Acute Reciprocal Changes Distant from the Site of Spinal Osteotomies Affect Global Postoperative Alignment

Author:

Klineberg Eric1,Schwab Frank2,Ames Christopher3,Hostin Richard4,Bess Shay5,Smith Justin S.6,Gupta Munish C.1,Boachie Oheneba7,Hart Robert A.8,Akbarnia Behrooz A.9,Burton Douglas C.10,Lafage Virginie2

Affiliation:

1. Department of Orthopaedic Surgery, University of California-Davis, 3301 C Street, Suite 1500, Sacramento, CA 95817, USA

2. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 306E 15th Street, New York, NY 10003, USA

3. Department of Neurosurgery, University of California San Francisco, 400 Parnassus Street, San Francisco, CA 94143-0112, USA

4. Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Boulevard, Suite 810, Plano, TX 75093, USA

5. Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA

6. Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA 22908-0212, USA

7. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA

8. Department of Orthopaedic Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA

9. San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr., Suite 300, CA 92037-1481, USA

10. Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7387, USA

Abstract

Introduction. Three-column vertebral resections are frequently applied to correct sagittal malalignment; their effects on distant unfused levels need to be understood.Methods. 134 consecutive adult PSO patients were included (29 thoracic, 105 lumbar). Radiographic analysis included pre- and postoperative regional curvatures and pelvic parameters, with paired independentt-tests to evaluate changes.Results. A thoracic osteotomy with limited fusion leads to a correction of the kyphosis and to a spontaneous decrease of the unfused lumbar lordosis (−8°). When the fusion was extended, the lumbar lordosis increased (+8°). A lumbar osteotomy with limited fusion leads to a correction of the lumbar lordosis and to a spontaneous increase of the unfused thoracic kyphosis (+13°). When the fusion was extended, the thoracic kyphosis increased by 6°.Conclusion. Data from this study suggest that lumbar and thoracic resection leads to reciprocal changes in unfused segments and requires consideration beyond focal corrections.

Publisher

Hindawi Limited

Subject

Orthopedics and Sports Medicine

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