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World J Clin Cases. Nov 16, 2013; 1(8): 242-248
Published online Nov 16, 2013. doi: 10.12998/wjcc.v1.i8.242
Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients
Seung-Jae Hyun, Yongjung J Kim, Seung-Chul Rhim
Seung-Jae Hyun, Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, South Korea
Yongjung J Kim, Department of Orthopaedic Surgery, Spine Service, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
Seung-Chul Rhim, Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Hyun SJ, Kim YJ and Rhim SC contributed to the manuscript writing and critical revision.
Correspondence to: Seung-Jae Hyun, MD, PhD, Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea. neurospine@snubh.org
Telephone: +82-31-7877164 Fax: +82-31-7874059
Received: June 18, 2013
Revised: October 18, 2013
Accepted: October 19, 2013
Published online: November 16, 2013
Abstract

In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The long-term overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.

Keywords: Sagittal imbalance, Pedicle subtraction osteotomy, Clinical outcome, Proximal junctional kyphosis, Complication

Core tip: In this review article, the literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The long-term overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.