Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities.

By London Spine
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Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities.

Eur Spine J. 2015 Jan;24 Suppl 1:S49-57

Authors: Berjano P, Aebi M

Abstract
INTRODUCTION: The narrow correlation between sagittal alignment parameters and clinical outcomes has been widely established, demonstrating that improper sagittal alignment is a clinical condition that is associated with increased pain and limitations in patients’ functional ability.
INDICATION: Lumbar pedicle subtraction osteotomy (PSO) is indicated in the treatment of large sagittal (more than 25° of rigid loss of lordosis) deformities of the lumbar spine or its combination with coronal deformity, especially when they are rigid. Indication should be based on careful assessment of the severity of symptoms, functional impairment, functional expectations of the patient, general clinical condition and surgical and anesthesiological team experience. Risk should be carefully assessed and discussed to obtain appropriate informed consent.
SURGICAL PROCEDURE: Surgical planning includes selection of the safest levels for the upper and lower instrumented vertebra, site of the osteotomy, modality of fixation, and, most importantly angular value of the correction goal (target lumbar lordosis). Failure to adequately obtain the necessary amount of sagittal correction is the most frequent cause of failure and reoperation.
CONCLUSION: PSO is a valuable surgical procedure in correction of severe hypolordosis (=relative kyphosis) in the lumbar spine. It is a demanding procedure for the surgeon, the anesthesiologist and the intensive care team. Although its complication rate is high, it has a substantial positive impact in the quality of life of patients, including the elderly.

PMID: 25487952 [PubMed – indexed for MEDLINE]

Middle-term therapeutic effect of the sacroiliac joint blockade in patients with lumbosacral fusion-related sacroiliac pain.

By London Spine
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Middle-term therapeutic effect of the sacroiliac joint blockade in patients with lumbosacral fusion-related sacroiliac pain.

Acta Orthop Traumatol Turc. 2014;48(1):61-6

Authors: Büker N, Akkaya S, Gökalp O, Kıtış A, Savkın R, Kıter AE

Abstract
OBJECTIVE: The aim of this study was to compare the therapeutic effect of sacroiliac (SI) blockade in patients with and without lumbosacral fusion.
METHODS: This study included 72 patients diagnosed with SI pain and who received blockade injection (methylprednisolone and lidocaine). Patients were divided into 2 groups; 22 patients in the fusion group who underwent previous lumbosacral fusion and 50 patients in the non-fusion group. Average follow-up was 17.7 (range: 6 to 30) months. All patients were evaluated before and after intervention using the Visual Analog Scale (VAS), Oswestry Disability Index, Rivermead Mobility Index and SF-36. Results were statistically analyzed.
RESULTS: Activity pain (a component of VAS) was significantly better in the non-fusion group than the fusion group (p=0.042). No other statistically significant differences were observed between groups (p>0.05).
CONCLUSION: Sacroiliac blockade has a similar therapeutic effect on patients who underwent lumbosacral fusion surgery as on non-operated patients in the middle-term. Therefore, alternative treatment options are not necessary in patients with fusion.

PMID: 24643102 [PubMed – indexed for MEDLINE]