Abstract
ABSTRACT Objective: To analyze the clinical and radiological evolution, indications and complications of the types of osteotomies in patients with disturbed sagittal balance (SB) resulting from post-traumatic kyphosis. The SB can be measured with a plumb line from the center of the body of C7 to S1, which allows recognizing the misalignment. The imbalance can be corrected by osteotomy. Methods: Thirty patients with SB loss due to post-traumatic kyphosis were studied from January 2014 to December 2017. SPO, PSO and VCR were performed to evaluate the degree of kyphosis before and after surgery, the Oswestry questionnaire was applied and the degree of correction, the days of hospital stay and transoperative bleeding were assessed. Results: Age, 50 years, SD = 14, follow-up time: 2-3 years. We performed 11 (36.7%) osteotomies of S-P, 17 (56.7%) pedicle subtractions and 2 (6.6%) vertebrectomies. Most of the lesions were found between levels L1 and L2; the complications were dehiscence of the surgical wound in 4 patients (13.3%) and infection in 2 (6.6%). The minimum surgical time was 3 hours; the Oswestry questionnaire did not showed statistically significant difference during the preoperative period, however, considerable improvement was observed 2 years after surgery. Conclusions: The use of corrective vertebral osteotomies significantly re-establishes the spinopelvic balance altered by different pathologies. It allows correcting in a single surgery the sagittal balance, achieving corrections from 10° to 40°, depending on the type of osteotomy performed, being a safe and effective procedure, which allows to restore the spinopelvic balance, improving the quality of life of the patients. Level of Evidence IIb; Prospective cohort study.
Highlights
We reviewed the medical records of 30 patients, 16 males (53.4%) and 14 females (46.6%), operated for sagittal balance resulting from post-traumatic kyphosis during the period from January 2014 to December 2017
Most of the osteotomies performed were at the lumbar level, 8 (26.6%) at L1 and 11 (36.7%) at L2
As regards the degree of fusion, an optimal level of fusion was observed in all the patients, it should be noted that the patients submitted to vertebrectomy had a lower average level of fusion than those who underwent SPO and pedicle subtraction osteotomy (PSO)
Summary
Sagittal balance (SB) is defined as the plumb line that runs from the center of the body of C7 and falls plus or minus 2 cm from the anterior part of the sacral promontory and is used to locate the position of the head in relation to the normal center of gravity (Figure 1).[1]Identifying this measurement is relevant to the diagnosis and treatment of the various pathologies that affect the spine, given that, by not identifying and not recognizing misalignment of this plane, there is a risk that patients will have deformities that can cause disability or limiting pain that affects quality of life.Deformity can cause the loss of this balance, which can be classified as Type I, where the loss of balance is segmental and one portion of the spine is in hyperlordosis or kyphosis, but the balance is satisfactory, or Type II, where the loss of balance occurs when the patient cannot compensate. Sagittal balance (SB) is defined as the plumb line that runs from the center of the body of C7 and falls plus or minus 2 cm from the anterior part of the sacral promontory and is used to locate the position of the head in relation to the normal center of gravity (Figure 1).[1] Identifying this measurement is relevant to the diagnosis and treatment of the various pathologies that affect the spine, given that, by not identifying and not recognizing misalignment of this plane, there is a risk that patients will have deformities that can cause disability or limiting pain that affects quality of life. This can help classify the deformity according to the categories of a) totally flexible, b) partially flexible, and c) rigid.[4]
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