Saturday, October 13, 2007

Pedicle Subtraction Osteotomy (PSO) to correct "Flat Back Syndrome": Hey Clinic Surgery Oct 8 2007

This 61 yo woman had a long spinal fusion performed down to the pelvis elsewhere, and has had severe flat back syndrome, with leaning forward posture, upper and lower back pain, and bilateral thigh pain and difficulty walking more than short distances. She suffered with severe fatigue, needing to walk with her knees slightly flexed.
To fix this problem, we performed a L3 pedicle subtraction osteotomy (PSO), where a wedge of L3 was removed, and the gap was then closed to recreate her lumbar lordosis. Her preoperative lumbar lordosis was less than 15 degrees. Her intraoperative lumbar lordosis after performing the osteotomy was 62 degrees. At the end of surgery after the incision was closed you could immediately see the results. Preoperatively, her thoracic and lumbar spine were totally flat, along with her buttock ("washboard") After surgery, she had a nice gentle curvature in the lumbar spine, with a more normal-appearing buttock.
Her surgery went quite well, taking approximately 5 hours, with 1200 cc blood loss, using cell saver machine to recycle the blood on the surgical field.
Postoperatively, she has done just great. On her first day after surgery, she stood up perfectly straight, and her leg pain was gone. She was all smiles.
She went home Friday, on her fourth hospital day at Duke Raleigh Hospital. On Friday, she was just beaming, feeling that she was starting a whole new life.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh NC USA

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