TY - JOUR
T1 - Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients
T2 - Retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Klineberg, Eric
AU - Lafage, Virginie
AU - Schwab, Frank
AU - Lafage, Renaud
AU - Kim, Han Jo
AU - Hostin, Richard
AU - Mundis, Gregory M.
AU - Gupta, Munish
AU - Liabaud, Barthelemy
AU - Scheer, Justin K.
AU - Diebo, Bassel G.
AU - Protopsaltis, Themistocles S.
AU - Kelly, Michael P.
AU - Deviren, Vedat
AU - Hart, Robert
AU - Burton, Doug
AU - Bess, Shay
AU - Ames, Christopher P.
N1 - Funding Information:
The International Spine Study Group (ISSG) is funded through research grants from DePuy-Synthes. Dr. Smith reports consultant relationships with Zimmer Biomet and NuVasive, receipt of clinical or research support for non–study-related effort as well as for the study described from DePuy Synthes, and fellowship funding from AOSpine and NREF. Dr. Shaffrey reports consultant relationships with Medtronic, NuVasive, Zimmer-Biomet, K2M, and Stryker; direct stock ownership in NuVasive; patent holder relationships with Medtronic, Nuvasive, and Zimmer-Biomet; and support of non–study-related clinical or research effort from DePuy-Synthes. Dr. Klineberg reports consultant relationships with DePuy-Synthes and Stryker and receipt of honoraria from K2M and a spine fellowship grant from AOSpine. Dr. LeFage reports direct stock ownership in Nemaris, Inc.; a consultant relationship with NuVasive, Inc.; support of non–study-related clinical or research effort from NuVasive, Stryker, K2M, DePuy Spine (paid through ISSGF), and SRS; and speaking/teaching arrangements with K2M, MSD, Medicrea, NuVasive, and DePuy Spine. Dr. Schwab reports ownership in Nemaris Inc.; consultant and teaching/speaking relationships with Zimmer Biomet, Medicrea, NuVasive, K2M, and MSD; patent holder relationships with K2M and MSD; and support of non–study-related research or clinical effort from NuVasive, Stryker, K2M, and DePuy Spine (paid through ISSGF). Dr. Hostin reports a consultant relationship with DePuy-Synthes and receipt of clinical or research support for the study described from DePuy-Synthes, NuVasive, Seeger, DJO, and K2M. Dr. Mundis reports consultant relationships with NuVasive, K2M, and DePuy-Synthes and patent holder relationships with NuVasive and K2M. Dr. Gupta reports consultant relationships with DePuy, Medtronic, and Orthofix; receipt of royalties from DePuy; and direct stock ownership in Pfizer, Johnson & John- son, and Proctor & Gamble. Dr. Protopsaltis reports consultant relationships with Medicrea, Globus, and Innovasis and support for non–study-related clinical or research effort from Zimmer Biomet. Dr. Kelly reports grants/research support to his institution from OREF, Barnes Jewish Foundation, AOSpine, CSRS, Fox Family Foundation, Cerapedics, and PCORI. Dr. Deviren reports a consultant relationship with NuVasive, ownership in Guidepoint, and fellowship grant support paid to his institution from Globus, NuVasive, and AOSpine North America. Dr. Burton reports receipt of royalties and clinical or research support from DePuy for the study described. Dr. Bess reports consultant relationships with K2, NuVasive, and Allosource; patent holder relationships with K2 and Innovasis; and clinical or research support from DePuy-Synthes for the study described. Dr. Ames reports consultant relationships with Stryker, DePuy, and Medtronic; a patent holder relationship with Fish & Richardson, P.C.; and receipt of royalties from Stryker and Biomet Spine.
Publisher Copyright:
© 2017 AANS.
