title: Asymmetrical pedicle subtraction osteotomy for rigid degenerative lumbar kyphoscoliosis.
abstract: METHODS
  A prospectively study.
  
  
  OBJECTIVE
  Our objective was to clarify the safety and efficacy of asymmetrical pedicle subtraction osteotomy (PSO) in the treatment of severe adult lumbar deformities prospectively.
  
  
  BACKGROUND
  Vertebral wedge osteotomy provides good correction of kyphosis but has rarely been applied to degenerative lumbar kyphoscoliosis.
  
  
  METHODS
  A total of 14 patients who had undergone corrective osteotomy were enrolled. The average age at PSO was 67 years (range, 45-76 yr). The minimum follow-up was 2 years. Patient questionnaires were administered prospectively. Radiographical parameters including sagittal and coronal balance were analyzed.
  
  
  RESULTS
  Average operative time was 310 minutes (range, 254-375 min). Average blood loss was 1090 mL (range, 700-2900 mL).Mean preoperative lumbar lordosis improved from -3° to 42° at the final follow-up, and sagittal balance improved from 12 to 3 cm, respectively. Mean lumbar scoliosis improved from 40° to 12°, and coronal offset improved from 3 to 1 cm, respectively. There was also statistically significant improvement from preoperative to final evaluation in all clinical domains. There were 4 complications: 1 dural tear, 2 hook dislodgements at the cephalad side requiring revision instrumentation, and 1 rod breakage not requiring surgical intervention. Overall, all 14 patients were satisfied with their surgical management and would choose to repeat the procedure.
  
  
  CONCLUSIONS
  Our data suggest that the surgical procedure of asymmetrical PSO is to correct the scoliosis, to restore the lumbar lordosis by way of convex-sided posterolateral wedge osteotomy, and may go a long way toward solving the problems of rigid lumbar degenerative kyphoscoliosis.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. tomotomot2001@gmail.com
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Shiboi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ozawa
authors.forename: Kunimasa
authors.initials: K
authors.lastname: Inada
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Shirahata
authors.forename: Koya
authors.initials: K
authors.lastname: Kamikawa
authors.forename: Atsuya
authors.initials: A
authors.lastname: Watanabe
authors.forename: Keisuke
authors.initials: K
authors.lastname: Matsuki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ochiai
authors.forename: Taku
authors.initials: T
authors.lastname: Kaiho
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Morikawa
authors.forename: Kitahara
authors.initials: K
authors.lastname: Sota
authors.forename: Aoki
authors.initials: A
authors.lastname: Yasuchika
authors.forename: Inoue
authors.initials: I
authors.lastname: Gen
authors.forename: Orita
authors.initials: O
authors.lastname: Sumihisa
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Wada
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008141:Lordosis / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D012600:Scoliosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery