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Abstract
Surgical correction of adult spinal deformity is a challenge, and is physically and mentally demanding for spinal surgeons. For satisfactory surgical outcomes, proper patient selection is fundamental and preoperative detailed physical examination, intra-operative neuromonitoring, and collaboration with anesthesiology or internal medicine department are critical for prevention of peri-operative complications associated with surgical treatments. A posterior-only or anterior-posterior combined approach can be used. Considering the patients' hemodynamic status or long-time anesthesia, surgeons can decide whether to operate by stage or one stage. Deformity correction can be performed using spinal osteotomy or anterior interbody fusion. Decision regarding correction method depends on the patient's condition and correction degree or level. In this review, the authors try to help in decision making with regard to deformity correction methods for ideal surgical technique, correction angle, fusion length etc. in reference to previous literature.
Figures and Tables
Figure 1
A 70-year-old female patient with degenerative flat back syndrome. Pedicle subtraction osteotomry L3 and unilateral transforaminal lumbar interbody fusion L4-S1 were performed. However, rod fracture (Rod fx.) and re-stooping was observed at postoperative (PO) 3 years. The patient underwent revision surgery and restored sagittal balance.
Figure 2
A 68-year-old female patient with degenerative flat back syndrome. Preoperative lumbar lordosis: -23°, pelvic incidence: 60°. The patient underwent a staged operation consisting of posterior release (1st stage) and anterior lumbar interbody fusion L3-S1 (arrows) and posterior instrumentation with iliac screw (2nd stage). Postoperatively, deformity was corrected enough without corrective osteotomy.
Figure 3
A 72-year-old female patient with degenerative flat back syndrome. Pelvic incidence: 55°. The patient underwent a staged operation with anterior lumbar interbody fusion (ALIF) L4-S1 (arrows) and partial-pedicle subtraction osteotomy L3 and posterior instrumentation T10-S1 with iliac screw. After ALIF L4-S1, additional osteotomy was performed. Preoperative sagittal vertical axis (SVA) (21 cm) reduced within normal limit (SVA: 2 cm) after surgical correction.
Figure 4
Schematic pictures of spinal osteotomies: Smith-Petersen osteotomy (A), pedicle subtraction osteotomy (B), partial pedicle subtraction osteotomy (C), vertebral column resection (D).
Figure 5
A 63-year-old female patient with operation for stooping and claudication. Preoperative (PO) thoracic kyphosis: 13°, lumbar lordosis (LL): -1°, sagittal vertical axis: 9 cm, pelvic incidence (PI): 48°. The patient underwent anterior lumbar interbody fusion L3-S1 and posterior instrumentation L1-S1. Immediate posteoperative LL: -47°. LL-PI: 1°. At postoperative 3 years, the patient showed no correction loss or complications.
References
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