Insufficient restoration of lumbar lordosis and FBI index following pedicle subtraction osteotomy is an indicator of likely mechanical complication

Eur Spine J. 2015 Jan;24 Suppl 1:S112-20. doi: 10.1007/s00586-014-3659-2. Epub 2014 Dec 17.


Purpose: Pedicle subtraction osteotomies (PSO) enable correction of spinal deformities but remain difficult and are associated with high complication rates. This study aimed to prospectively review different post-operative complications and mechanical problems in patients who underwent PSO as treatment for sagittal imbalance as sequelae of degenerative disc disease or previous spinal fusion.

Method: This was a descriptive prospective single center study of 63 patients who underwent sagittal imbalance correction by PSO. Radiographic analysis of pre- and post-operative pelvic and spinal parameters was completed based on EOS images following 3D modeling. Global and sub-group analyses were completed based on the Roussouly classification. A systematic analysis of post-operative complications was conducted during hospital stay and at follow-up visits.

Results: Complications included 15 cases (20.2%) of bilateral leg pain, with transient neurological deficit in 6 cases (9.5%), and 9 cases (12.5%) of early surgical site infections. Intra-operative complications included five tears of the dura mater and two cases of excessive blood loss (>5,000 mL). Two mortalities occurred from major intracerebral bleeds in the early post-operative period. Mechanical complications were principally non-union (9 cases) and junctional kyphosis (3 cases). All 19 post-operative complications (28.1%) were revised at an average of 2 years following surgery. All mechanical complications were found in the patients who had insufficient imbalance correction and this was mainly associated with high PI (>60°) or a moderate PI (45-60º) combined with excess FBI pre-operatively that remained >10° post-operatively.

Conclusion: Infection and neurologic complications following PSO are relatively common, and frequently reported in the literature. The principal cause of mechanical complications, such as non-union or junctional kyphosis, was insufficient sagittal correction, characterized by post-operative FBI >10°. The risks of insufficient correction are greater in patients with higher pelvic incidence and those patients who required very high correction.

MeSH terms

  • Adolescent
  • Adult
  • Blood Loss, Surgical
  • Cerebral Hemorrhage / mortality
  • Child
  • Child, Preschool
  • Dura Mater / injuries
  • Female
  • Follow-Up Studies
  • Humans
  • Intraoperative Complications*
  • Kyphosis / surgery*
  • Lordosis / surgery*
  • Male
  • Middle Aged
  • Osteotomy / methods*
  • Pain, Postoperative
  • Postoperative Complications*
  • Prospective Studies
  • Reoperation
  • Surgical Wound Infection
  • Young Adult