Less is more: complication rates and outcome measures of intradiscal osteotomy versus pedicle subtraction osteotomy in adult spinal deformity

OBJECTIVE Intradiscal osteotomy (IDO), which is used for the treatment of spinal deformities, involves a three-column release that creates lordosis. It is believed to be as effective as pedicle subtraction osteotomy (PSO). The authors of this study compared the two techniques in restoring sagittal balance and evaluated their safety profiles. METHODS They conducted a retrospective database review of patients who had undergone long construct fusions from 2016 to 2022. Long construct fusions were defined as having an upper instrumented vertebra of L2 or higher and a lower instrumented vertebra of S1 or the pelvis. The study included only those patients with lumbar degenerative disease, evidence of fusion at the treatment level on preoperative imaging, and 2 years of follow-up. RESULTS Fifty-three patients met the study inclusion criteria, of whom 28 had undergone IDO and 25 had undergone PSO. The IDO cohort had a 3.6% frequency of proximal junctional kyphosis (PJK), 17.9% frequency of hardware failure (HF), 10.7% frequency of deep vein thrombosis (DVT), 3.6% frequency of wound infection, and 10.7% frequency of pseudarthrosis. The PSO cohort had a 4.0% incidence of PJK, 28.0% incidence of HF, 16.0% incidence of DVT, 4.0% incidence of wound infection, and 12.0% incidence of pseudarthrosis. The average postoperative sagittal vertical axis (SVA) for the PSO group was 7 cm, whereas the average for the IDO group was 5 cm (p = 0.01). Patients who had undergone IDO reported less back pain on their visual analog scale assessments at 3 months postoperatively (p = 0.01). The IDO cohort had an average operative time (OT) of 7 hours and estimated blood loss (EBL) of 800 ml, whereas the PSO group had an OT of 8.5 hours (p = 0.01) and EBL of 1400 ml (p = 0.01). CONCLUSIONS IDO can be as effective as PSO in lordosis restoration and is a powerful technique for SVA correction (p = 0.01), significantly improving postoperative back pain, as compared with PSO (p = 0.01), while maintaining a similar risk profile.