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Optimizing Pedicle Subtraction Osteotomy Techniques: A New Reduction Plier to Increase Technical Safety and Angular

Antonio Faundez1, Jean-Charles Le Huec2, Lars V Hansen3

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Summary

A new surgical instrument improves pedicle subtraction osteotomy (PSO) for thoracolumbar spine sagittal imbalance. This tool offers safe, precise correction, enhancing patient outcomes and avoiding common complications.

Keywords:
Osteotomy reductionPedicle subtraction osteotomySagittal balanceTechnique

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Area of Science:

  • Spine surgery
  • Orthopedic instrumentation
  • Surgical technique optimization

Background:

  • Pedicle subtraction osteotomy (PSO) is a complex spinal surgery.
  • Existing instruments offer limited guidance for angular correction and osteotomy closure.
  • There is a need for improved instrumentation to enhance PSO procedures.

Purpose of the Study:

  • To introduce and evaluate a novel surgical instrument designed to optimize pedicle subtraction osteotomies (PSOs) in the thoracolumbar spine.
  • To assess the instrument's efficacy in guiding angular correction and facilitating osteotomy reduction.

Main Methods:

  • Seventeen patients with major sagittal imbalance underwent lumbar PSO at three European university hospitals.
  • The Full Balance Integrated (FBI) method determined the required vertebral angular correction.
  • A specialized plier instrument was used intraoperatively to control angular correction.
  • Preoperative and early postoperative global sagittal balance parameters were compared.

Main Results:

  • The mean correction achieved was 32.1° (preoperative target: 33.8°).
  • Lumbar lordosis significantly increased (55.8° vs. 19.4°, P < .0001).
  • Global sagittal balance improved, with a trend towards increased spino-sacral angle (128° vs. 122°, P = .0547).
  • No intraoperative or early postoperative neurologic or mechanical complications occurred.

Conclusions:

  • The new instrument enables safe, precise, and efficient reduction during PSO.
  • It facilitates accurate angular correction and osteotomy closure, mitigating risks of collapse and undercorrection.
  • Further prospective studies are warranted to validate these findings.