrossRef

18.

Ji ML, Qian BP, Qiu Y, Wang B, Zhu ZZ, Yu Y et al (2013) Change of aortic length after closing-opening wedge osteotomy for patients with ankylosing spondylitis with thoracolumbar kyphosis: a computed tomographic study. Spine (Phila Pa 1976) 38:E1361–E1367CrossRef

19.

Zheng GQ, Song K, Zhang YG, Wang Y, Huang P, Zhang XS et al (2014) Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis. Experience with 48 patients. Spine (Phila Pa 1976) 39:1055–1058CrossRef

20.

Chen IH, Chien JT, Yu TC (2001) Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis: experience with 78 patients. Spine (Phila Pa 1976) 26:E354–E360CrossRef

21.

Van Royen BJ, De Gast A, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 9:492–498PubMedCentralPubMedCrossRef

22.

Kim KT, Lee SH, Son ES, Kwack YH, Chun YS, Lee JH (2012) Surgical treatment of “chin-on-pubis” deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies. Spine (Phila Pa 1976) 37:E1017–E1021CrossRef

23.

Boissiere L, Bourghli A, Vital JM, Gille O, Obeid I (2013) The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J 22:1339–1345PubMedCentralPubMedCrossRef

24.

Boissiere L, Vital JM, Aunoble S, Fabre T, Gille O, Obeid I (2014) Lumbo-pelvic related indexes: impact on adult spinal deformity surgery. Eur Spine J. doi:10.1007/s00586-014-3402-z

Title: Osteotomy of the spine for multifocal deformities
Authors: Ibrahim Obeid
Louis Boissière
Jean-Marc Vital
Anouar Bourghli
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 1/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3660-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Osteotomy of the spine for multifocal deformities

Abstract

Introduction

Materials and methods

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Conclusion

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