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Comparison of Pedicle Subtraction and Smith-Petersen Osteotomies in Correcting Thoracic Kyphosis When Closed With a Central Hook-Rod Construct

Lewis, Stephen J. MD, MSc, FRCSC(C); Goldstein, Sergey MD; Bodrogi, Andrew MD; Dear, Taylor BSc; Keshen, Sam G. N.; Shihata, Shadi MBChB, FRCSC; Lewis, Noah D. H.; Magana, Sofia BSc

doi: 10.1097/BRS.0000000000000377

Study Design. Retrospective analysis.

Objective. To demonstrate the effectiveness of hook-rod constructs in closing thoracic osteotomies safely and effectively.

Summary of Background Data. The outcomes of hook-rod instrumentation in osteotomies for the correction of kyphosis at the lumbar region of the spine have been described. Little literature exists on the outcomes at the thoracic level.

Methods. The radiographs and clinical scores of 38 patients who underwent pedicle subtraction osteotomy or Smith-Petersen osteotomy in the thoracic spine with the osteotomies closed using a central rod were retrospectively reviewed. Measurements included osteotomy angle, thoracic kyphosis (T2–T12), and maximum kyphosis. Perioperative and long-term complications were reviewed.

Results. Thirty-eight patients underwent thoracic level osteotomies. There were 8 males and 30 females with a mean age of 51.9 years (range, 18–76 yr) at the time of surgery. The mean construct length was 13.2 levels (4–25). Kyphosis correction was equal in the 2 groups. In the pedicle subtraction osteotomy group, a mean of 24.7° (4°–47°) correction was obtained through the osteotomies compared with 24.0° (9°–65°) in the Smith-Petersen osteotomy group. Correction per osteotomy was 23.7° (4°–47°) in the pedicle subtraction osteotomy group compared with 11.8° (2.8°–46.0°) in the Smith-Petersen osteotomy group. No difference in the amount of correction achieved at the different regions of the thoracic spine was observed with either type of osteotomy with central rod closure.

Conclusion. Central hook-rod constructs provide a safe and effective means of closing thoracic osteotomies and result in good correction of rigid sagittal plane deformities.

Level of Evidence: 4

Osteotomies in the thoracic spine for kyphosis are more challenging due to the risk to the spinal cord and the difficulty in closing the osteotomies. This study shows that closing thoracic level pedicle subtraction osteotomies and Smith-Petersen osteotomies can be performed safely and effectively with the use of a central hook-rod construct in the setting of neuromonitoring.

From the Toronto Western Hospital, Toronto, Ontario, M5T 2S8, Canada.

Address correspondence and reprint requests to Stephen J. Lewis, MD, MSc, FRCSC(C), Division of Orthopaedics, Toronto Western Hospital, 399 Bathurst St 1-E442, Toronto, Ontario, M5T 2S8, Canada; E-mail:

Acknowledgment date: January 13, 2014. Revision date: March 11, 2014. Acceptance date: April 4, 2014.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy and payment for lectures.

© 2014 by Lippincott Williams & Wilkins