Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results.
METHODS
A retrospective consecutive case series, radiographic analysis, outcomes analysis, and report on complications.


OBJECTIVE
To evaluate the radiographic and functional outcomes of a reconstructive realignment procedure for fixed sagittal imbalance and discuss the complications.


BACKGROUND
We describe a modification of an existing technique permitting greater single-level correction for which no reports exist in the peer-reviewed literature.


METHODS
Twenty-four patients were eligible for 2-year minimum follow-up (average, 4.0 years). Etiologies included iatrogenic (n = 17), post-traumatic (n = 3), ankylosing spondylitis (n = 2), degenerative (n = 1), and congenital (n = 1). Patients were evaluated by standardized upright radiographs, chart review, and National Spine Network questionnaire.


RESULTS
Seventeen patients had undergone 17 previous procedures. Seven of 24 patients required augmentation with anterior structural grafting. The majority of osteotomies were performed at L3 (15); others included L2 (6), L4 (2), and L5 (1). Lumbar lordosis before surgery averaged 13 degrees (range, 55 degrees to -65 degrees) and improved to 53 degrees (range, 20 degrees to 99 degrees), an average correction of 40%. The sagittal vertical axis measured from C7-S1 demonstrated a preoperative sagittal decompensation averaging 11.4 cm (range, 5.5-23 cm) with correction to 2.4 cm (-9.0 cm or 79% average correction). Coronal balance did not change significantly. There were 17 complications in 14 patients. Nine patients required additional surgery at latest follow-up.


CONCLUSIONS
Transpedicular wedge resection osteotomy procedure is a very effective technique to correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio before undertaking what is a major reconstructive procedure. Most patients are satisfied, particularly when sagittal balance is achieved.
Scoliosis Service, Hospital for Special Surgery, Cornell University Medical School, USA.
Oheneba
O
Boachie-Adjei
John A I
JA
Ferguson
Richard G
RG
Pigeon
Melissa R
MR
Peskin
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008141:Lordosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome