The dome pelvis osteotomy as alternative for pedicle subtraction osteotomy in patients with loss of lumbar lordosis.

Introduction The aim of this study was to investigate the possible correction of the pelvic sacral angle (PSA) with a dome pelvis osteotomy (DPO) as alternative for a pedicle subtraction osteotomy (PSO) in patients with loss of lumbar lordosis (LL). Methods Three DPO types were performed on 10 human pelves in an in-silico study using Materialise 3-matic. The ADPO was chosen as the best and was tested on a saw bone using a patient-specific 3D modelled saw guide. The PSA and bone contact were assessed on CT scans. Results The cranial pelvic part was rotated with 20 degrees, resulting in a PSA correction of 20 degrees and a respective mean bone contact of 34% (SD 9%), 28% (SD 10%), and 31% (SD 5%) for the SEDPO, SIDPO, and ADPO. The ADPO on the saw bone test resulted in 4 degrees PSA deviation and 3% bone contact deviation from the planning. Conclusion The ADPO proved to be technically effective and practically feasible. A cadaveric study and clinical study are required to determine the anatomical viability and safety in humans. The DPO is regarded as a useful tool in the orthopedic arsenal for spinal alignment surgery based on in-silico and practical tests.