L5 pedicle subtraction osteotomy: indication, surgical technique and specificities

Area of Science:

• Spine surgery
• Orthopedics
• Spinal deformity correction

Background:

• Fixed sagittal and coronal malalignment can significantly impact spinal biomechanics and patient quality of life.
• Revision spinal surgeries often present complex challenges in achieving desired correction and stability.

Purpose of the Study:

• To evaluate the radiographic and functional outcomes of L5 pedicle subtraction osteotomy (PSO).
• To assess complications and surgical specificities associated with L5 PSO for fixed sagittal and coronal malalignment.

Main Methods:

• Retrospective cohort study of 10 patients undergoing L5 PSO with a minimum 2-year follow-up.
• Analysis of prospectively collected data, including standardized upright radiographs, surgical details, and complications.

Main Results:

• Significant improvement in lumbar lordosis (from -22.5° to -58.5°) and sagittal vertical axis (from 13.7 cm to 4.6 cm) postoperatively.
• All surgeries were revision procedures, with 3 patients requiring further surgery for rod breakage.

Conclusions:

• L5 PSO is a safe and effective technique for correcting fixed sagittal imbalance and enhancing biomechanical stability.
• Despite a high complication rate, patient satisfaction is generally high when sagittal balance is restored.