Risk Factors for and Assessment of Symptomatic Pseudarthrosis After Lumbar Pedicle Subtraction Osteotomy in Adult Spinal Deformity
| Autor: | Lawrence G. Lenke, Keith H. Bridwell, Douglas D. Dickson, Linda A. Koester |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Sacrum medicine.medical_specialty Time Factors Adolescent Decompression medicine.medical_treatment Bone Screws Scoliosis Osteotomy Thoracic Vertebrae Disability Evaluation Young Adult Postoperative Complications Lumbar Risk Factors medicine Humans Orthopedics and Sports Medicine Aged Retrospective Studies Lumbar Vertebrae business.industry Lumbosacral Region Middle Aged medicine.disease Sagittal plane Surgery Oswestry Disability Index Pseudarthrosis Treatment Outcome medicine.anatomical_structure Female Spinal Diseases Neurology (clinical) Radiology business Lumbosacral joint Follow-Up Studies |
| Zdroj: | Spine. 39:1190-1195 |
| ISSN: | 0362-2436 |
| DOI: | 10.1097/brs.0000000000000380 |
| Popis: | STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To assess the prevalence, risk factors, and clinical outcomes for pseudarthrosis after a lumbar pedicle subtraction osteotomy (PSO). SUMMARY OF BACKGROUND DATA There exists no large series that examines pseudarthrosis rates of PSOs. METHODS Data of 171 consecutive patients with adult deformity who underwent a lumbar PSO by 2 surgeons at a single institution with a minimum 2-year follow-up were analyzed. Pseudarthrosis diagnosed through sagittal malalignment and instrumentation failure noted on radiograph was confirmed intraoperatively. RESULTS Eighteen (10.5%) of 171 patients developed pseudarthrosis after a PSO. Eleven of the 18 patients (6.4% of all patients, 61.1% of the 18 patients with pseudarthrosis) had pseudarthrosis at the PSO site, L3 being the most common; other locations included the lumbosacral junction (4/18), thoracolumbar junction (2/18), and upper thoracic spine (1/18). Preoperative pseudarthrosis level was a predictor of the postoperative level of pseudarthrosis (93%). Fifteen of the 18 patients (83%) had no interbody fusion directly above or below the PSO site, 16 (88%) had a history of pseudarthrosis at the time of PSO surgery and 2 of 3 patients who had prior radiation to the lumbar region developed pseudarthrosis. Most pseudarthroses occurred within the first 2 years (n = 13/18), between 2 and 5 years (n = 3/18), and more than 5 years (n = 2/18) postoperatively. Prior pseudarthrosis (P < 0.0001), pseudarthrosis at the PSO site (P < 0.0001), prior decompression in the lumbar region (P = 0.0037), prior radiation to the lumbar region (P < 0.0001), and presence of inflammatory/neurological disorders (P < 0.0036) were identified as risk factors. All 18 patients with pseudarthroses required revision surgery (posterior-only surgery, n = 12; anteroposterior surgery, n = 6) due to loss of sagittal alignment and pain. The mean pre-revision Scoliosis Research Society score was 85, post-revision score was 95 (P = 0.0166), and the mean pre-revision Oswestry Disability Index score was 42.5, post-revision score was 34.5 (P = 0.0203). CONCLUSION The overall prevalence of pseudarthrosis was 10.5% of which 61% occurred at the actual PSO site and Scoliosis Research Society and Oswestry Disability Index scores improved significantly after pseudarthrosis repair. LEVEL OF EVIDENCE 4. |
| Databáze: | OpenAIRE |
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