European Spine Journal最新文献

Study design: Technical case report.

Introduction: Severe thoracic hyperkyphosis caused by multiple osteoporotic fractures can lead to significant disability. When deformities are rigid, surgical correction may be required. This report describes a rare case of four-level pedicle subtraction osteotomy (PSO) to address a fixed deformity, with focus on technique, outcomes, and complications.

Case presentation: A 65-year-old female with Scheuermann's disease developed progressive thoracic hyperkyphosis due to osteoporotic vertebral fractures. Radiographs showed a rigid kyphosis of 130.3°. The patient underwent a two-stage surgery: cement-augmented instrumentation (T2-L3), followed by contiguous PSOs from T6 to T9. Neurophysiological monitoring was used throughout.

Results: Kyphosis was corrected from 130.3° to 48°. Postoperatively, the patient developed progressive lower limb weakness due to spinal cord kinking. Revision surgery allowed neurological recovery. At two years, radiological parameters remained stable, and the patient reported reduced pain, improved mobility, and restored quality of life.

Conclusion: Four-level PSO can be an effective treatment for severe rigid thoracic hyperkyphosis in osteoporotic patients. Although technically demanding and associated with potential complications, careful planning and staged correction can result in successful outcomes.

Level of evidence: IV (Case Report).

Purpose: Pedicle subtraction osteotomies (PSOs) are well-established for rigid sagittal deformities, but the efficacy and safety of biplanar PSOs (BiPSOs) remain uncertain. This study aims to evaluate whether BiPSOs compromise sagittal correction or elevate surgical morbidity or complication rates.

Methods: A retrospective analysis of a prospective multicentric adult spinal deformity database included patients who underwent a single Schwab-3/4 PSO with at least two years of follow-up. BiPSOs were defined by segmental angular changes (SAD) greater than 5° in both the sagittal and coronal planes, while uniplanar (UPSOs) had SAD greater than 5° in one plane. Demographic, surgical, and outcome variables were compared.

Results: The study included 33 BiPSOs and 123 UPSOs. No differences were found for baseline demographic characteristics. UPSOs were more common in patients with prior spinal surgery (57.6% vs. 80.5%) with less L4-S1 lordosis (29.5° vs. 22°), meanwhile BiPSOs' patients showed worse preoperative coronal alignment (C7-SVL 37.2 vs. 25.2 mm) and greater Cobb angles (44.6° vs. 24°). Comparable coronal and sagittal alignment were obtained postoperatively according to C7-CSVL (19.1 vs. 17.0 mm) and GAP Score (5.1 vs. 5.6 points, - 48.6% vs. - 43.8%). Comparable surgical aggressiveness including surgical time, blood loss, or hospitalization stays was observed. Neurological complications were comparable between the groups (15.2% BiPSOs vs. 19.5% UPSOs), with no significant differences in motor deficits. Overall complication rates and patient-reported outcomes were comparable, though BiPSOs had higher satisfaction at final follow-up.

Conclusions: BiPSOs effectively treat rigid biplanar deformities, achieving optimal coronal correction without compromising sagittal alignment restoration or increasing surgical morbidity and neurological risks.

Purpose: Surgical treatment of adolescent spinal deformities requires accurate pre-operative planning. Few studies confirmed that sagittal alignment restoration is crucial to reduce the risk of early degeneration, yet sagittal alignment targets are lacking in adolescents. No predictive formula for ideal sacral slope (SS_ideal) based on pelvic incidence (PI) has been developed specifically for surgical planning in adolescents. The aim of the present study is to investigate the relationship between PI and SS in healthy adolescents aged 11-18 years to identify the most accurate model for SS_ideal prediction based on PI.

Methods: Full-spine standing biplanar X-rays were analyzed. PI, SS and pelvic tilt (PT) were measured. Three regression models (linear, polynomial, and logarithmic) were generated to describe the PI-SS relationship. The adult-derived model by Yilgor et al. was also applied to the study cohort. Accuracy and precision of all models were assessed globally and within PI-based subgroups. External validation was performed using a previously published dataset.

Results: A total of 122 patients (mean age 14 years) were included. Logarithmic and polynomial models achieved the best fit within the study cohort (R² = 0.63 and 0.63). The Yilgor et al. model showed substantially lower fit (R² = 0.39) and systematic underestimation of SS in intermediate and high PI subgroups. The linear model performed best within the external validation cohort showing the best goodness-of-fit, accuracy, precision, and robustness. The Yilgor model again showed systematic SS underestimation and higher errors.

Conclusion: Our results suggest that the formula SS_ideal = 0.61 x PI + 11.4 can be reliably employed in the pre-operative planning of adolescent spinal deformities.