title: Pedicle subtraction osteotomy in the thoracic spine and thoracolumbar junction: a retrospective series of 28 cases.
abstract: OBJECTIVE
  Pedicle subtraction osteotomy is a well-described surgical technique for treatment of kyphotic deformity in the spine. It is not widely used for treatment of thoracic kyphosis. We present the first documented series of 28 patients who underwent this procedure in 3 international centers. These patients presented with severe deformity with a wide range of aetiologies.
  
  
  METHODS
  Kyphosis larger than 70 degrees, which is demonstrably rigid based on dynamic imaging.
  
  
  METHODS
  28 patients underwent surgery following pre-op neurological and radiographic assessment to fully assess the deformity. A triangular osteotomy was carried out using intraoperative navigation techniques. The patients were assessed post-operatively again with clinical and radiographic parameters at regular follow-up.
  
  
  RESULTS
  The mean ODI score after surgery was 24.7 (16-42) while the pre-op was 53.4 (38-76). Mean thoracic kyphosis was improved from 64.2° (±20.1°) to 41.1° (±17.4°) resulting in a mean sagittal correction of 23.1°. Mean segmental correction at the PSO for all 28 cases was 17.8° (±8.1°). Stratified by region we found different values for the PSO correction: between T1 and T5 (6 cases) it was 17.5° (±5.4°) and between T6 and T9 (4 cases) 18.2° (±4.7°) and between T10 and L1 (18 cases) 26.2° (±5.2°). FBI index was 22.3° pre-op and improved to 7.8° post-op. Calculations were performed with Microsoft excel (2011 Microsoft, Redmond, WA).
  
  
  CONCLUSIONS
  Global sagittal balance was statistically improved in this series as demonstrated by FBI and C7 SVA correction.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Faundez
authors.forename: F
authors.initials: F
authors.lastname: Byrne
authors.forename: C
authors.initials: C
authors.lastname: Sylvestre
authors.forename: V
authors.initials: V
authors.lastname: Lafage
authors.forename: A
authors.initials: A
authors.lastname: Cogniet
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Le Huec
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D064232:Visual Analog Scale