Multilevel schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity

Publication date: Available online 11 May 2017
Source:The Spine Journal
Author(s): George M. Ghobrial, Nathan H. Lebwohl, Barth A. Green, Joseph P. Gjolaj
Background contextPrior reports have compared posterior column osteotomies to pedicle subtraction osteotomies in terms of utility for correcting fixed sagittal imbalance in adolescent patients with deformity. No prior reports have described the use of multilevel Smith-Petersen Osteotomies (SPOs) alone for surgical correction in the adult spinal deformity (ASD) population.PurposeTo determine the utility of multilevel Smith-Petersen Osteotomies (SPOs) in the management of global sagittal imbalance in adult spinal deformity (ASD) patients.Study Design/SettingRetrospective Observational Study at a single academic center.Patient Sample85 Adult Spinal Deformity PatientsOutcome Measuresradiographic outcomes cohort study.MethodsThe radiographs of 85 ASD patients were retrospectively evaluated before and after long-segment (>5 spinal levels) fusion and multilevel SPO (≥3 levels) for sagittal imbalance correction. The number of osteotomies, correction in regional lumbar lordosis, and correction per osteotomy was evaluated. Independent predictors of correction per SPO were evaluated with a hierarchical linear regression analysis.Results85 patients (mean age 67.5± 11 years) were identified with ASD (372 SPOs). The mean preoperative SVA and TPA was 8.16 ± 6.75 cm and 25° ± 13.23°, respectively. The mean postoperative CSVL and SVA was 0.67 ± 0.70 cm and 1.29 ± 5.41 cm, respectively. The mean improvement in SVA was 6.29 cm achieved with a correction of approximately 5.05° per SPO. The mean LL restoration was 20.3° ± 13.9° and 33(39%) patients achieved a final PI-LL ≤ 10°. 54(64%) achieved a postoperative PI-LL ≤ 15°, 75(88%) with a PI-LL ≤ 20°, and 85(100%) achieved a PI-LL ≤ 25°. Correction per SPO was similar regardless of prior fusion (4.87° versus 5.72° for revisions, p=0.192). In a subgroup analysis of SVA greater than 10 cm, there was no significant difference in the final LL, TK, PI-LL, SVA, CSVL, and TPA, as compared with SVA < 10 cm. LL was the only independent predictor of osteotomy correction per level (LL: β coefficient= -0.108, CI: -0.141—0.071, p<0.0001).ConclusionsMultilevel SPOs are feasible for restoration of lumbar lordosis as well as sagittal and coronal alignment in the adult spinal deformity population with or without prior instrumented fusion.



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