Journal of Korean Society of Geriatric Neurosurgery 2016;12(2):168-172.
Published online September 30, 2016.
Surgical Result of Corrective Osteotomy for Post-fusion Lumbar Flatback Deformity in Elderly Patients
Jin Seong Kim1 , Sung Min Kim2
1Department of Neurosurgery, Kyung Hee University Graduate School, Seoul, 2Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
Abstract
Objective
To review the radiographic and clinical results of patients with post-fusion lumbar flatback deformity treated with lumbar osteotomies.
Methods
Fourteen elderly patients underwent corrective osteotomies. All patients were divided into 2 groups, LL ≥ pelvic incidence (PI)+10°, LL from PI+9° to PI-9°. Two groups were compared for PI-LL mismatch, sagittal vertical axis (SVA), and pelvic tilt (PT). Clinical outcomes were reviewed.
Results
Mean age was 71.6 years, and follow-up was 27 months. The mean LL was 5.8±18.0° kyphosis before surgery, which increased to -60.7±6.5° lordosis after surgery and was well maintained at -60.3±10.1° at the final follow up. The PI-LL mismatch was 62.6±19.1° preoperatively, -3.1±9.1° after surgery, and was well maintained at -2.4±8.8° at the final follow up. Likewise, the SVA was 182.8±76.9 mm preoperatively, 7.9±30.2mm after surgery, and 23±29.6mm at the final follow up. The PI+10° group showed the great improvement in radiological and clinical outcome at postoperative 1 month and at the final follow up. The mean scores for the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22r) patient questionnaire were improved at the final follow-up.
Conclusion
For restoration and maintenance of normal sagittal balance, postoperative lumbar lordosis should be greater than PI+9°. Patient satisfaction with surgery and overall clinical outcomes are excellent.
Key Words: Post-fusion lumbar flatback deformity, PSO, multilevel SPOs with ALIFs, Clinical Outcomes


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