Pedicle subtraction osteotomy (POS)

[jhk]

Hello everyone.

Recently, I've developed symtpoms, such as clonus, weakness, and stiffness and was told that is was probably due to my kyphosis. They said that the only solution they had for me was a spine reconstruction surgery. They are thinking about performing a T3 Pedicle Subtraction Osteotomy and possibly a T2 PSO. I was told that there is a 25% of death and/or a 50% chance of paralysis. I was wondering if anyone here on this forum had something similar performed. If so, what should I expect? Did you motor functions improve after surgery? Any complications after surgery? Any help or advice would be greatly appreciated.

Thank you,

Ed

[LindaRacine]

Hi Ed...

Those percentages are WAY high, so I'd think about shopping for another surgeon.

Regards,
Linda

[jhk]

Hi Linda.

That is what I thought as well, but my Doctor is from Hopkins. I have a syrinx that lies on the kyphosis as well..could this complicate matters that much? What are the normal risk percentages?

Thank you for your reply!

[LindaRacine]

Hi...

Here are some PSO outcome study abstacts:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14501920&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11884909&query_hl=1&itool=pubmed_docsum

While neither of these studies were for kyphosis, I'm guessing that the oucomes should be approximately the same. The syrinx could definitely add a level of complication, I would definitely seek another opinion to verify.

Regards,
Linda

[Theresa]

Hi Ed,

I had a PSO done at the L3 level about a year and a half ago. The percentages that I was given was no where near what you were given. Mine were much lower.

I had it done for thoracular lumbar kyphosis. I had a little over an inch and a quarter taken out of the spine. It pulled me back upright about 30 degrees.

I had the surgery done on June 2nd and I returned back to work the day after Labor Day. It didn't solve my problems completely. I still have a forward lean and lots of pain. I am going to see Dr. LaGrone in Amarillo on the 12th of December.

[BentMetal]

Is this the same thing (or similar) as an osteotomy for purposes of removing fusion from a previous surgery?

[Theresa]

BentMetal,

Mine was done a year after my previous A/P surgery. Yes, they did cut into the previous fusion.

[BentMetal]

Theresa - Did they remove your fusion from your curve to do the surgery over the same curve again? What is the purpose of a Pedicle subtraction osteotomy? Also, how did they know wherte your spinal cord was when removing the fusion? Thanks.

[Theresa]

BentMetal,

For me the PSO was to correct a forward lean that I had. I couldn't stand straight up without bending my knees. If I remember right, your spinal cord is behind the spine. When they do the cut into your spine it's in a triangle shape. They don't cut all the way through. It's the same process if you were you chop down a tree. They basically chisel into the spine from a top angle and a bottom angle. Another way you could look at it; the way you cut a piece of pie or cake. My screws and rod segments were removed in that area and then replaced with new ones to pull the two ends of the spine back together.

I don't know if I'm explaining this very well. There is a real good description on a website. I'll find it and put it on here in a minute.

[BentMetal]

Thanks Theresa. I'd like to see it. I saw a Doc who said that the risk of paralysis was too high in removing enough fusion on my upper curve to re-do the surgery. I wish I could do it to reduce a 40 degree curve. I know a lot of folks would say it's not worth it, but if it can be done; I can endure the pain :eek: The doc said that "they" are working on a new MRI which would tell him where my spinal cord is in relation to the uneven fusion (7 verts). He said they are 1 year from sending the machine to a couple of top hospitals.

[jhk]

Theresa,

Thanks for telling me about your surgery. Do you remember the percentage of risks involved? Any other advice about the surgery? My kyphosis is causing major stiffness, which has caused weakness and instability in my walking. They said the spinal cord looked tight and that this should alleviate the symptoms I am having. About 18 years ago, I had a fusion done and it has held well. They are going to have to break the fusion, do the PSO, and then place the rods and screws in. After this surgery, my Doctor said I might have to have another surgery to place a shunt in a syrnix.



Thanks,

Ed

[LindaRacine]

BentMetal,

For me the PSO was to correct a forward lean that I had. I couldn't stand straight up without bending my knees. If I remember right, your spinal cord is behind the spine. When they do the cut into your spine it's in a triangle shape. They don't cut all the way through.
Hi Theresa...

I actually got to watch a PSO about 8-10 years ago, and was surprised when I saw the spinal cord. It was a scary moment.

You can see drawings of PSO and other osteotomies here:

http://www.spineuniverse.com/displayarticle.php/article858.html

Regards,
Linda

[Theresa]

Linda,

Was that a PSO in the lumber area or thorasic area? I thought they said in the lumbar area the spinal cord was behind the spine and further back so the risks weren't as great as a thorasic PSO.

The was the drawings that I was thinking of.

[LindaRacine]

Hi Theresa...

It was a thoracic PSO. The spinal cord stops at L1.

The spinal cord always is in the center of the vertebrae, in the hole between the "body" and the posterior elements. You can see a diagram here:

http://www.sandiego-spine.com/image/sdcsd/vertebrae.jpg

--Linda

[Theresa]

That's probably why my risks were so much lower. My PSO was done at L3.