Journal of Korean Neurosurgical Society

  • 제62권5호
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  • Pages.567-576
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  • 2019
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up

  • Kim, Yong-Chan (Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine) ;
  • Kim, Ki-Tack (Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine) ;
  • Kim, Cheung-Kue (Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine) ;
  • Hwang, Il-Yeong (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jin, Woo-Young (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lenke, Lawrence G. (Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences) ;
  • Cha, Jae-Ryong (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 투고 : 2018.09.29
  • 심사 : 2019.01.15
  • 발행 : 2019.09.01
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초록

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.

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참고문헌

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