Modified pedicle subtraction osteotomy for osteoporotic. Nov 16, 2007 spinal osteotomy codes top the list of neurosurgery changes published on fri nov 16, 2007 graft and instrumentation descriptors gain new language cpt 2008 will bring relatively few changes directed specifically at neurosurgery practice, but among them are three exciting new codes for spinal osteotomy procedures. Object thoracolumbar fractures, treated operatively or nonoperatively, may cause painful kyphotic deformities over time. Aug 01, 2016 thoracic pedicle subtraction osteotomy for fixed sagittal deformity newyorkortho. Learn more about the facility that manufactures our pso instrument sets. The purpose of this video is to present the surgical technique of a thoracic pedicle subtraction osteotomy pso for fixed sagittal spine deformity. Do you need a pedicle subtraction osteotomy pso to correct an abnormal curvature of the spine. Pdf changes in thoracic kyphosis negatively impact. For patient 1, we employed stealth navigation medtronic, minneapolis, mn, usa using the oarm intraoperative ct scanner because she had a large fusion mass obliterating all anatomic landmarks. A pedicle subtraction osteotomy pso is a singlestage posterior procedure designed to correct sagittal plane deformity. Pedicle subtraction osteotomy neurosurgery oxford academic. Spinal osteotomy codes top the list of neurosurgery.
Vertebral column resection osteotomy has been widely used in the surgical correction of fixed spinal deformity. Pdf pedicle subtraction osteotomy in the treatment of. Posterior vertebral column subtraction osteotomy for the. For both patients, we planned for a pso through the compression fractures because these were the apices of the kyphoses. Although it was initially used to treat nontraumatic conditions, a pso can be highly effective in chronic, posttraumatic fractures of the lumbar spine. Apr 01, 2006 after consulting with top spinal experts on the east coast, the recommendation was that sullivan undergo a procedure called a pedical subtraction osteotomy. Pedicle subtraction osteotomy ibrahim obeid on vimeo. Pedicle subtraction osteotomy for the treatment of fixed. Indications discuss indications and more general concerns. The technique involves a transpedicular vertebral wedge resection extending from the posterior elements. A case report wamae d, orwotho n, nyati m abstract introduction pedicle subtraction osteotomy pso is an effective tool for the correction of fixed sagittal. Nov 16, 20 the pedicle subtraction osteotomy pso is typically performed at l3 as these vertebrae are the normal apex of lumbar lordosis. Pedicle subtraction osteotomy, generally performed in the mid lumbar spine, is indicated for the management of degenerative or iatrogenic flatback deformity in which loss of lordosis creates a fixed sagittal imbalance. The longterm overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.
This is pedicle subtraction osteotomy ibrahim obeid by icv bordeaux on vimeo, the home for high quality videos and the people who love them. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. These deformities may have a variety of etiologies, including. Keywords spinal imbalance 4 posterior wedge osteotomy 4 subtraction osteotomy 4 calculation. Thoracolumbar imbalance analysis for osteotomy planification using. Pedicle subtraction osteotomy in the revisionversusprimary a.
Sidetoside curvature visible from behind is known as scoliosis. S1 pedicle subtraction osteotomy for fixed sagittal imbalance. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Biomechanical analysis of revision strategies for rod fracture in pedicle subtraction osteotomy. Despite complications, patient satisfaction after pso has been reported to be greater than 90%. It is also safer to perform the osteotomy at one of these levels, as they are caudad to the conus medullaris. The technique involves a transpedicular vertebral wedge resection extending from the posterior elements through the pedicles and into the. Cervical pedicle subtraction osteotomy was initially described by simmons 1 in 1972 for fixed cervical flexion deformity in ankylosing spondylitis. Bridwell washington university school of medicine in st. The utilization trends of pedicle subtraction osteotomy pso for sagittal plane correction in spinal deformity surgery have not been well characterized. However, removal of the pedicles a narrow strip of bone that connects the body of the vertebra to.
