Transpedicular Decompression and Pedicle Subtraction Osteotomy: Review of 101 Patients

· (a - Surgical Dynamics)

Houston, Texas; Charlotte, NC; Statesville, NC; USA

PURPOSE:
We evaluated the effectiveness of transpedicular decompression with or without pedicle subtraction osteotomy in terms of neurological outcome, effectiveness of correction, stability of fusion, complication rates, and outcomes.

METHODS:
Chart review of 101 consecutive cases between 1990 and 1998 was carried out. Those available underwent interview, physical examination, and x-rays. Outcome data were collected using SF-36 and SRS instruments.

RESULTS:
Of the 101 patients, 76 had >2 year follow-up with an average of 6.0 +/- 1.9 years. Fourteen patients died and 26 were lost to follow-up. The remaining 61 were interviewed, examined, and radiographed. Chart review was performed on all 101 patients. Forty-two patients had the procedure for acute trauma, 37 for deformity and 22 for tumor or infection.

No patients experienced worsening of neurological deficit from the procedure alone although one patient who underwent treatment of a syrinx at the same time had increased spasticity compared to pre-op. All patients with incomplete spinal cord injuries improved.

All patients achieved solid fusion radiographically and no loss of correction over time was identified. No overcorrection was identified. Instrument failure rate was less than 3%. Systemic complication rates were low with a pulmonary complication rate of less than 4%. There were no perioperative deaths. Blood loss averaged 1989cc ± 1899cc with higher losses seen in deformity cases and lower losses seen with acute trauma. Outcomes measured using the SF-36 and SRS questionnaires showed sex differences when correlating against length of follow-up. For women, self-image and general function scores decreased with increasing time from surgery. For men, function-related domains improved with increasing time from surgery. For both men and women, physical function, role physical, bodily pain, and general health were significantly lower than normal subjects of the same age, even at longer term follow-up.

Two-thirds of patients used only NSAIDs or no pain medication. Less than 20% of patients used narcotics frequently. Patient satisfaction was high with 92.9% of patients relatively or completely satisfied with their results and 98% would recommend the procedure to another patient in similar circumstances.

CONCLUSION:
Overall, the results suggest that this procedure is a reliable and safe way to achieve anterior decompression of the spinal canal and posterior stabilization through a single approach.