PY - 2017/10
Y1 - 2017/10
N2 - OBJECTIVE Although 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with high complication rates. The authors' objective was to assess complications associated with ASD surgery that included 3CO based on a prospectively collected multicenter database. METHODS This study is a retrospective review of a prospectively collected multicenter consecutive case registry. ASD patients treated with 3CO and eligible for 2-year follow-up were identifed from a prospectively collected multicenter ASD database. Early (= 6 weeks after surgery) and delayed (> 6 weeks after surgery) complications were collected using standardized forms and on-site coordinators. RESULTS Of 106 ASD patients treated with 3CO, 82 (77%; 68 treated with pedicle subtraction osteotomy [PSO] and 14 treated with vertebral column resection [VCR]) had 2-year follow-up (76% women, mean age 60.7 years, previous spine fusion in 80%). The mean number of posterior fusion levels was 12.9, and 17% also had an anterior fusion. A total of 76 early (44 minor, 32 major) and 66 delayed (13 minor, 53 major) complications were reported, with 41 patients (50.0%) and 45 patients (54.9%) affected, respectively. Overall, 64 patients (78.0%) had at least 1 complication, and 50 (61.0%) had at least 1 major complication. The most common complications were rod breakage (31.7%), dural tear (20.7%), radiculopathy (9.8%), motor defcit (9.8%), proximal junctional kyphosis (PJK, 9.8%), pleural effusion (8.5%), and deep wound infection (7.3%). Compared with patients who did not experience early or delayed complications, those who had these complications did not differ signifcantly with regard to age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, smoking status, history of previous spine surgery or spine fusion, or whether the 3CO performed was a PSO or VCR (p = 0.06). Twenty-seven (33%) patients had 1-11 reoperations (total of 44 reoperations). The most common indications for reoperation were rod breakage (n = 14), deep wound infection (n = 15), and PJK (n = 6). The 24 patients who did not achieve 2-year follow-up had a mean of 0.85 years of follow-up, and the types of early and delayed complications encountered in these 24 patients were comparable to those encountered in the patients that achieved 2-year follow-up. CONCLUSIONS Among 82 ASD patients treated with 3CO, 64 (78.0%) had at least 1 early or delayed complication (57 minor, 85 major). The most common complications were instrumentation failure, dural tear, new neurological defcit, PJK, pleural effusion, and deep wound infection. None of the assessed demographic or surgical parameters were signifcantly associated with the occurrence of complications. These data may prove useful for surgical planning, patient counseling, and efforts to improve the safety and cost-effectiveness of these procedures.
AB - OBJECTIVE Although 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with high complication rates. The authors' objective was to assess complications associated with ASD surgery that included 3CO based on a prospectively collected multicenter database. METHODS This study is a retrospective review of a prospectively collected multicenter consecutive case registry. ASD patients treated with 3CO and eligible for 2-year follow-up were identifed from a prospectively collected multicenter ASD database. Early (= 6 weeks after surgery) and delayed (> 6 weeks after surgery) complications were collected using standardized forms and on-site coordinators. RESULTS Of 106 ASD patients treated with 3CO, 82 (77%; 68 treated with pedicle subtraction osteotomy [PSO] and 14 treated with vertebral column resection [VCR]) had 2-year follow-up (76% women, mean age 60.7 years, previous spine fusion in 80%). The mean number of posterior fusion levels was 12.9, and 17% also had an anterior fusion. A total of 76 early (44 minor, 32 major) and 66 delayed (13 minor, 53 major) complications were reported, with 41 patients (50.0%) and 45 patients (54.9%) affected, respectively. Overall, 64 patients (78.0%) had at least 1 complication, and 50 (61.0%) had at least 1 major complication. The most common complications were rod breakage (31.7%), dural tear (20.7%), radiculopathy (9.8%), motor defcit (9.8%), proximal junctional kyphosis (PJK, 9.8%), pleural effusion (8.5%), and deep wound infection (7.3%). Compared with patients who did not experience early or delayed complications, those who had these complications did not differ signifcantly with regard to age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, smoking status, history of previous spine surgery or spine fusion, or whether the 3CO performed was a PSO or VCR (p = 0.06). Twenty-seven (33%) patients had 1-11 reoperations (total of 44 reoperations). The most common indications for reoperation were rod breakage (n = 14), deep wound infection (n = 15), and PJK (n = 6). The 24 patients who did not achieve 2-year follow-up had a mean of 0.85 years of follow-up, and the types of early and delayed complications encountered in these 24 patients were comparable to those encountered in the patients that achieved 2-year follow-up. CONCLUSIONS Among 82 ASD patients treated with 3CO, 64 (78.0%) had at least 1 early or delayed complication (57 minor, 85 major). The most common complications were instrumentation failure, dural tear, new neurological defcit, PJK, pleural effusion, and deep wound infection. None of the assessed demographic or surgical parameters were signifcantly associated with the occurrence of complications. These data may prove useful for surgical planning, patient counseling, and efforts to improve the safety and cost-effectiveness of these procedures.
KW - Adult spinal deformity
KW - Complications
KW - Osteotomy
KW - Pedicle subtraction osteotomy
KW - Prospective
KW - Vertebral column resection
UR - http://www.scopus.com/inward/record.url?scp=85030725730&partnerID=8YFLogxK
U2 - 10.3171/2016.10.SPINE16849
DO - 10.3171/2016.10.SPINE16849
M3 - Article
C2 - 28291402
AN - SCOPUS:85030725730
SN - 1547-5654
VL - 27
SP - 444
EP - 457
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 4
ER -