Management of fixed sagittal plane deformity - Results of the transpedicular wedge resection osteotomy

Study Design. Retrospective review of a consecutive clinical series. Objectives. To evaluate the efficacy of the transpedicular wedge resection osteotomy as a technique for correction of sagittal and coronal deformity and to assess the clinical value of the procedure as assessed by patient satisfaction. Summary of Background Data. The transpedicular wedge resection osteotomy is a well-established procedure for management of fixed sagittal deformity in ankylosing spondylitis. The utility of the procedure for applications in fixed deformity other than ankylosing spondylitis has not been demonstrated, and the efficacy of the procedure in the correction of coronal deformity has not been reported. Methods. A total of 13 consecutive cases undergoing transpedicular wedge resection osteotomy for the management of sagittal deformity of any etiology were reviewed. Radiographic studies, complications, and satisfaction assessment using the modified Scoliosis Research Society instrument were the outcome parameters measured. Results. Etiologies of deformity included postsurgical, ankylosing spondylitis, idiopathic, and infectious. Measurement of C7 sagittal plumb line to sacrum improved 63% at the most recent follow-up. Lumbar lordosis increased from -15.5 degrees to -45.4 degrees. Coronal balance was improved in all patients who had preoperative imbalance, with an average improvement of 60% maintained at follow-up. Patient satisfaction was high in all patients and not dependent on the etiology of deformity. Conclusions. The transpedicular wedge resection osteotomy is an effective procedure for the management of fixed sagittal deformity and is generalizable for multiple etiologies. Simultaneous correction of coronal deformity is possible. The clinical value of the procedure is demonstrated in high rates of patient satisfaction.