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Thoracic Pedicle Subtraction Osteotomy for Fixed Sagittal Deformity

March 01, 2017

Contributors: Amos Dai, BS; Michael L Smith, MD; Themistocles Stavros Protopsaltis, MD; Jonathan H Oren, MD; Jonathan H Oren, MD

Purpose: The cervical spine is an incredibly complex segment of the spine because it not only supports the head but also allows for the widest range of motion compared with the other segments of the spine. Sagittal plane malalignment is directly associated with decreased health-related quality of life outcome scores. Patients with sagittal plane malalignment often complain of the inability to stand upright and increasing pain and fatigue during everyday activities. In general, symptomatic sagittal spine deformity is not responsive to nonsurgical management. This video demonstrates the surgical technique of thoracic pedicle subtraction osteotomy for the management of fixed sagittal spine deformity. Methods: This video discusses the case presentation of a 55-year-old woman with forward thrust of the neck and difficulty with horizontal and upward gaze after undergoing C4 through T3 laminectomy and fusion for management of a C7 burst fracture. Distal junctional kyphosis and a fracture at the fracture site were diagnosed. The video reviews the radiographic evaluation and preoperative planning for the patient. The patient elected to proceed with a grade 6 thoracic pedicle subtraction osteotomy, which involved complete removal of the posterior structures at the appropriate level, complete facetectomy of the joints above and below the planned vertebral resection, and a closing wedge osteotomy. Results: After demonstrating the surgical technique, the video reviews the patient’s radiographic correction with regard to the cervical sagittal vertical axis, cervical lordosis, and T1 slope. The patient's postoperative and preoperative postures also are compared. Conclusions: Cervical sagittal spine deformity is a major cause of morbidity in adults. Cervical sagittal spine deformity typically is refractory to nonsurgical management; therefore, surgery must be considered. Thoracic pedicle subtraction osteotomy is an effective method to achieve normal curvature of the spine.

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