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Pedicle subtraction osteotomy with patient-specific instruments.

Marco D Burkhard1, Daniel Suter2, Bastian Sigrist2

  • 1Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland.

North American Spine Society Journal
|February 10, 2022
PubMed
Summary

Patient-specific instruments (PSI) offer a more accurate method for pedicle subtraction osteotomy (PSO) in spinal deformity correction compared to the free-hand technique. This approach enhances lordosis correction and reduces bone gaps, potentially improving fusion rates.

Keywords:
3D-printPatient-specificPedicle subtraction osteotomySagittal imbalanceSpinal osteotomySpine

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Area of Science:

  • Spinal Surgery
  • Orthopedic Biomechanics
  • Surgical Navigation

Background:

  • Patient-specific instruments (PSI) are established for orthopedic osteotomies but lack comparative analysis in complex spinal deformity correction, specifically pedicle subtraction osteotomy (PSO).
  • Evaluating PSI's efficacy in PSO is crucial for advancing surgical techniques in spinal deformity.
  • Traditional free-hand (FH) techniques for PSO may have limitations in accuracy and reproducibility.

Purpose of the Study:

  • To compare the accuracy and effectiveness of PSI-guided PSO versus the free-hand (FH) technique for spinal deformity correction in a cadaver model.
  • To quantify differences in lordosis correction, accuracy of angular correction, and osseous gap formation between PSI and FH techniques.
  • To assess the feasibility of PSI for achieving planned surgical goals in PSO.

Main Methods:

  • Nine pedicle subtraction osteotomies (PSOs) were performed using PSI and nine using the FH technique in six thoracolumbar human cadavers.
  • Preoperative CT scans guided osteotomy plane planning, targeting a 30° closing-wedge angle for each PSO.
  • Postoperative CT scans evaluated segmental lordosis correction, deviation from the planned angle, and posterior element osseous gap size.

Main Results:

  • The PSI group demonstrated significantly greater lordosis gain (29°) compared to the FH group (21°).
  • PSI provided significantly more accurate angular correction (1° deviation) than the FH technique (9° deviation).
  • PSI resulted in a smaller residual osseous gap (5 mm) compared to the FH group (11 mm), with minimal deviations in osteotomy planes.

Conclusions:

  • PSI-guided PSO is a more feasible and accurate method for achieving planned lordosis angles than the traditional FH technique in a cadaver model.
  • The PSI approach significantly reduces osseous gaps, which may potentially promote higher spinal fusion rates in vivo.
  • PSI demonstrates potential for improved outcomes in complex spinal deformity correction surgeries.