Sagittal deformity correction and Patient Reported Outcomes with Schwab 4 osteotomy and a large footprint cage

Sunday, May 5, 2024

2:18 PM – 2:20 PM CT

Location: Booth 745 Neuro Spotlight

Presenting Author(s)

Esteban Quiceno Restrepo, MD

Spine fellow
University at Buffalo Neurosurgery
Buffalo, NY, US

Co-Author(s)

EH

Eisa Hashmi, BS

Medical Student
University at Buffalo Neurosurgery, United States
AK

Asham Khan, MD

Neurosurgery Resident
University at Buffalo Neurosurgery, United States
Jeffrey Mullin, MD

Assistant Professor
University of Buffalo
Buffalo, NY, US
BO

Bernard Okai, BS

Medical Student
University at Buffalo, United States
John Pollina, MD

Vice Chairman Director of Spine Surgery Director of Fellowship, Spine Surgery Associate Professor
University at Buffalo Neurosurgery
Williamsville, New York, United States
Mohamed AR Soliman, MD

Neurosurgeon
University of Buffalo
Buffalo, NY, US

Disclosure(s):

Esteban Quiceno Restrepo, MD: No financial relationships to disclose

John Pollina, MD: No financial relationships to disclose

Mohamed AR Soliman, MD: No financial relationships to disclose

Introduction: Modified subtraction osteotomy techniques are sometimes underutilized due to
reported high morbidity rates and a lack of clear data regarding patient-reported outcomes. This
study aims to present our experience with the Schwab 4 osteotomy using a large footprint cage and explore the associated
radiographic and patient reported outcomes.

Methods: Patients were included if they underwent a Schwab Type IV osteotomy, and the addition of a lordotic cage with a large footprint at the
osteotomy site. We recorded patient demographics, surgical variables, preoperative and postoperative radiographic parameters, and patient outcomes.

Results: The retrospective analysis included data from 26 patients who had a follow up of at least 6 months’ post op. The patient
mean age was 65.2+/-7.8 years, the average intraoperative bleeding was 1684 ± 625 ml, surgical duration averaged 532 ± 72 minutes, and the mean number of fused levels was 10.26±3.35. Ten patients (38%) experienced postoperative complications, with surgical site infections being the most common (40%), followed by deep vein thrombosis and delirium (20% each). Radiographic parameters showed significant improvement after surgery: sagittal vertical axis mean change was 6.7 ± 0.7 cm (p < 0.001) and lumbar mismatch change was 32+/- 14° (p < 0.001), the change in segmental lordosis was 38+/-10° (p < 0.001).
Patient-reported outcomes also improved significantly, with the Oswestry disability index decreasing from 35 ± 8 to 22 ± 9 (p < 0.001), and the SRS-22r demonstrating increased satisfaction in pain (0.99±1.3, p < 0.00 1), self-image (1.03±0.86, p< 0.001) activity (0.31, p < 0.001), function (0.84±0.7, p< 0.001), and satisfaction with management (1.38±1.29 p< 0.001).

Conclusion : The Schwab 4 osteotomy, despite its associated morbidity, demonstrated significant improvements in patient-reported outcomes and radiographic parameters. This technique can positively impact the quality of life for patients with severe sagittal misalignment who have
previously undergone multiple surgical procedures.