Posterior column osteotomy for spinal realignment in patients with prior lumbar fusion: illustrative case.

Barnabas Obeng-Gyasi, Anoop Chinthala, Michael J Visconti, Ahmed M Belal, Gordon Mao
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Abstract

Background: Iatrogenic flat back syndrome following prior posterolateral fusion without interbody support is challenging, especially with adjacent segment stenosis. While pedicle subtraction osteotomy (PSO) offers strong correction, it is associated with higher morbidity. Alternative techniques with reduced risk are needed.

Observations: The authors present the case of a 71-year-old woman with a 25-year-old L4-S1 fusion and severe sagittal deformity who underwent a Schwab grade 2 posterior column osteotomy (PCO) through the L4-5 fusion mass, with insertion of interbody cages of varying heights and lordotic angles. Preoperative parameters included C7 sagittal vertical axis (SVA) +10 cm, pelvic incidence (PI) 65°, lumbar lordosis (LL) -13°, PI-LL mismatch 79°, and pelvic tilt (PT) 43°. Postoperative improvements were C7 SVA +5.7 cm, LL 41°, PI-LL mismatch 24°, and PT 35°. The 285-minute surgery had an estimated blood loss of 1100 mL. At 1 month, the patient could walk a one-quarter mile, compared with < 50 feet before surgery.

Lessons: This modified PCO technique provides effective decompression and substantial sagittal correction for iatrogenic flat back syndrome while potentially reducing morbidity compared with PSO. By distributing correction across multiple levels, this approach offers a valuable alternative for patients with moderate to severe sagittal imbalance and concurrent stenosis above prior fusion constructs-avoiding a three-column osteotomy. https://thejns.org/doi/10.3171/CASE25251.

后柱截骨术治疗腰椎融合术患者脊柱复位:说明性病例。
背景:医源性后外侧融合后无椎间支持的平背综合征是具有挑战性的,特别是相邻节段狭窄。虽然椎弓根减截骨术(PSO)提供了强有力的矫正,但与较高的发病率相关。需要风险较低的替代技术。观察:作者报告了一例71岁的25岁L4-S1融合和严重矢状畸形的妇女,她通过L4-5融合肿块行Schwab 2级后柱截骨术(PCO),并插入不同高度和前凸角度的椎间笼。术前参数包括C7矢状垂直轴(SVA) +10 cm,骨盆倾角(PI) 65°,腰椎前凸(LL) -13°,PI-LL不匹配79°,骨盆倾斜(PT) 43°。术后改善为C7 SVA +5.7 cm, LL 41°,PI-LL错配24°,PT 35°。285分钟的手术估计失血量为1100毫升。1个月后,患者可以行走四分之一英里,而手术前还不到50英尺。经验:与PSO相比,这种改良的PCO技术为医源性平背综合征提供了有效的减压和大量矢状面矫正,同时潜在地降低了发病率。通过在多节段进行矫正,该入路为中度至重度矢状面不平衡和合并狭窄的患者提供了有价值的选择,避免了三柱截骨。https://thejns.org/doi/10.3171/CASE25251。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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