Review of the literature and clinical outcomes of all cases reported to date. Changes in thoracic kyphosis negatively impact sagittal alignment following lumbar pedicle subtraction osteotomy. Spinal pedicle subtraction osteotomy for fixed sagittal imbalance. The narrow correlation between sagittal alignment parameters and clinical outcomes has been widely established, demonstrating that improper sagittal alignment is a clinical condition that is associated with increased pain and limitations in patients functional ability. A pedicle subtraction osteotomy pso is a surgical procedure used in adults and children to. In this report, we describe a new method for performing pedicle subtraction osteotomy pso via a miniopen surgical approach. An osteotomy is a surgical procedure that involves dividing a bone at a selected site to create an artificial fracture, and fixing it in a corrected position. Pedicle subtraction osteotomy are the complications too morbid. Utilization trends of pedicle subtraction osteotomies. It is used to correct axial and torsion deformities and length discrepancies in the lower limbs. Nov 29, 2017 to evaluate the radiographic, functional outcomes, complications and surgical specificities of l5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome. Each specimen was tested in the following sequential configurations. Thoracic pedicle subtraction osteotomy for fixed sagittal.
Pdf biomechanical analysis of revision strategies for. Pedicle subtraction osteotomy pso is a surgical procedure that can be used to help correct fixed sagittal plane deformities. Pdf pedicle subtraction osteotomies pso in the lumbar. Pedicle subtraction osteotomy the spine hospital at the. Pdf pedicle subtraction osteotomy pso for the treatment. Inclusion criteria were age at least 18 years, lumbar pso, and available data on perioperative up to 6 weeks after surgery complication data. A moderate amount of scoliosis can sometimes be corrected during a pedicle subtraction osteotomy. Pedicle subtraction osteotomy is an effective surgical technique for fixed sagittal deformity e. Louis anthony rinella loyola university medical center lawrence g. Pso set avalign technologies medical instruments original. Pedicle subtraction osteotomy for the treatment of fixed sagittal. A pedicle subtraction osteotomy pso is a form of surgical treatment that is used to reverse spinal deformities as the name suggests, osteotomy means to remove bone. We report our perioperative morbidity rate in recently performed pso cases tr. Abstract pedicle subtraction osteotomy pso consists of creating posteriorly.
When my surgeon told me that having a second osteotomy there was certainly an option, i did consider it. The revere corrective osteotomy set is a truly comprehensive instrument set designed to enhance the efficiency of smithpetersen osteotomies, pedicle subtraction osteotomies and vertebral column resections by providing dedicated instruments that accommodate various surgical preferences and anatomical variations. To the authors knowledge, this is the first article to present a pedicle subtraction osteotomy in the lumbar spine to correct and stabilize a highgrade isthmic. Pso are performed to correct sagittal plane deformity. Corrective osteotomy information for patients what is corrective osteotomy. Pedicle subtraction osteotomy pso is an effective tool for the correction of fixed sagittal plane deformity. Cervical pedicle subtraction osteotomy for fixed flexion. Pedicle subtraction osteotomy orthopaedicsone articles. In his original description, the osteotomy was indicated in patients with a fixed cervical kyphotic deformity and a chinonchest deformity. This video has been taken from pedicle subtraction osteotomy, a manuscript that can be read here.
Comparison of smithpetersen, pedicle subtraction osteotomy and. Revere corrective osteotomy set, pedicle subtraction osteotomies. Pedicle subtraction osteotomy is a useful tool to restore sagittal balance, and the degree of correction can be predicted by trigonometric means 34, 35. Lewis washington university school of medicine in st. The anterior column is not opened up as in a smithpetersen osteotomy. However, there is potentially significant perioperative morbidity associated with. As you can probably guess from that last sentence then, my lumbar osteotomy was a complete success. Corrective osteotomy information for patients what is. All 3 columns should be bone on bone at the completion. Our neurosurgeon performed a l23, l34 revision laminectomy 63047 and 63048 and placed the iliac screws 22848. A retrospective cohort of consecutive patients with prospectively collected data. However, a more powerful method for restoring sagittal alignment would involve a threecolumn osteotomy.
