title: Pedicle Subtraction Osteotomy in the Revision Versus Primary Adult Spinal Deformity Patient: Is There a Difference in Correction and Complications?
abstract: METHODS
  Multicenter, prospective study of consecutive adult spinal deformity (ASD) patients.
  
  
  OBJECTIVE
  To compare alignment correction and perioperative complications after pedicle subtraction osteotomies (PSO) in the primary versus revision surgery setting for ASD.
  
  
  BACKGROUND
  PSO are performed to correct sagittal plane deformity; however, these are difficult procedures that have potential for large blood loss and risk for intraoperative and postoperative complications.
  
  
  METHODS
  Inclusion criteria were age at least 18 years, lumbar PSO, and available data on perioperative (up to 6 weeks after surgery) complication data. Patients were classified according to SRS-Schwab sagittal modifiers: PT (pelvic tilt), SVA (sagittal vertical axis), and lumbo-pelvic mismatch (pelvic incidence-lumbar lordosis). Patients were divided into primary (P; no previous spine fusion surgery) or revision (R; previous fusion). Baseline and 1-year demographic, radiographic parameters, complications and revision rates were analyzed.
  
  
  RESULTS
  A total of 421 patients were included. P (n = 70) and R (n = 351) were similar for age, body mass index, sex, mean total Posterior Spinal Fusion (PSF) levels (P = 10.0; R = 10.5), PSO angle (P = 27°; R = 25°), estimated blood loss (P = 2.76L; R = 2.92L), and operative time (P = 437 min; R = 434 min). The most common osteotomy site was L3 for both primary (31.8%) and revision groups (43.6%). Both groups demonstrated improvement in sagittal spinopelvic parameters from baseline to 1 year, with similar changes in sagittal modifiers except for the pelvic mismatch that improved to a grade 0 (i.e., less than 10°) more often for primary PSO group (83%) than revision PSO group (57%; P = 0.004). Complication rates were similar (P > 0.05) for the following: new motor deficit (P = 4.2%, R = 9.4%), bowel/bladder deficit (P = 1.4%, R = 2.8%), 1-year revision rate (P = 4.3%, R = 7.4%), and pseudarthrosis rate (P = 1.4%; R = 2.5%; P < 0.05).
  
  
  CONCLUSIONS
  PSO may be performed in primary or revision ASD patient with similar sagittal deformity correction and similar complication rates; however, primary PSO patients were more likely to achieve better lumbo-pelvic mismatch correction.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, Washington University, St. Louis, MO†Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY‡San Diego Center for Spinal Disorders, La Jolla, CA§Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA¶Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY||Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, CO**Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX††Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS‡‡Department of Neurosurgery, University of California, San Francisco Medical Center, San Francisco, CA§§Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD¶¶ISSGF, Littleton, CO.
authors.forename: Munish C
authors.initials: MC
authors.lastname: Gupta
authors.forename: Emmanuelle
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authors.lastname: Ferrero
authors.forename: Gregory
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authors.lastname: Mundis
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Frank
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authors.lastname: Schwab
authors.forename: Han Jo
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authors.forename: Oheneba
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authors.lastname: Boachie-Adjei
authors.forename: Virginie
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authors.lastname: Lafage
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authors.forename: Richard
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authors.initials: CP
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authors.forename: Eric
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authors.lastname: Klineberg
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods