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Article Abstract
Objective: The objective of this study was to introduce and evaluate foraminoplastic inferior pedicle subtraction osteotomy (FiPSO), a novel technique that involves downward resection of the pedicle and vertebral body, aimed at addressing rigid lower lumbar kyphosis.
Methods: The clinical records were reviewed of the patients who underwent corrective surgery from January 2012 through December 2021 for adult spinal deformity using a combination of procedures: pedicle subtraction osteotomy (PSO) at the lumbar level and spinopelvic fixation. Inclusion criteria included patients older than 40 years with sagittal imbalance symptoms and significant radiographic findings: sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI) minus lumbar lordosis (LL) > 10°. Patients were categorized into three groups: L1-3 PSO, L4-S1 PSO, and FiPSO. The authors assessed thoracic kyphosis, LL, lower LL (LLL), PI, PT, sacral slope, SVA, global tilt (GT), and Global Alignment and Proportion (GAP) score preoperatively, postoperatively, and at the last follow-up. Complications were also analyzed.
Results: A total of 65 patients were included in the final analysis: 25 in the L1-3 PSO group, 29 in the L4-S1 PSO group, and 11 in the FiPSO group. The FiPSO group showed significantly larger postoperative LLL (39.2° ± 7.7° vs 29.7° ± 10.7°, p < 0.05) and smaller PI-LL mismatch (9.6° ± 10.3° vs 24.6° ± 13.4°, p < 0.01) compared to the L4-S1 PSO groups. At the last follow-up, the FiPSO group maintained larger LLL (38.3° ± 8.9° vs 27.1° ± 10.0°, p < 0.05), lower PT (23.1° ± 9.9° vs 33.3° ± 10.7°, p < 0.05), and good global sagittal alignment (SVA, 64.0 ± 43.8 mm vs 106.8 ± 55.7 mm, p < 0.05; GT, 28.7° ± 13.9° vs 43.5° ± 15.5°, p < 0.05) compared to the L4-S1 PSO group. The FiPSO group had higher nerve deficits (45%) but lower proximal junctional kyphosis (18%) and revision surgery rates (9.1%) than the L1-3 or L4-S1 PSO groups. However, the differences were not statistically significant.
Conclusions: FiPSO provides effective lower lumbar correction and long-term sagittal alignment with comparable complication rates, offering a valuable option for overcoming the challenges associated with PSO in the lower lumbar spine.
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| http://dx.doi.org/10.3171/2025.4.SPINE241232 | DOI Listing |
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Foraminoplastic inferior pedicle subtraction osteotomy: a novel pedicle subtraction osteotomy technique for adult spinal deformity with radiographic outcomes and complications.
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1Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and.
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Stabilization of L5 pedicle Subtraction osteotomies (PSO) with ≥ 6-rods and bilateral dual pelvic fixation with osseointegrative implants: surgical technique description and early postoperative outcomes.
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View Article and Find Full Text PDFRestoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile.
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Department of Orthopedics, Brown University, Providence, Rhode Island, USA. Electronic address:
Article Synopsis
- Severe sagittal plane deformity, particularly with significant loss of L4-S1 lordosis, can be effectively improved through surgical techniques like ALIF, PSO, and TLIF, but there’s limited data on their comparative effectiveness.
- A study included 96 patients with severe spinal deformity, undergoing ALIF, PSO, or TLIF, and assessed their demographics, surgical outcomes, and complications.
- Results showed that ALIF had similar lordosis correction to PSO but with fewer intraoperative complications, making it a preferable option for surgery when applicable.