The techniques actually employed in each case will always depend upon the medical judgment of the surgeon exercised before and during surgery as to the best mode of treatment for each patient. Hinges on anterior column middle and posterior shortened 10 degrees correction. Pso is a valuable surgical procedure in correction of severe. Although most pediatric chance fractures pcfs can be treated successfully with casting and bracing, some pcfs cause progressive spinal deformities requiring surgical treatment.
Cervicothoracic junction pedicle subtraction osteotomy pso offers more controlled closure and greater biomechanical stability but has been infrequently reported in the literature. Pediclesparing transforaminal thoracic spine wedge. Technique for lumbar pedicle subtraction osteotomy for sagittal. Standard and advanced techniques cervical spine research society europe instructional surgical atlas. Pedicle subtraction osteotomies pso in the lumbar spine. Pedicle subtraction osteotomy for the treatment of fixed sagittal. Biomechanical study of rod stress after pedicle subtraction. A retrospective cohort of consecutive patients with prospectively collected data. L5 pedicle subtraction osteotomy for highgrade isthmic. Decisions and expectations with osteotomy surgery for. Learn more about the facility that manufactures our pso instrument sets. He and his colleague, lawrence lenke, md, professor of orthopedic surgery at washington university, have now done more than 60 of these procedures, considered one of the highest. It is not widely used for treatment of thoracic kyphosis. These deformities may have a variety of etiologies, including.
A pso releases the posterior, middle and anterior columns of the spine by resecting the facet joints, pedicles, and a portion of the vertebral body at the apex of a. Initial kyphosis and posterior ligament complex should be evaluated at some point when treating pcfs. Optimizing pedicle subtraction osteotomy techniques. Utilization trends of pedicle subtraction osteotomies. Asymmetrical pedicle subtraction osteotomy for progressive. To evaluate the radiographic, functional outcomes, complications and surgical specificities of l5 pedicle subtraction osteotomy. Correction of a focal kyphotic deformity at times requires performing a pedicle subtraction osteotomy, which is accompanied by loss of pedicles as anchor points at the affected level in addition to significant blood loss. Pedicle reduction osteotomy in the upper cervical spine. Pedicle subtraction osteotomy orthopaedicsone articles. Lumbar pedicle subtraction osteotomy pso is indicated in the. Pedicle subtraction osteotomy pso has been extensively applied for correcting kyphosis of various etiologies. Single level proximal thoracic pedicle subtraction osteotomy for fixed hyperkyphotic deformity. Pedicle subtraction osteotomy in the thoracic spine and. Pedicle subtraction osteotomy pso is the most commonly performed osteotomy to increase lumbar lordosis and gain a balanced spine on the sagittal plane in adults with sagittal imbalance 3, 4.
Pedicle subtraction osteotomy is a welldescribed surgical technique for treatment of kyphotic deformity in the spine. The case for t2 pedicle subtraction osteotomy in the surgical treatment. From may 2010 to may 20, 46 consecutive patients experiencing posttraumatic thoracolumbar kyphosis underwent the technique of onestage pedicle subtraction osteotomy and disc resection with cage placement and longsegment fixation. Since then, the use of pso has expanded, especially in the setting of adult spine deformity asd correction. However, removal of the pedicles a narrow strip of bone that connects the body of the vertebra to. The procedure involves removal of a wedgeshaped segment of vertebra, including the posterior elements and bilateral pedicles, to increase lordosis and recenter the.
Technique of cervicothoracic junction pedicle subtraction. Pedicle subtraction osteotomy pso is a surgical procedure that can be used to help correct fixed sagittal plane deformities. Bridwell kh, lewis sj, lenke lg, baldus c, blanke k. All 3 columns should be bone on bone at the completion. Cervical pedicle subtraction osteotomy for correction of sagittal deformities 12.
These include smithpetersen osteotomy spo, pedicle subtraction osteotomy pso, and vertebral column resection vcr, among others. Pedicle subtraction osteotomy in the revisionversusprimary. Pedicle subtraction osteotomy for the treatment of. Miniopen pedicle subtraction osteotomy as a treatment for severe. The exposed surfaces of the vertebra are compressed and secured using a posterior screwrod fusion. A pedicle subtraction osteotomy pso is a surgical procedure used in adults and children to correct certain deformities of the spine.
Pso is a complex, extensive surgery most often performed in the revision setting. Asymmetrical pedicle subtraction osteotomy can be a useful surgical option when treating rigid kyphoscoliosis associated. To help alleviate these two issues, a novel osteotomy technique for correction of kyphosis using a transforaminal approach to the thoracic vertebral body is described. Ten patients who underwent pso at l5 were eligible for a 2year minimum followup average, 4. Pedicle subtraction osteotomy pso and vertebral column resection vcr procedures provide you with powerful techniques for fixed sagittal deformity correction. These patients presented with severe deformity with a wide range of aetiologies. A novel technique for sublaminarbandassisted closure of pedicle subtraction osteotomy. Indication lumbar pedicle subtraction osteotomy pso is indicated in the treatment of large sagittal more than 25. Pedicle flap definition of pedicle flap by medical.
