SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Thoracic pedicle Subtraction osteotomies: a systematic review of indications, correction magnitudes, and safety profile.
Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundThoracic pedicle subtraction osteotomies (T-PSO) are used to correct severe primary and revision thoracic spinal deformities. While lumbar PSOs are well established, literature describing the efficacy and safety of T-PSOs remains limited. This systematic review aims to characterize indications, correction magnitudes, and complications associated with T-PSO.
methodsA systematic review was conducted across PubMed, Web of Science, and Scopus in accordance with PRISMA guidelines. Studies were included if they reported outcomes specific to T-PSO in either primary or revision surgeries. Surgical correction characteristics, thoracic region sub-analyses, and adverse events were summarized.
resultsData were extracted from 52 studies, including 38 case reports/series and 14 retrospective chart reviews. Among 404 T-PSO patients, 167 patients had the level of procedure reported. Most procedures were single-level osteotomies (n = 161, 96.4%), with the most frequent levels at T11 and T12. The most common indications for T-PSO based on thoracic region were postoperative kyphosis (n = 15, 32.6%) for the upper thoracic spine, thoracic kyphosis (n = 3, 37.5%) alongside thoracic kyphoscoliosis (n = 3, 37.5%) for the middle thoracic spine, and thoracolumbar kyphosis (n = 54, 50.5%) for the lower thoracic spine. Mean magnitude of thoracic kyphosis correction was 25.8° and correction at the T-PSO level was 25.5°. Adverse events occurred in 48.5% of patients, including structural complications (22.5%), instrumentation failures (11.8%), infections (10.8%), and neurologic deficits (9.8%). Three deaths were reported. Complication rates were similar between primary and revision procedures.
conclusionT-PSO achieves meaningful sagittal plane correction in appropriately selected patients with severe and/or rigid primary and revision thoracic spinal deformities. However, high complication rates emphasize the importance of careful patient selection and surgical planning. Standardization of outcome reporting is critical to optimize future clinical guidance.
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