School of Medicine, MD Candidate University of Colorado University of Colorado School of Medicine
Introduction: Pedicle Subtraction Osteotomy (PSO) is a three-column osteotomy used to restore spinal alignment. In rare cases, multiple PSOs may be needed to adequately address deformity, but studies reporting complication rates for multiple-level PSO are limited.
Methods: This retrospective study reviewed patients aged 18-85 who underwent double-level PSO for adult deformity correction at the University of Colorado from 2012 to 2022, with a minimum of three months of follow-up. Data were collected via chart review and analyzed using GraphPad Prism.
Results: Eleven patients underwent single-stage double PSO, while four underwent staged double PSO (two separate operations). In the single-stage group, average blood loss was 2,915 mL, with an average of 4 units of PRBC and 723 mL from cell saver. One death was related to narcotic overdose. Complications included three wound infections, one persistent neurologic deficit, and one deep vein thrombosis (DVT) (9%). Average postoperative alignment parameters were SVA 43 mm, PI 52.6, LL 54, TPA 21.1, and CTPA 4.3 degrees. No reoperations for complications or loss of correction occurred in this group. In the staged double PSO, total blood loss averaged 3,399 mL, with 4.6 units of PRBC and 635 mL from cell saver. No deaths were reported. Two patients (50%) had wound infections requiring return to the OR; no DVT/PE or neurological deficits were observed. Average alignment parameters were SVA 57.5 mm, PI 53.5, LL 59.2, TPA 23.4, and CTPA 5.1 degrees.
Conclusion : While the small sample size may overestimate or underestimate complications, double PSO appears to have similar complication rates to single PSO in literature. The single-stage double PSO achieved more effective correction, with alignment parameters close to normal, whereas the staged PSO resulted in less effective correction.