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Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up

Journal of Korean Neurosurgical Society 2019년 62권 5호 p.567 ~ 576
김용찬, 김기택, 김충규, 황형서, 진우영, Lenke Lawrence G., 차재룡,
소속 상세정보
김용찬 ( Kim Yong-Chan ) - Kyung Hee University Hospital at Gangdong Department of Orthopaedic Surgery
김기택 ( Kim Ki-Tack ) - Kyung Hee University Hospital at Gangdong Department of Orthopaedic Surgery
김충규 ( Kim Cheung-Kue ) - Kyung Hee University Hospital at Gangdong Department of Orthopaedic Surgery
황형서 ( Hwang Hyung-Seo ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Orthopedic Surgery
진우영 ( Jin Woo-Young ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Orthopedic Surgery
 ( Lenke Lawrence G. ) - University of Arkansas for Medical Sciences Department of Orthopaedic Surgery
차재룡 ( Cha Jae-Ryong ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Orthopedic Surgery

Abstract


Objective: Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection.

Methods: Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/ six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5-10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed.

Results: Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05).

Conclusion: Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.

키워드

Spine; Joint deformities, Acquired; Osteotomy; Pseudarthrosis; Conservative management

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