TY - JOUR
T1 - Clinical and radiographic outcomes after 3-column osteotomies with 5-year follow-up
AU - Oêneill, Kevin R.
AU - Lenke, Lawrence G.
AU - Bridwell, Keith H.
AU - Hyun, Seung Jae
AU - Neuman, Brian
AU - Dorward, Ian
AU - Koester, Linda
PY - 2014/3/1
Y1 - 2014/3/1
N2 - STUDY DESIGN.: Retrospective review of prospective database. OBJECTIVE.: To investigate long-term results after 3-column osteotomies (3-CO). SUMMARY OF BACKGROUND DATA.: Short-term studies have noted improved outcomes and alignment after 3-CO, but there is a paucity of long-term studies with a large group of patients. METHODS.: An analysis of 126 patients who underwent a 3-CO (pedicle subtraction osteotomy [N = 101]/vertebral column resection [N = 25]) with minimum 5-year follow-up was performed at a single institution. The mean age was 48 years (range, 8-79 yr) and average follow-up was for 7 years (range, 5-14 yr). Oswestry Disability Index and Scoliosis Research Society (SRS) scores and radiographical parameters were assessed at baseline, 6 weeks, and 1, 2, 3, and/or 5 years postoperatively and complications were recorded. RESULTS.: Sagittal alignment improved at all postoperative time points from baseline (mean, 117 mm), but diminished from 6 weeks (mean, 24 mm) to 5 years (mean, 41 mm; P = 0.03). Average coronal alignment was improved from baseline (27 mm) at 6 weeks (18 mm; P = 0.003) and 5 years postoperatively (19 mm; P = 0.007), with no deterioration between 6 weeks and 5 years postoperatively (P = 0.9). Major surgical complications occurred in 36% (n = 45) and major repeat surgery was performed in 28% (n = 35). Significant improvements (P < 0.05) in Oswestry Disability Index and all SRS domain scores were found at each time point. All mean outcome scores at 5 years postoperatively exceeded minimal clinically important difference thresholds except the SRS function domain. Improvement in outcomes at 5 years postoperatively was similar in groups with major surgical complications versus those without and in those with reoperation versus those without. CONCLUSION.: This study of 126 patients undergoing 3-CO found significant and sustained improvements in Oswestry Disability Index and SRS scores and sagittal alignment at a minimum 5 years postoperatively. This demonstrates the durability of these complex spinal reconstructions, even surprisingly in those patients having a major complication and/or revision surgery.Level of Evidence: 4
AB - STUDY DESIGN.: Retrospective review of prospective database. OBJECTIVE.: To investigate long-term results after 3-column osteotomies (3-CO). SUMMARY OF BACKGROUND DATA.: Short-term studies have noted improved outcomes and alignment after 3-CO, but there is a paucity of long-term studies with a large group of patients. METHODS.: An analysis of 126 patients who underwent a 3-CO (pedicle subtraction osteotomy [N = 101]/vertebral column resection [N = 25]) with minimum 5-year follow-up was performed at a single institution. The mean age was 48 years (range, 8-79 yr) and average follow-up was for 7 years (range, 5-14 yr). Oswestry Disability Index and Scoliosis Research Society (SRS) scores and radiographical parameters were assessed at baseline, 6 weeks, and 1, 2, 3, and/or 5 years postoperatively and complications were recorded. RESULTS.: Sagittal alignment improved at all postoperative time points from baseline (mean, 117 mm), but diminished from 6 weeks (mean, 24 mm) to 5 years (mean, 41 mm; P = 0.03). Average coronal alignment was improved from baseline (27 mm) at 6 weeks (18 mm; P = 0.003) and 5 years postoperatively (19 mm; P = 0.007), with no deterioration between 6 weeks and 5 years postoperatively (P = 0.9). Major surgical complications occurred in 36% (n = 45) and major repeat surgery was performed in 28% (n = 35). Significant improvements (P < 0.05) in Oswestry Disability Index and all SRS domain scores were found at each time point. All mean outcome scores at 5 years postoperatively exceeded minimal clinically important difference thresholds except the SRS function domain. Improvement in outcomes at 5 years postoperatively was similar in groups with major surgical complications versus those without and in those with reoperation versus those without. CONCLUSION.: This study of 126 patients undergoing 3-CO found significant and sustained improvements in Oswestry Disability Index and SRS scores and sagittal alignment at a minimum 5 years postoperatively. This demonstrates the durability of these complex spinal reconstructions, even surprisingly in those patients having a major complication and/or revision surgery.Level of Evidence: 4
KW - 3-column osteotomy
KW - adult spinal deformity
KW - clinical outcomes
KW - complications
KW - osteotomy
KW - patient-reported outcomes
KW - pedicle subtraction osteotomy
KW - radiographical outcomes
KW - spinal deformity
KW - vertebral column resection
UR - http://www.scopus.com/inward/record.url?scp=84896350999&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000000156
DO - 10.1097/BRS.0000000000000156
M3 - Article
C2 - 24573074
AN - SCOPUS:84896350999
SN - 0362-2436
VL - 39
SP - 424
EP - 432
JO - Spine
JF - Spine
IS - 5
ER -