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European Spine Journal
Published in: European Spine Journal 1/2015

01-01-2015 | Original Article

Osteotomies through a fusion mass in the lumbar spine

Authors: Jean-Marc Vital, Louis Boissière, Anouar Bourghli, Jean-Etienne Castelain, Vincent Challier, Ibrahim Obeid

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

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Abstract

Introduction

Flat-back syndrome is one of the main causes of surgical failure after lumbar fusion and can lead to a revision surgery to correct it. Three-column pedicle subtraction osteotomy is an efficient technique to restore lumbar lordosis (LL) for fixed sagittal malalignment. The fusion mass stemming from the past surgeries makes the procedure demanding as most anatomical landmarks are missing.

Material and methods

This review article will focus on the correction of this lack of LL through the fusion mass. We will successively review the preoperative management, the surgical specificities, and various types of clinical cases that can be encountered in flat-back syndromes.

Conclusion

PSO in the fixed fusion mass is technically demanding. Preoperative CT-scan and preoperative navigation allow us to push the limits when anatomical landmarks disappear. Bleeding and neurologic are the two major complications feared by the surgeon. The best way to avoid these revision surgeries is to restore a proper lumbar lordosis at the time of initial surgery by considering lumbo-pelvic indexes.
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Metadata
Title
Osteotomies through a fusion mass in the lumbar spine
Authors
Jean-Marc Vital
Louis Boissière
Anouar Bourghli
Jean-Etienne Castelain
Vincent Challier
Ibrahim Obeid
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/s00586-014-3657-4

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