ArticleInternational journal of spine surgery2025
Optimizing Spinal Realignment: A Comparative Analysis of Correction and Complications of Osteotomy Techniques in Adult Spinal Deformity.
Article in International journal of spine surgery, 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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1 citing paper in PubMed.
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13 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundOsteotomies are fundamental for correcting adult spinal deformity (ASD). This study sought to compare the effectiveness of anterior column realignment (ACR), pedicle subtraction osteotomy (PSO), intradiscal osteotomy (IDO), and Ponte osteotomies in achieving spinopelvic correction, clinical outcomes, and complications.
methodsA retrospective analysis of 146 patients who underwent posterior fusions for ASD correction between 2016 and 2022 was conducted. Patients with ≥1 year of follow-up were included. Patients were grouped according to the osteotomies with the most significant impact on sagittal alignment change: IDO, PSO, ACR, or Ponte. Spinopelvic parameters-including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), PI-LL mismatch, and sagittal vertical axis (SVA)-and their changes from pre- to postoperative images were compared. Surgical and clinical variables were collected, including mechanical complications (proximal junctional kyphosis, proximal junctional failure, different types of hardware failure, estimated blood loss, packed red blood cell transfusions, and length of stay). Clinical status was measured with the Oswestry Disability Index. Revision-free survival time was analyzed using Kaplan-Meier curves, with patients followed from index surgery until revision or last follow-up, and differences between osteotomy types were assessed.
resultsA total of 146 patients underwent ASD correction with IDO (
conclusionsPSO achieved the greatest sagittal correction, while IDO and ACR provided intermediate correction. Although not statistically significant, IDO showed a numerically higher revision-free survival, with the earlier reoperations observed in Ponte, followed by ACR and PSO. These findings suggest a trend toward greater durability with IDO, highlighting the importance of osteotomy selection in maintaining long-term alignment. CLINICAL RELEVANCE: These findings highlight the distinct corrective profiles, safety considerations, and long-term mechanical complication outcomes of four osteotomy techniques, emphasizing their clinical implications for surgical planning and decision-making. LEVEL OF EVIDENCE: 3:
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