The Outcome of Pedicle Subtraction Osteotomy (PSO) For the Correction of Post-Traumatic and Post-Tubercular Kyphotic Deformity
Anowarul Islam*, Mohoshin Sarker, Suvradev Saha, Naiemuzzaman Siddique and Afia Ibnat Islam
Introduction: Pedicle subtraction osteotomy (PSO) is one of the well-established and well-known techniques for kyphosis correction.
Objective: Objective of our study is to analyze the clinical and radiological outcomes of PSO in terms of VAS to access the pain relief, ODI to assess the functional outcome, and the ASIA impairment scale for preoperative and postoperative assessment of neurology. The per-operative and postoperative complications related to surgery, access radiological correction of deformity in terms of kyphosis angle, and postoperative fusion status.
Method: Ten patients with dorso-lumbar kyphosis (5 post-tubercular and 5 post-traumatic) were followed up for an average of 2 years after PSO. They were assessed prospectively for clinico-radiological and functional outcomes. The neurological deficit, cosmetic deformity & back pain were the major complaints among the study population.
Result: For the post-tubercular kyphosis group, the mean pre-operative kyphosis angle was 67.5°±10.4° and 14.9°±6.1° postoperatively, with significant improvement (p<0.001) at a mean follow-up of 24 months. The mean ODI improved from 44.1±12.4 pre-operatively to 21.1±7.1 at the latest follow-up. Pre-operative VAS was 8.9±2.5, with a significant improvement of 1.5±1 in the final follow-up. For the post-traumatic kyphosis group, the mean pre-operative kyphosis angle was 33.7°±4.5° and 3.8°±3.4° postoperatively, with a significant improvement (p<0.001). Here the mean ODI improved from 37±2.5 pre-operatively to 6.0±1.9 at the latest follow-up. Pre-operative VAS was 8.4±1 with a significant improvement of 1.25±1 in the last postoperative follow-up. Fusion was achieved in all cases. Transient neurological deficit was found in 1 patient who became normal after 3 months. All patients had ASIA grade “E” at last follow-up. There were no significant intraoperative major complications in this group either, except a few minor complications.
Conclusion: A greater degree of kyphotic correction (>40°) can be obtained with a single pedicle subtraction osteotomy at the dorso-lumbar level with minimal neurological complications.