• Abdulmajeed Alzakri, Louis Boissière, Derek T Cawley, Anouar Bourghli, Vincent Pointillart, Olivier Gille, Jean-Marc Vital, and Ibrahim Obeid.
• Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. a.alzakri@gmail.com.
• Eur Spine J. 2018 Mar 1; 27 (3): 644-651.

PurposeTo evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment.MethodsA retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected.ResultsAll surgeries were revision surgeries. The mean lumbar lordosis before surgery was - 22.5° (range, 8° to - 33°) and improved to - 58.5° (range, - 40° to - 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage.ConclusionsPSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.

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