ArticleJournal of craniovertebral junction & spine
Role of T2 pedicle subtraction osteotomy in rigid cervicothoracic sagittal imbalance correction: A case series with technical details.
Article in Journal of craniovertebral junction & spine. 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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Abstract
Background: Correction of rigid cervicothoracic sagittal imbalance is technically demanding, especially in patients with prior cervical fusion or ankylosing spondylitis. Three-column osteotomies at C6-T1 can achieve deformity correction but carry risks of vertebral artery and cervical nerve root injury. T2 pedicle subtraction osteotomy (PSO) may provide comparable correction with a more favorable neurovascular risk profile. We evaluated radiographic outcomes, durability of correction, and safety of T2 PSO for rigid cervicothoracic deformity. Materials and Methods: Nineteen consecutive patients who underwent T2 PSO (2017-2025) were retrospectively reviewed. Radiographic parameters, including C2-C7 sagittal vertical axis (SVA), C2-S1 SVA, T1 slope (TS), TS-CL mismatch, and C6-T4 cervicothoracic angle (CTA), were assessed preoperatively, immediately postoperatively, and at last follow-up. Complications and reoperations were recorded. Results: Mean C2-C7 SVA improved from 65.5 mm to 40.1 mm postoperatively (-25.4 mm, P < 0.001) and remained improved at 46.5 mm at final follow-up (P = 0.005). C2-S1 SVA decreased by 30.8 mm (P = 0.008). TS improved from 47.3° to 31.2° (-16.1°, P < 0.001), TS-CL mismatch by 12.9° (P < 0.001), and CTA from 16.7° to 5.2° (-11.5°, P = 0.002). Radiographic gains were largely maintained at a mean 11.6-month follow-up. Complications occurred in 47.4%; one transient neurologic deficit occurred, with no permanent spinal cord, nerve root, or vascular injuries. Conclusion: T2 PSO provides substantial and durable correction of cervicothoracic sagittal imbalance with a favorable neurovascular safety profile, particularly in patients with prior cervical fusion or ankylosing spondylitis.
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