INTRODUCTION: Transpedicular decancellation osteotomy provides correction for fixed sagittal plane deformity. There is a paucity of literature regarding the acute neurological complications and early outcomes related to these complex procedures.
METHODS: A retrospective review of patients with kyphotic deformity and associated sagittal imbalance from a single surgeon. Inclusion criteria were patients undergoing corrective decancellation osteotomy with segmental spinal instrumentation. Medical records, clinic notes, and radiographs pre‐ and post‐operatively were reviewed.
RESULTS: A consecutive series of 30 patients (F: 16, M: 14) at a mean age of 64.3 ± 2.7 years was identified and followed for a mean of 27.1 ± 3.5 months. 29 out of 30 patients (97%) had previous spinal surgery, and the remaining 1 patient had a kyphotic deformity related to TB. The operative level was L1 (n=2), L2 (n=5), L3 (n=16), L4 (n=1), and multiple spinal segments at the T‐L junction (n=3). Supplemental interbody fusion was performed by anterior or transpoas approach in 57% (n=17). The mean sagittal vertical axis was 15.4cm preoperatively, 5.3cm postoperatively, and 6.1cm at most recent follow‐up. All patients were neurologically at baseline immediately postoperatively. 1 patient (3%) had a delayed lower extremity neurological deficit after mobilizing in the postoperative period without hardware complication. Nonunion was seen at most recent follow‐up in 10% (n=3), proximal breakdown in 17% (n=5), and failure of fixation in 17% (n=5).
DISCUSSION: Decancellation osteotomy for the treatment of fixed sagittal deformity is a relatively safe yet complex revision spine procedure. Acute neurological sequelae remain a risk of these complex procedures in patients with kyphotic deformities. The relatively high complication rate requires careful patient selection and informed decision making prior to undertaking major corrective spinal surgery.