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Modified S1 Pedicle Subtraction Osteotomy
Precious C Oyem1, Jacob K Greenberg2, Colin R Rhoads3
1Department of Orthopaedic Surgery, Cleveland Clinic.
Study Design:
Surgical technique video.
Objective:
To report a surgical technique to revise patients with previous fusions at L4-S1 leading to an iatrogenic flat back and sagittal imbalance using L5-S1 transforaminal interbody fusion combined with a small S1 corner osteotomy.
Background:
This is a case of a woman (51 y old) with a history of multiple lumbar surgeries, severe back pain, sagittal imbalance, and loss of lordosis.
Methods:
We describe a feasible revision technique in a complex patient with the goal of attaining optimal distribution of lumbar lordosis and sagittal balance through a modified S1 pedicle subtraction osteotomy, and the use of an interbody cage to enhance the fusion rate and facilitate closure of the 3-column osteotomy.
Results:
The preoperative patient lordosis angle of 31 degrees at L1-L4 and 16 degrees at L4-S1 became 12 degrees at L1-L4 and 44 degrees at L4-S1 postoperatively.
Conclusion:
The combination of L5-S1 transforaminal interbody fusion and S1 corner osteotomy is a feasible technique for the restoration of lumbar lordosis in patients with previous fusion and consequent loss of lordosis.
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