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Pseudarthrosis is the most common cause of revision surgery after sagittal correction with long posterior spinal fusion (PSF) in patients with ASD. Although revision surgery for pseudarthrosis after surgical correction of adult spinal deformity (ASD) remains challenging and without consensus, previous studies did not sufficiently compare the methods of revision surgery. We aimed to determine the most useful of the following three methods of revision surgery: surgery for rod change only, anterior lumbar interbody fusion (ALIF) around pedicle subtraction osteotomy (PSO), and 4-rod constructs. Retrospective, consecutive case review. A total of 79 patients (average age 70.5 years) who were diagnosed adult spinal deformity with sagittal imbalance and followed up for more than 5 years after surgical correction with pedicle subtraction osteotomy. Description and analysis of X-ray changes. There were 42 revision surgeries for pseudarthrosis performed by one of three methods: rod change with 2-rod constructs (n=16), anterior lumbar interbody fusion around PSO with rod change (n=9), and rod change with 4-rod constructs (n=17). Preoperative lumbar lordosis was corrected (69.4˚) from 3.6° to -65.8˚ while sagittal vertical axis (SVA) was corrected (185.7 mm) from 176.9 mm to -8.8 mm. Pseudarthrosis occurred (42/79, 53%) around PSO site on the average of 21 months after the surgery, so that revision surgery was performed. There were no statistically significant differences among the other risk factors except the surgical methods for the three groups. Re-pseudarthrosis occurred in 4 of 42 (9.5%) cases in patients who received rod change using the 2-rod constructs method around PSO site at 15, 18, 24 and 35 months postoperatively, and there was no re-pseudarthrosis in the other two groups (P=0.042). Our study showed that anterior lumbar interbody fusion around PSO and 4-rod constructs are preferable to rod change with 2-rod constructs. Therefore, our research can provide an effective guideline for revision surgery for pseudarthrosis that occurs after long PSF with PSO. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Restoration of the sagittal alignment in adult spinal deformity (ASD) can produce excellent radiological and clinical outcomes, but pseudarthrosis is one of the most common complications with an incidence of 0% to 29%. Various surgical options are reported for reducing the incidence of pseudarthrosis, but these methods are controversial and have limitations. The purpose of this study was to identify the methods for reducing the incidence of pseudarthrosis in the surgical treatment of ASD. Retrospective, consecutive case review. A total of 186 consecutive patients with degenerative lumbar kyphosis (average age 70.8 years) who underwent a long-segment fixation with a minimum 2-year follow-up. Description and analysis of X-ray changes. Subjects were classified into the pseudarthrosis group (n=39) and the non-pseudarthrosis group (n=147). For predicting the factors of pseudarthrosis, patient factors, radiologic parameters, and surgical factors which include rod materials (Titanium vs Cobalt Chrome), the use of 4-rod fixation and sacropelvic fixation, correction methods (pedicle subtraction osteotomy vs oblique lumbar interbody fusion), and the history of the previous spine surgery were analyzed. The overall pseudarthrosis rate was 21% (39/186). No significant differences in the incidence of pseudarthrosis regarding patient factors and preoperative radiological parameters were found between the two groups (p >0.05). Significant differences were observed in the postoperative sagittal vertical axis and thoracic kyphosis angle (p <0.05), but there were no significant differences during the last follow-up. Postoperative and last follow-up measurements showed significant differences in thoracolumbar junctional angles (p <0.05). As for surgical factors, the use of cobalt chrome rod (p =0.000), 4-rod fixation (p =0.001), sacropelvic fixation (p =0.045), and oblique lumbar interbody fusion (p =0.000) showed statistically lower incidence of pseudarthrosis than did the use of titanium rod, 2-rod fixation, non-sacropelvic fixation and PSO. Applications of cobalt chrome rod, 4-rod fixation, or oblique lumbar interbody fusion procedure with sacropelvic fixation will be promising methods for reducing pseudarthrosis in surgically treated ASD. Unavailable from authors at time of publication. [ABSTRACT FROM AUTHOR]

Pedicle subtration osteotomy (PSO) is highly effective as a method for sagittal correction in patients with adult spinal deformity, but there are issues such as surgical complexity and long-term complications. Although, recently, minimally invasive techniques have been reported to be useful for surgical treatment of adult spinal deformity, few reports have directly compared it with PSO. The purpose of this study was to evaluate the radiological and clinical efficacies of lateral lumbar interbody fusion (LLIF) combined with posterior column osteotomy (PCO) using stiff rod (6.35 mm Cobalt Chrome; CoCr). Retrospective, consecutive case review. A total of 106 patients (average age 71.5 years) who were diagnosed adult spinal deformity with sagittal imbalance and followed up for more than 2 years after sagittal correction Description and analysis of X-ray and clinical questionaires (Oswestry Disability Index, Visual Analogie Scale) Comparative analysis was performed on the spinopelvic parameters and clinical outcomes of patients who underwent PSO (PSO group; n=65) and the patients who underwent multilevel pre-psoas LLIF combined with PCO and open posterior spinal fusion using 6.35 mm Cobalt Chrome rod (LLIF group; n=41). There were no differences in preoperative spinopelvic parameters between PSO group and LLIF group. Although there were no differences between the two groups in terms of postoperative SVA (-12.7 mm vs -16.5 mm), postoperative lumbar lordosis (-71.5° vs -72.6°), lumbar lordosis correction (78.0°vs 73.5°), sacral slope (46.3° vs 49.1°) and pelvic tilt (9.4° vs 7.2°), estimated blood loss was significantly lower in the LLIF group (2,824 ml vs 1,736 ml, P=0.000). No differences were observed in the clinical outcomes (Oswestry Disability Index, Visual Analog Scale), proximal junctional kyphosis, and spinopelvic parameters between the two groups 2 years after the surgery, but reoperation due to pseudarthrosis was significantly higher in the PSO group (P=0.004). Minimally invasive multilevel LLIF combined with PCO using a stiff rod leads to better clinical and radiological outcomes as much as PSO, accompanied by fewer long-term major complications, such as pseudarthrosis and reoperation. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]