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DOI: 10.1055/s-0039-1693723
Four-rod Technique Stabilization after Pedicle Subtraction Osteotomy (PSO) for the Treatment of Thoracolumbar Hyperkyphosis Secondary to Pott Disease: A Two-Year Follow-Up Case Report
Técnica das quatro hastes após osteotomia de subtração pedicular para o tratamento de hipercifose toracolombar secundária à doença de Pott: Relato de caso de dois anos de seguimento Funding The authors received no financial support for the research, authorship, and/or publication of the present article.Publikationsverlauf
03. April 2019
12. Juni 2019
Publikationsdatum:
02. August 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028832/201903/lookinside/thumbnails/10-1055-s-0039-1693723_1900023-1.jpg)
Abstract
Pedicle subtraction osteotomy (PSO) is a powerful tool for the management of sagittal misalignment. However, this procedure has a high rate of implant failure, particularly rod breakages. The four-rod technique diminishes this complication in the lumbar spine. The aim of the present study is to provide a case report regarding PSO and four-rod technique stabilization in the treatment of short-angle hyperkyphosis in the thoracolumbar (TL) junction. The authors describe the case of a patient with TL hyperkyphosis secondary to spinal tuberculosis treated with L1 PSO and fixation with a four-rod technique. There were no major surgical complications. The self-reported quality of life questionnaires (the Short-Form Health Survey 36 [SF-36] and the Oswestry disability index) and radiological parameters were assessed preoperatively, as well as 6, 12 and 24 months after surgery, and they showed considerable and sustained improvements in pain control and quality of life. No hardware failure was observed at the two-year follow-up.
Resumo
A osteotomia de subtração pedicular (OSP) é uma ferramenta importante no manejo de doenças com desalinhamento sagital. Entretanto, este procedimento apresenta altas taxas de falência do instrumental, em especial a quebra de hastes. A técnica de fixação com quatro hastes reduz essa complicação na região lombar. O objetivo deste estudo é relatar um caso de hipercifose na transição toracolombar (TL) tratado com OSP e estabilização com a técnica das quatro hastes. Os autores descrevem o caso de uma paciente com hipercifose TL secundária a tuberculose espinhal, tradada com PSO e fixação com a técnica das quatro hastes. Não houve complicações cirúrgicas maiores. Os questionários autorrelatados de qualidade de vida (Short-Form Health Survey 36 [SF-36] e índice de incapacidade de Oswestry) e os parâmetros radiográficos foram avaliados no pré-operatório e 6, 12 e 24 meses após a cirurgia, e demonstram considerável e estável melhora na qualidade de vida e no controle da dor da paciente. Não houve falência da instrumentação após 2 anos de seguimento.
Keywords
pedicle subtraction osteotomy - kyphosis - spinal tuberculosis - four-rod technique - postoperative complications - thoracolumbar spinePalavras-chave
osteotomia de subtração pedicular - cifose - tuberculose da coluna vertebral - técnica das quatro hastes - complicações pós-operatórias - coluna toracolombarEthical approval and consent to participate
The medical ethics committee of the Medical Sciences Center at Universidade Federal da Paraíba approved this study under the following registration number: CAAE 89898718.3.0000.8069. Before and during the present study, informed consent was obtained from the participant after a brief discussion and explanation.
Consent for publication
Written informed consent was obtained from the patient for the publication of this case report and its accompanying images.
Availability of data and materials
The data and materials used during the present study are available from the corresponding author on reasonable request.
Competing interests
The authors report no competing interests concerning the materials or methods used in the present study or the findings specified in this paper.
Author contribution
AB was in charge of patient management. He also wrote the case summary, and was responsible for supervising, correcting and proof-reading the writings of other authors. SP was involved in writing the manuscript alongside AB, as well as in maintaining patient follow-up. TT was involved in patient management; she supervised and proof-read the writings of other authors as well. RN participated in the writings of the discussion session. All authors read and approved the final manuscript.
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