Medical Student Jacobs School of Medicine and Biomedical Sciences
Disclosure(s):
Emily K. Vallee, B.S.: No financial relationships to disclose
Introduction: Pedicle subtraction osteotomy (PSO) is a useful surgical intervention in the correction of fixed sagittal deformity. The purpose of this study is to present a detailed analysis of postoperative clinical and radiographic outcomes of patients who underwent proximal thoracic PSO for adult spinal deformity.
Methods: A retrospective chart review was performed on 19 patients who underwent proximal thoracic (T2-T4) PSO between January 2018 and December 2021. Baseline patient characteristics, 30-day complications and radiographic outcomes were collected. Radiographic outcomes including thoracic kyphosis correction, overall segment correction, and global sagittal balance correction were measured using preoperative and postoperative radiographs.
Results: 19 patients with an average age of 66.9 ± 8.3 years underwent thoracic PSO, with 94.7% (n=18) females. All patients who underwent proximal thoracic PSO were in the setting of revision surgery. The mean thoracic kyphosis correction was 20.4 ± 8.5°. Overall segmental correction had a mean of 16.2 ± 3.9°. Global sagittal balance correction was an average of 13.9 ± 23.2 millimeters (mm). The median hospital stay was 4.0 (IQR: 3.0) days with a median of 1.0 (IQR: 2.0) days in the intensive care unit (ICU). 36.8% (n=7) of patients had a major complication within 30 days: proximal junction kyphosis (2), neurologic deficits (2), pneumonia (1), cardiopulmonary (1), death (1), Within two years of index procedure, 47.4% (n=9) of patients had a major complication: proximal junctional kyphosis (5), neurologic deficits (2), wound dehiscence/infection (1), pneumonia (1), cardiopulmonary (1), death (2),. Average follow up was 571 days, with the shortest follow up being 32 days.
Conclusion : Although thoracic PSO can achieve successful radiographic and clinical outcomes, it can also be associated with significant complications, including instrumentation/junctional failure and neurologic deficits.