title: A pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report.
abstract: BACKGROUND
  A pedicle subtraction osteotomy can be considered as part of the surgical treatment of a symptomatic sagittal imbalance. The literature on the use of this technique is limited and thus far not applied to a rigid thoracolumbar hyperkyphosis.
  
  
  OBJECTIVE
  To evaluate our preliminary results of a pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of thoracolumbar kyphotic deformities.
  
  
  METHODS
  Case series
  
  
  METHODS
  Eleven patients with a symptomatic kyphotic deformity were treated with a thoracolumbar pedicle subtraction osteotomy in combination with a multilevel correction. The mean follow-up was 42.8 months (range 26-105). The clinical outcome, radiographic correction, and perioperative complications were analyzed. The results in six more traditional indications (ankylosing spondylitis, kyphoscoliosis, congenital and posttraumatic deformity), were compared with the results in a subgroup of five cases with a rigid thoracolumbar hyperkyphosis.
  
  
  RESULTS
  All patients had a kyphotic thoracolumbar junction. An average of 5.8 levels was involved in the corrective fusion. A pedicle subtraction was always performed between the level Th10 and L2 to correct the sagittal balance. A lordotic correction of 38.8 (range 25-49) degrees was established with this fusion. The osteotomy contributed 66% (26.9 degrees) of the correction, whereas the remaining correction came from multilevel facetectomies. The visual analogue scale for both pain and impairment improved significantly (p<.005) for the entire group. Statistical analysis on the results for both subgroups separately was inappropriate because of the small number of patients available; however, overall both subgroups appeared to do equally well. All patients were very satisfied with the result and would choose surgical treatment again. No major complications were encountered.
  
  
  CONCLUSIONS
  A pedicle subtraction osteotomy is a technically demanding but well tolerated operative procedure for the correction of a kyphotic deformity. This technique can also be considered as an adjunctive tool in the surgical treatment of a rigid thoracolumbar (Scheuermann's) kyphosis.
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, Postbus 9555, 6800 TA, Arnhem, Netherlands.
authors.forename: Piet J M
authors.initials: PJ
authors.lastname: van Loon
authors.forename: Gijs
authors.initials: G
authors.lastname: van Stralen
authors.forename: Corne J M
authors.initials: CJ
authors.lastname: van Loon
authors.forename: Job L C
authors.initials: JL
authors.lastname: van Susante
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008141:Lordosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010865:Pilot Projects; D011183:Postoperative Complications; D011859:Radiography; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome