Domino connector for thoracic pedicle subtraction osteotomy reduction: surgical technique and patient series

• Published in: European spine journal Vol. 32; no. 5; pp. 1800 - 1809
• Main Authors: Bourghli, Anouar, Boissiere, Louis, Konbaz, Faisal, Larrieu, Daniel, Almusrea, Khaled, Obeid, Ibrahim
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2023; Springer Nature B.V
• Subjects: Adult; Complications; Female; Follow-Up Studies; Humans; Kyphosis; Kyphosis - diagnostic imaging; Kyphosis - surgery; Lordosis - surgery; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Osteotomy; Osteotomy - methods; Postoperative; Retrospective Studies; Spine (lumbar); Spine (thoracic); Surgical Orthopedics; Surgical site infections; Surgical techniques; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Treatment Outcome; Domino connector; Sagittal alignment; Adult spinal deformity; Thoracic kyphosis; Pedicle subtraction osteotomy
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-023-07650-3

Purpose
Different techniques have been previously described to close the pedicle subtraction osteotomy (PSO) site for correction of sagittal malalignment; the use of a side-to-side domino connector as a correction tool in the thoracic spine has not been specifically studied.
Methods
Twenty adult patients who underwent single-level thoracic PSO from T1 to T12 were included and retrospectively reviewed (two centers). Preoperative and postoperative full-body X-rays, perioperative data, clinical data and complications were recorded with a minimum 2 years of follow-up. Surgical technique and the nuances in using the domino connector were described in detail.
Results
Patients had a mean age of 40y; 40% were female. Two different techniques involving the domino were applied for closure of the PSO site depending on the type of kyphosis (smooth vs. angular deformity). Both techniques provided significant correction of the local kyphosis (from 48° to 18°) with reciprocal reduction of compensatory cervical lordosis (from 37.6° to 18.6°,
p
 < 0.01) in upper thoracic PSO or lumbar lordosis (from 74.5° to 46.6°,
p
 < 0.01) in lower thoracic PSO. Four patients presented postoperative complications that resolved (hemothorax, GI bleeding), and two patients presented transient neurological deficit. Oswestry Disability Index score improved in the majority of the patients (from 32.7 to 22.5,
p
 < 0.05). There were no pseudarthroses, symptomatic instrumentation breakage, or surgical site infection.
Conclusion
Use of a side-to-side domino connector in combination with two different rod cantilever techniques is effective for the reduction of thoracic pedicle subtraction osteotomy achieving satisfactory radiological and clinical outcome.