Org volume 85a number 3 march 2003 pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance pedicle subtraction osteotomy fig. Single level proximal thoracic pedicle subtraction osteotomy for. Modified c7 pedicle subtraction osteotomy for the correction of. Transpedicular threecolumn pediclevertebral body subtraction osteotomy. L5 pedicle subtraction osteotomy for highgrade isthmic. Ten patients who underwent pso at l5 were eligible for a 2year minimum followup average, 4. However, many of those experts were nervous about operating on someone as young as sullivan and said there was only one person in the united states they trusted for her case.
Pedicle subtraction osteotomies are being used with increasing frequency to treat the problem of sagittal imbalance caused by a variety of diseases. Farhan siddiqi, md affiliate assistant professor university of south florida trinity spine center disclosures globus royalties i am not an expert on psos i am unfortunately an expert at complications i dont want any complications obama is watching 69. Aug 24, 2016 increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. Pedicle subtraction osteotomy in the lumbar spine icvbordeaux. Several reports described the cervical pedicle subtraction osteotomy pso technique and have demonstrated that it is more stable and safer than. Pedicle subtraction osteotomy pso for the treatment of sagittal deformities article pdf available in coluna columna 102. Jun 01, 2012 cervical pedicle subtraction osteotomy was initially described by simmons 1 in 1972 for fixed cervical flexion deformity in ankylosing spondylitis. The orthopaedic surgeon performed l3 pedicle subtraction osteotomy 22207, l1 and l4 smith peterson osteotomy 22214, 22216, l34 posterior interbody fusion 22630, removal of l3,4,5,s1 and iliac screw,22852, replaced l4,l5,s1 screws, new screws placed at t12,l1,l2. However, there is potentially significant perioperative morbidity associated with this technique. Pedicle subtraction osteotomy pso is a highly effective procedure in the context of adult spinal deformity asd surgery to achieve lordosis at the index segment. Single level proximal thoracic pedicle subtraction osteotomy for fixed hyperkyphotic deformity.
Comparison of smithpetersen, pedicle subtraction osteotomy and vertebral column resection for the correction of sagittal imbalance. Technique for lumbar pedicle subtraction osteotomy for sagittal. Comparison of smithpetersen, pedicle subtraction osteotomy. A spine with too much kyphosis forward curvature, or hunchback or too little lordosis inward curvature, or swayback can be corrected with a pso. During a pedicle subtraction osteotomy, the shaded. Pedicle subtraction osteotomy versus multiple posterior column. Pedicle subtraction osteomy pso vertebral column resection vcr unmatched quality and performance we use the highest quality materials and manufacturing technologies to ensure that our surgical instruments meet or exceed stringent quality and performance standards. In this article, the authors describe the use of posterior vertebral column subtraction osteotomy pvcso for the treatment of 2 patients with multiple recurrences of tcs.
Lumbar pedicle subtraction osteotomy pso was first described by thomasen in 1985 for the management of fixed sagittal plane deformities in ankylosing spondylitis and has since become an increasingly popular method for correcting spinal kyphosis from a number of other etiologies 1, 4. During a pso, your doctor will remove or subtract a number of bony structures. Nov 16, 2011 this video has been taken from pedicle subtraction osteotomy, a manuscript that can be read here. Pedicle subtraction osteotomy is one surgical option for treating sagittal imbalance. Decisions and expectations with osteotomy surgery for fixed. Pedicle substraction osteotomy demonstration by christopher. By hospital for special surgery featuring oheneba boachieadjei. Lumbar pedicle subtraction osteotomy pso is indicated in the treatment of large sagittal more than 25 of rigid loss of. Extended pso with en mass reduction technique for severe coronal and sag. Spinal pedicle subtraction osteotomy for fixed sagittal.
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