Transpedicular Osteotomy in Revision Scoliosis Surgery

Methods: We evaluated patients undergoing TPO for revision scoliosis surgery at our institution between 1989 and 2004 with a minimum follow up of 2 years. Demographic data, anaesthetic risk factors, peri-operative data and complications were recorded. Radiographs pre-operatively, post-operatively and at last follow up recorded sagittal balance, coronal balance, lumbar lordosis and pelvic parameters. Functional outcome was measured using the Whitecloud score.

Results: 21 patients (24 TPO's) mean age 48.7 years with mean follow up 4.4 years fulfilled criteria for study. All cases had fixed sagittal imbalance pre-operatively. Mean operative time was 4.6 hours and mean transfusion requirement was 2.3. units. A significant improvement (p<0 .03) in sagittal imbalance was gained (although 3 cases of pseudarthroses this partially lost) and the post-operative lumbar lordosis correlated closely significantly pelvic incidence (p<0.03). Functional outcome good/excellent 67% cases. We report 28 complications. 22 early included 4 dural tears, cardiac decompensation with reduction, 5 neurological deficits including one secondary to haematoma which evacuated patient made a good recovery at 6 months, 2 UTIs, IVI infection, superficial wound infection extension metalwork due proximal decompensation. Late complications (8 years), removal prominent metalwork, radiculopathy screw (6 months) pseudarthroses. There no statistically significant correlation complication weight, ASA grade or smoking.

Conclusion: TPO in revision scoliosis is an effective method of correcting both coronal and sagittal imbalance but is not without complication, although good functional outcome is achieved in most patients. It is important to consider pelvic parameters pre-operatively to plan the level and magnitude of TPO required.