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European Spine Journal

, Volume 28, Issue 1, pp 161–169 | Cite as

Possible factors associated with sagittal malalignment recurrence after pedicle subtraction osteotomy

  • David Eichler
  • Yann Philippe CharlesEmail author
  • Florent Baldairon
  • Yves Ntilikina
  • Erik André Sauleau
  • Jean-Paul Steib
Original Article

Abstract

Purpose

This retrospective study investigates sagittal alignment after pedicle subtraction osteotomy (PSO). The purpose was to investigate factors associated with malalignment recurrence.

Methods

Full spine radiographs were analyzed in 66 patients (average age 54.5 years, follow-up 3.8 years). Measurements were taken preoperatively, 3 months postoperatively, at follow-up: SVA C2 and C7, C2–C7 lordosis, T4–T12 kyphosis, L1–S1 lordosis, PSO lordosis, pelvic incidence, pelvic tilt, sacral slope. Follow-up CTs were screened for pseudarthrosis and gas in sacroiliac joints.

Results

PSO lordosis increased from 11.8° to 40.8° (p < 0.0001) and kept stable. Lumbar lordosis increased from 28.6° to 57.7° (p < 0.0001) and decreased to 49.7° (p = 0.0008). Pelvic tilt decreased from 29.2° to 16.5° (p < 0.0001) and increased to 22.5° (p < 0.0001). SVA C7 decreased from 105.1 to 35.5 mm (p < 0.0001) and increased to 64.8 mm (p = 0.0005). Twenty-eight patients (42%) had an SVA C7 increase of more than 70 mm in the postoperative course: recurrence group. These patients were older: 62.8 years versus 52.3 years (p = 0.0031). Loss of lordosis was 11.9° (recurrence group) versus 5.0° (non-recurrence group). Eleven patients (17%) had pseudarthrosis. Pelvic incidence increased by 9.3° (recurrence group) versus 3.8° (non-recurrence group). In 23 patients (35%), pelvic incidence increased > 10°. Gas was evidenced in sacroiliac joints in 22 patients (33%).

Conclusion

Postoperative anterior malalignment recurrence may occur after PSO. Elderly patients were at risk of recurrence. Loss of lumbar lordosis linked to pseudarthrosis represented another factor. With malalignment recurrence, anterior trunk rotation and pelvic retroversion might additionally have augmented moments across sacroiliac joints with subsequent ligament laxity and pelvic incidence increase.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Sagittal balance Thoracolumbar alignment Pedicle subtraction osteotomy Malalignment recurrence Lumbar pseudarthrosis Loss of reduction Sacroiliac joint laxity 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any conflict of interest related to this study.

Supplementary material

586_2018_5767_MOESM1_ESM.pptx (440 kb)
Supplementary material 1 (PPTX 440 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS)Université de StrasbourgStrasbourg CedexFrance
  2. 2.Département de Santé Publique, Hôpitaux Universitaires de StrasbourgUniversité de StrasbourgStrasbourgFrance

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