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Preoperative simulation of pedicle subtraction osteotomy for treating sagittal deformity of the spine-Comparison of prediction accuracy of 2 computerized protocols
摘要
Introduction: Pedicle subtraction osteotomy (PSO) is a powerful technique to correct sagittal malalignment of the spine. Inadequate correction during PSO may lead to poor functional outcome. Purpose: We used Surgimap to prove the efficacy of preoperative simulation. Methods: Two protocols of preoperative simulation were compared for their prediction accuracy of sagittal parameters including pelvic incidence minus lumbar lordosis (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA) in twenty-four patients. PT method targeted 20° of PT postoperatively. Fixed wedge angle (FWA) method aimed to simulate a 30° wedge correction at the level of PSO. The location of PSO was decided by the results of simulation. The differences between these two methods were evaluated by Student’s t-test. Results: PT method could predict post-operative SVA, PI-LL and PT more accurately than FWA method although statistical significance was shown only in the SVA parameter. The achievement rate was around 80% in three parameters by PT method. Larger variation of achievement rates was noticed in FWA method (59.9–80.2%). The difference of osteotomy angle (proposed osteotomy angle according to simulation minus actual osteotomy angle) was significantly smaller in PT method (3.25 ± 1.42°) than in FWA method (7.17 ± 5.39°). Conclusion: PT method could provide more reliable simulation of PSO than FWA method, even though computerized simulation software did not take possible reciprocal changes in the unfused segments into considerations. PT method of simulation could provide suggestions of PSO location and angle for pre-operative planning of PSO. Since sagittal parameters are highly correlated to clinical functions, better outcomes could be expected if accurate correction is achieved.
延伸閱讀
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