Abstract
Purpose
Different techniques have been previously described to close the pedicle subtraction osteotomy (PSO) site for correction of sagittal malalignment; the use of a side-to-side domino connector as a correction tool in the thoracic spine has not been specifically studied.
Methods
Twenty adult patients who underwent single-level thoracic PSO from T1 to T12 were included and retrospectively reviewed (two centers). Preoperative and postoperative full-body X-rays, perioperative data, clinical data and complications were recorded with a minimum 2 years of follow-up. Surgical technique and the nuances in using the domino connector were described in detail.
Results
Patients had a mean age of 40y; 40% were female. Two different techniques involving the domino were applied for closure of the PSO site depending on the type of kyphosis (smooth vs. angular deformity). Both techniques provided significant correction of the local kyphosis (from 48° to 18°) with reciprocal reduction of compensatory cervical lordosis (from 37.6° to 18.6°, p < 0.01) in upper thoracic PSO or lumbar lordosis (from 74.5° to 46.6°, p < 0.01) in lower thoracic PSO. Four patients presented postoperative complications that resolved (hemothorax, GI bleeding), and two patients presented transient neurological deficit. Oswestry Disability Index score improved in the majority of the patients (from 32.7 to 22.5, p < 0.05). There were no pseudarthroses, symptomatic instrumentation breakage, or surgical site infection.
Conclusion
Use of a side-to-side domino connector in combination with two different rod cantilever techniques is effective for the reduction of thoracic pedicle subtraction osteotomy achieving satisfactory radiological and clinical outcome.
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References
Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85:454–463. https://doi.org/10.2106/00004623-200303000-00009
Lau D, Haddad AF, Fury MT, Deviren V, Ames CP (2021) Multilevel pedicle subtraction osteotomy for correction of severe rigid adult spinal deformities: a case series, indications, considerations, and literature review. Oper Neurosurg (Hagerstown) 20:343–354. https://doi.org/10.1093/ons/opaa419
Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 194:142–152
Bullmann V, Halm HF, Schulte T, Lerner T, Weber TP, Liljenqvist UR (2006) Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J 15:440–448. https://doi.org/10.1007/s00586-005-1016-1
El-Sharkawi MM, Koptan WM, El-Miligui YH, Said GZ (2011) Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. Eur Spine J 20:1434–1440. https://doi.org/10.1007/s00586-011-1720-y
Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L (1995) The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 20:1592–1599. https://doi.org/10.1097/00007632-199507150-00007
Chiffolot X, Lemaire JP, Bogorin I, Steib JP (2006) Pedicle closing-wedge osteotomy for the treatment of fixed sagittal imbalance. Rev Chir Orthop Reparatrice Appar Mot 92:257–265. https://doi.org/10.1016/s0035-1040(06)75733-6
Girod PP, Kogl N, Molliqaj G, Lener S, Hartmann S, Thome C (2021) Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients. Neurosurg Rev. https://doi.org/10.1007/s10143-021-01559-5
Gupta S, Gupta MC (2018) The Nuances of pedicle subtraction osteotomies. Neurosurg Clin N Am 29:355–363. https://doi.org/10.1016/j.nec.2018.03.001
Bakaloudis G, Lolli F, Di Silvestre M, Greggi T, Astolfi S, Martikos K, Vommaro F, Barbanti-Brodano G, Cioni A, Giacomini S (2011) Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J 20(Suppl 1):S95-104. https://doi.org/10.1007/s00586-011-1749-y
Cesare F, Francesca B, Giovanni V, Marco M, Giuseppe G, Alberto R (2022) Multilevel non-contiguous thoracic pedicle subtraction osteotomy for fixed rounded hyperkyphotic deformity of the thoraco-lumbar junction with anterior bony fusion: technical note. J Orthop Traumatol 23:47. https://doi.org/10.1186/s10195-022-00665-4
Bourghli A, Boissiere L, Konbaz F, Al Eissa S, Al-Habib A, Qian BP, Qiu Y, Hayashi K, Pizones J, Ames C, Vital JM, Obeid I (2021) On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab’s spinal osteotomy classification. Spine Deform 9:515–528. https://doi.org/10.1007/s43390-020-00247-6
Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685. https://doi.org/10.1007/s00586-011-1936-x
Barrey C, Roussouly P, Perrin G, Le Huec JC (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20(Suppl 5):626–633. https://doi.org/10.1007/s00586-011-1930-3
Hyun SJ, Lenke LG, Kim YC, Koester LA, Blanke KM (2015) Long-term radiographic outcomes of a central hook-rod construct for osteotomy closure: minimum 5-year follow-up. Spine 40:E428-432. https://doi.org/10.1097/BRS.0000000000000783
Faundez A, Le Huec JC, Hansen LV, Poh Ling F, Gehrchen M (2019) Optimizing pedicle subtraction osteotomy techniques: a new reduction plier to increase technical safety and angular reduction efficiency. Oper Neurosurg (Hagerstown) 16:383–388. https://doi.org/10.1093/ons/opy086
Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA (2006) Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine 5:9–17. https://doi.org/10.3171/spi.2006.5.1.9
Bourghli A, Boissiere L, Cawley D, Larrieu D, Pizones J, Alanay A, PelIise F, Kleinstuck F, Obeid I, European Spine Study G (2022) Domino connector is an efficient tool to improve lumbar lordosis correction angle after pedicle subtraction osteotomy for adult spinal deformity. Eur Spine J 31:2408–2414. https://doi.org/10.1007/s00586-022-07322-8
O’Shaughnessy BA, Kuklo TR, Hsieh PC, Yang BP, Koski TR, Ondra SL (2009) Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity. Spine 34:2893–2899. https://doi.org/10.1097/BRS.0b013e3181c40bf2
Cacho-Rodrigues P, Campana M, Obeid I, Vital JM, Gille O (2016) Sagittal correction and reciprocal changes after thoracic pedicle subtraction osteotomy. Spine 41:E791–E797. https://doi.org/10.1097/BRS.0000000000001386
Smith JS, Shaffrey CI, Lafage V, Blondel B, Schwab F, Hostin R, Hart R, O’Shaughnessy B, Bess S, Hu SS, Deviren V, Ames CP, International Spine Study G (2012) Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine 17:300–307. https://doi.org/10.3171/2012.6.SPINE1250
Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23:1177–1189. https://doi.org/10.1007/s00586-014-3227-9
Bourghli A, Abduljawad SM, Boissiere L, Obeid I (2020) Thoracolumbar kyphoscoliotic deformity with neurological impairment secondary to a butterfly vertebra in an adult. Spine Deform 8:819–827. https://doi.org/10.1007/s43390-020-00050-3
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Bourghli, A., Boissiere, L., Konbaz, F. et al. Domino connector for thoracic pedicle subtraction osteotomy reduction: surgical technique and patient series. Eur Spine J 32, 1800–1809 (2023). https://doi.org/10.1007/s00586-023-07650-3
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DOI: https://doi.org/10.1007/s00586-023-07650-3