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01-03-2018 | Original Article

L5 pedicle subtraction osteotomy: indication, surgical technique and specificities

Authors: Abdulmajeed Alzakri, Louis Boissière, Derek T. Cawley, Anouar Bourghli, Vincent Pointillart, Olivier Gille, Jean-Marc Vital, Ibrahim Obeid

Published in: European Spine Journal | Issue 3/2018

Abstract

Purpose

To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment.

Methods

A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected.

Results

All surgeries were revision surgeries. The mean lumbar lordosis before surgery was − 22.5° (range, 8° to − 33°) and improved to − 58.5° (range, − 40° to − 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage.

Conclusions

PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.

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Title: L5 pedicle subtraction osteotomy: indication, surgical technique and specificities
Authors: Abdulmajeed Alzakri
Louis Boissière
Derek T. Cawley
Anouar Bourghli
Vincent Pointillart
Olivier Gille
Jean-Marc Vital
Ibrahim Obeid
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 3/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5403-1

At a glance: The STEP trials

Springer Medicine

L5 pedicle subtraction osteotomy: indication, surgical technique and specificities

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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