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Thoracic Pedicle Subtraction vs. Smith‐Petersen Osteotomies for Correction of Sagittal Plane Deformity: A Case‐Matched Series: Paper #114

Hsu, Brian MB BS, FRACS (Children's Hospital at Westmead); Mehbod, Amir A. MD; Transfeldt, Ensor E. MD; Garvey, Timothy A. MD; Perra, Joseph H. MD; Schwender, James D. MD; Pinto, Manuel MD; Dykes, Daryll C. MD, PhD; Denis, Francis MD; Lonstein, John E. MD; Winter, Robert B. MD

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Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 133–134
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Introduction: Pedicle subtraction and Smith Peterson osteotomies are commonly used in the correction of sagittal plane deformity. In this study, we compared the complications and outcomes of these procedures in the thoracic spine

Methods: Between 1985 to 2005, 322 patients underwent spinal osteotomy procedures. Included were adults having a sagittal plane deformity, a previous spine fusion, and at least a 2‐year follow‐up with adequate radiographs. Inclusion criteria were met by 151 patients. Thirteen patients who underwent a thoracic PSO (TPSO) and were matched with 13 patients who had a thoracic SPO (TSPO). The clinical charts and radiographs were reviewed and all complications recorded.

Results: The TPSO group (mean age 56.6) each had a 1 level procedure. The was a pneumothorax in 1 patient, MEP loss in 1 patient during removal of implants, chylothorax repair (1 patient) and 1 dural tear. Long‐term complications included 2 patients with pseudarthrosis. The mean length of stay was 10.2 days (5–22). The mean EBL was 1970mls (675–4740. Two patients in this group had a concomitant anterior procedure. Ine the TSPO group (mean age 50), the mean number of levels was 2.38 per patient. One patient had a respiratory failure requiring re‐intubation. Long‐term complications included 2 patients with pseudarthrosis and 1 patient with failure of hardware requiring revision. The mean length of stay was 6.9 days (4–12). The mean EBL was 1872mls (150–5520). Six patients had a concomitant anterior procedure. TPSO had a higher segmental kyphosis correction (29 vs 19 deg). TSPO had a greater improvement of global thoracic kyphosis correction (17 vs 12 deg). The C7 plumbline improvement was 28mm in TPSO and ‐10mm in the TSPO. This was due to 3 TSPO patients developing loss of correction

Conclusion: TPSO had a higher complication rate (31 vs 8%)and a longer hospital stay. TPSO is effective in managing segmental kyphosis without an anterior procedure and gives greater segmental kyphosis correction but to a lesser degree than Lumbar PSOs. TSPO are more effective in improving global thoracic kyphosis when performed over 2 or more levels

Significance: TPSO has a higher complication rate but provides better segmental kyphosis correction

© 2009 Lippincott Williams & Wilkins, Inc.