title: Surgical management of coronal and sagittal imbalance of the spine without PSO: a multicentric cohort study on compensated adult degenerative deformities.
abstract: Sagittal imbalance of severe adult degenerative deformities requires surgical correction to improve pain, mobility and quality of life. Our aim was a harmonic and balanced spine, treating a series of adult degenerative thoracolumbar and lumbar kyphoscoliosis by a non posterior subtraction osteotomy technique.
  
  
  
  We operated 22 painful thoracolumbar and lumbar compensated degenerative deformities by anterior (ALIF), extreme lateral (XLIF) and transforaminal (TLIF) interbody fusion and grade 2 osteotomy (SPO) to restore lumbar lordosis and mobilize the coronal curve. Two-stage surgery, first anterior and after 2 or 3 weeks posterior, was proposed when the Oswestry Disability Index (ODI) was equal to or greater than 50% and VAS more than 5. All patients were submitted to X-ray and clinical screening during pre, post-operative and follow-up periods.
  
  
  
  We performed 5 ALIFs, 39 XLIFs, 8 TLIFs, 32 SPOs. No major complications were recorded and complication rate was 18% after lateral fusion and 22.7% after posterior approach. Pelvic tilt, lumbar lordosis, sagittal vertical axis and thoracic kyphosis improved (p < 0.05). Clinical follow-up (mean 20.5; range 18-24) was satisfactory in all cases, except for two due to sacroiliac pain. Mean preoperative VAS was 7.7 (range 6-10), while ODI was 67% on average (range 50-78). After two-stage surgery, VAS and ODI decreased, respectively, to 2.4 (range 2-4) and 31% (range 25-45), while their values were 4 (range 2-6) and 35% (range 20-55) at the final follow-up.
  
  
  
  Current follow-up does not allow definitive conclusions. However, the surgical approach adopted in this study seems promising, improving balance and clinical condition of adult patients with a compensated sagittal degenerative imbalance of the thoracolumbar spine.
authors.affiliation: Orthopaedics, Don Gnocchi Foundation, ONLUS, Milan, Italy. alexramieri@libero.it.|, Via M. Caviglia, 30, Rome, Italy. alexramieri@libero.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ramieri
authors.affiliation: Neurosurgery, S. Andrea Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Miscusi
authors.affiliation: Department Neurology and Psychiatry, Neurosurgery, Sapienza Rome University, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
authors.affiliation: Neurosurgery, S. Andrea Hospital, Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
authors.affiliation: Orthopaedics, Polo Pontino Sapienza Rome University, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costanzo
mesh_terms: D000328:Adult; D006801:Humans; D010027:Osteotomy; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion
keywords: Adult degenerative spine; Interbody fusion; Kyphosis; Osteotomy; Scoliosis