Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity.

Area of Science:

• Spine surgery
• Orthopedic surgery
• Spinal deformity correction

Background:

• Pedicle subtraction osteotomy (PSO) is established for lumbar spine sagittal imbalance.
• Limited data exists on thoracic spine PSO application and efficacy.
• Thoracic kyphosis correction requires effective surgical techniques.

Purpose of the Study:

• Evaluate the corrective capacity of thoracic pedicle subtraction osteotomy (PSO).
• Assess if thoracic PSO segmental correction varies by spinal level.
• Determine the impact of thoracic PSO on regional and global spinal balance.

Main Methods:

• Retrospective clinical study of 15 patients undergoing 25 thoracic PSOs.
• Analysis of pre- and post-operative radiographs for sagittal correction (segmental, regional, global).
• Intraoperative neurophysiological monitoring and post-operative SRS-22 questionnaire for clinical outcomes.

Main Results:

• Mean thoracic kyphosis improved significantly (75.7° to 54.3°), with regional sagittal correction of 21.4°.
• Global sagittal balance improved by a mean of 67.3 mm.
• Distal thoracic PSO (T9-T12) provided the greatest segmental correction (~24°), with no neurological deficits reported.

Conclusions:

• Thoracic PSO is a safe and effective procedure for correcting thoracic kyphosis.
• Sagittal correction is level-dependent, with distal thoracic segments yielding superior results.
• Thoracic PSO leads to favorable clinical outcomes and significant spinal balance improvement.