Evidence map›Paper›PMID 40629093›Full record

ArticleSpine deformity2025

Impact of lumbar pedicle subtraction osteotomy (PSO) level on global alignment and proportion (GAP) score in revision adult iatrogenic flatback spinal deformities.

Perry Lim, Aaron J Clark, Austen D Katz, Asra Toobaie, Vedat Deviren, Christopher P Ames, Alekos A Theologis

Abstract read
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In one paragraph

Article in Spine deformity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Perry LimDepartment of Orthopedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA.
Aaron J ClarkDepartment of Neurological Surgery, UCSF, San Francisco, CA, USA.
Austen D KatzDepartment of Orthopedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA.
Asra ToobaieDepartment of Orthopedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA.
Vedat DevirenDepartment of Orthopedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA.
Christopher P AmesDepartment of Neurological Surgery, UCSF, San Francisco, CA, USA.
Alekos A TheologisDepartment of Orthopedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3 Floor, San Francisco, CA, 94143, USA. alekos.theologis@ucsf.edu.ORCID http://orcid.org/0000-0001-6170-2813

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo explore the impact of different lumbar pedicle subtraction osteotomy (L-PSO) levels on Global Alignment and Proportion (GAP) scores.

methodsAdults at a single center who underwent lumbar PSOs with revision instrumentation [thoracolumbar junction (T9-L1) to pelvis] and a minimum 2-year follow-up were reviewed. The patients were divided by level of PSO (L2, L3, L4, and L5) and compared with respect to demographic and surgical data, sagittal parameters, GAP scores, and mechanical complications requiring revision operations.

results152 patients (average age 64.4 ± 10.6 years, average follow-up 9.0 ± 4.1 years) were included for analysis. L3 (40.8%) and L4 (45.4%) PSOs were more common than L2 (4.6%) and L5 (9.2%) PSOs. Average pre-op GAP scores (9.8 ± 2.8) were similar and improved significantly for all L-PSO levels, although post-op GAP scores (7.1 ± 2.2) remained "disproportioned" for all L-PSO levels. Post-op Lumbar Distribution Index (LDI) scores were significantly better for lower PSOs (L4 + L5) given better improvement of L4-S1 lordosis. The revisions for mechanical failures were higher in L2 and L3 PSOs. Average post-op GAP scores were not different for patients who did and did not undergo mechanical failure revisions.

conclusionsL-PSOs, irrespective of the level, improve GAP scores. While residual disproportionate post-operative alignment was observed for all L-PSO levels, distal PSOs improved L4-S1 lordosis and LDI scores to a greater extent than proximal PSOs. Although more distal lumbar PSOs also had lower rates of revision operations for mechanical complications, other patient and surgical factors also likely played a role in the observed rates of mechanical failures.

Indexed as

Lumbar VertebraeOsteotomySpinal CurvaturesAdultAgedFemaleFollow-Up StudiesHumansIatrogenic DiseaseLordosisMaleMiddle AgedReoperationRetrospective StudiesSpinal FusionTreatment OutcomeAdult spinal deformityGAP scoreIatrogenic flatbackLumbar pedicle subtraction osteotomyMechanical failures

Identifiers

PMID40629093
PMCPMC12634709

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.