To evaluate the radiographic, functional outcomes, complications and surgical specificities of l5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. Sagittal imbalance is a spinal deformity with multifactorial etiology, associated with higher risk of low back pain, disability and poor healthrelated quality of life 1, 2. Uncovertebral joint osteotomy anterior riew osteotomy for correction of rigid cervical spine deformity 11. Extended asymmetrical pedicle subtraction osteotomy for adult. Multiple authors have described the technique for pso. The case for t2 pedicle subtraction osteotomy in the. Technique of lowgrade osteotomies for semirigid deformities 10. Pedicle subtraction osteomy pso vertebral column resection vcr unmatched quality and performance we use the highest quality materials and manufacturing technologies to ensure that our surgical instruments meet or exceed stringent quality and performance standards. Please see the instructions for use for the complete list of indications, warnings. We present the first documented series of 28 patients who underwent this procedure in 3 international centers. During a pso, your doctor will remove or subtract a number of bony structures. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance.
To achieve lordosis with the smithpetersen osteotomy, the posterior column is shortened and the anterior column is lengthened. Scoliosis with fixed kyphosis aw painpseutoarthrosis. Cervical pedicle subtraction osteotomy for fixed flexion. Other surgeons in the united states perform pedical subtraction osteotomies, but dr. We designed this set to assist in these technically challenging and highly complex procedures. Demographics, surgery type, osteotomy type smithpetersen spo, pedicle subtraction osteotomy pso, anterior osteotomy ato, operative details and radiographs were collected for preop and. Pedicle subtraction osteotomy pso is a powerful but highrisk surgical technique for destabilizing the spine for deformity correction in both the.
Key tips and pointers from true masters in the field. An alternative to this three stage operation is a single stage pedicle subtraction osteotomy pso. This video discusses the case presentation of a 55yearold woman with forward thrust of the neck and difficulty with horizontal and upward gaze after undergoing c4 through t3 laminectomy and. Obeid i, diebo bg, boissiere l, bourghli a, cawley dt, larrieu d. This study details the cervicothoracic pso technique in 11 cases and correlates clinical kyphosis chinbrow to vertical angle cbva with radiographic measurements. The anterior column is not opened up as in a smithpetersen osteotomy. Pedicle subtraction osteotomy is a technique used to correct sagittal imbalance in the lumbar spine. Pedicle subtraction osteotomy in the lumbar spine youtube. This video demonstrates the surgical technique of thoracic pedicle subtraction osteotomy for the management of fixed sagittal spine deformity. Pedicle subtraction osteotomies pso in the lumbar spine for. Pso are performed to correct sagittal plane deformity.
During a pedicle subtraction osteotomy, the shaded. A pedicle subtraction osteotomy pso is a form of surgical treatment that is used to reverse spinal deformities as the name suggests, osteotomy means to remove bone. The technique of pedicle subtraction osteotomy pso was initially described by thomasen et al. However, the use of asymmetric pso for correcting coronal plane deformities has been inadequately reported in the literature. Merola on being chosen by new york magazine for its prestigious best doctors 2015 list this outstanding guide to spine surgery provides stepbystep instructions to nearly 60 different spinal procedures. Transpedicular threecolumn pediclevertebral body subtraction osteotomy. In this report, we describe a new method for performing pedicle subtraction osteotomy pso via a miniopen surgical approach. Bridwell is recognized as one of the worlds leaders in treating the deformity. Methods from may 2010 to may 20, 46 consecutive patients 24 males, 22 females. However, a more powerful method for restoring sagittal alignment would involve a threecolumn osteotomy. Cervical pedicle subtraction osteotomy was initially described by simmons 1 in 1972 for fixed cervical flexion deformity in ankylosing spondylitis. The surgical technique shown is for illustrative purposes only.
Pedicle subtraction osteotomy is an effective surgical technique for fixed sagittal deformity e. Pedicle subtraction osteotomy, generally performed in the mid lumbar spine, is indicated for the management of degenerative or iatrogenic flatback deformity in which loss of lordosis creates a fixed sagittal imbalance. Transpedicular closed wedge osteotomy in ankylosing spondylitis. Org volume 85a number 3 march 2003 pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance pedicle subtraction osteotomy fig. The posterior elements are removed, and a wedge shaped osteotomy is performed on the anterior column.
Procedure 35 pedicle subtraction osteotomy for fixed sagittal imbalance. A novel technique for sublaminarbandassisted closure of. Surgical technique the patient is placed in prone position on a surgical table that. To compare alignment correction and perioperative complications after pedicle subtraction osteotomies pso in the primary versus revision surgery setting for asd. Pedicle subtraction osteotomy and disc resection with cage. Pedicle subtraction osteotomy the spine hospital at the.
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