TY - JOUR
T1 - Contemporary utilization of three-column osteotomy techniques in a prospective complex spinal deformity multicenter database
T2 - implications on full-body alignment and perioperative course
AU - The International Spine Study Group
AU - Williamson, Tyler K.
AU - Mir, Jamshaid M.
AU - Smith, Justin S.
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Line, Breton
AU - Diebo, Bassel G.
AU - Daniels, Alan H.
AU - Gum, Jeffrey L.
AU - Hamilton, D. Kojo
AU - Scheer, Justin K.
AU - Eastlack, Robert
AU - Demetriades, Andreas K.
AU - Kebaish, Khaled M.
AU - Lewis, Stephen
AU - Lenke, Lawrence G.
AU - Hostin, Richard A.
AU - Gupta, Munish C.
AU - Kim, Han Jo
AU - Ames, Christopher P.
AU - Burton, Douglas C.
AU - Shaffrey, Christopher I.
AU - Klineberg, Eric O.
AU - Bess, Shay
AU - Passias, Peter G.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Scoliosis Research Society 2024.
PY - 2024/11
Y1 - 2024/11
N2 - Background: Research has focused on the increased correction from a three-column osteotomy (3CO) during adult spinal deformity (ASD) surgery. However, an in-depth analysis on the performance of a 3CO in a cohort of complex spinal deformity cases has not been described. Study design/setting: This is a retrospective study on a prospectively enrolled, complex ASD database. Purpose: This study aimed to determine if three-column osteotomies demonstrate superior benefit in correction of complex sagittal deformity at the cost of increased perioperative complications. Methods: Surgical complex adult spinal deformity patients were included and grouped into thoracolumbar 3COs compared to those who did not have a 3CO (No 3CO) (remaining cohort). Rigid deformity was defined as ΔLL less than 33% from standing to supine. Severe deformity was defined as global (SVA > 70 mm) or C7-PL > 70 mm, or lumbopelvic (PI-LL > 30°). Means comparison tests assessed correction by 3CO grade/location. Multivariate analysis controlling for baseline deformity evaluated outcomes up to six weeks compared to No 3CO. Results: 648 patients were included (Mean age 61 ± 14.6 years, BMI 27.55 ± 5.8 kg/m2, levels fused: 12.6 ± 3.8). 126 underwent 3CO, a 20% higher usage than historical cohorts. 3COs were older, frail, and more likely to undergo revision (OR 5.2, 95% CI [2.6–10.6]; p <.001). 3COs were more likely to present with both severe global/lumbopelvic deformity (OR 4), 62.4% being rigid. 3COs had greater use of secondary rods (OR 4st) and incurred 4 times greater risk for: massive blood loss (> 3500 mL), longer LOS, SICU admission, perioperative wound and spine-related complications, and neurologic complications when performed below L3. 3COs had similar HRQL benefit, but higher perioperative opioid use. Mean segmental correction increased by grade (G3–21; G4–24; G5–27) and was 4 × greater than low-grade osteotomies, especially below L3 (OR 12). 3COs achieved 2 × greater spinopelvic correction. Higher grades properly distributed lordosis 50% of the time except L5. Pelvic compensation and non-response were relieved more often with increasing grade, with greater correction in all lower extremity parameters (p <.01). Due to the increased rate of complications, 3COs trended toward higher perioperative cost ($42,806 vs. $40,046, p =.086). Conclusion: Three-column osteotomy usage in contemporary complex spinal deformities is generally limited to more disabled individuals undergoing the most severe sagittal and coronal realignment procedures. While there is an increased perioperative cost and prolongation of length of stay with usage, these techniques represent the most powerful realignment techniques available with a dramatic impact on normalization at operative levels and reciprocal changes.
AB - Background: Research has focused on the increased correction from a three-column osteotomy (3CO) during adult spinal deformity (ASD) surgery. However, an in-depth analysis on the performance of a 3CO in a cohort of complex spinal deformity cases has not been described. Study design/setting: This is a retrospective study on a prospectively enrolled, complex ASD database. Purpose: This study aimed to determine if three-column osteotomies demonstrate superior benefit in correction of complex sagittal deformity at the cost of increased perioperative complications. Methods: Surgical complex adult spinal deformity patients were included and grouped into thoracolumbar 3COs compared to those who did not have a 3CO (No 3CO) (remaining cohort). Rigid deformity was defined as ΔLL less than 33% from standing to supine. Severe deformity was defined as global (SVA > 70 mm) or C7-PL > 70 mm, or lumbopelvic (PI-LL > 30°). Means comparison tests assessed correction by 3CO grade/location. Multivariate analysis controlling for baseline deformity evaluated outcomes up to six weeks compared to No 3CO. Results: 648 patients were included (Mean age 61 ± 14.6 years, BMI 27.55 ± 5.8 kg/m2, levels fused: 12.6 ± 3.8). 126 underwent 3CO, a 20% higher usage than historical cohorts. 3COs were older, frail, and more likely to undergo revision (OR 5.2, 95% CI [2.6–10.6]; p <.001). 3COs were more likely to present with both severe global/lumbopelvic deformity (OR 4), 62.4% being rigid. 3COs had greater use of secondary rods (OR 4st) and incurred 4 times greater risk for: massive blood loss (> 3500 mL), longer LOS, SICU admission, perioperative wound and spine-related complications, and neurologic complications when performed below L3. 3COs had similar HRQL benefit, but higher perioperative opioid use. Mean segmental correction increased by grade (G3–21; G4–24; G5–27) and was 4 × greater than low-grade osteotomies, especially below L3 (OR 12). 3COs achieved 2 × greater spinopelvic correction. Higher grades properly distributed lordosis 50% of the time except L5. Pelvic compensation and non-response were relieved more often with increasing grade, with greater correction in all lower extremity parameters (p <.01). Due to the increased rate of complications, 3COs trended toward higher perioperative cost ($42,806 vs. $40,046, p =.086). Conclusion: Three-column osteotomy usage in contemporary complex spinal deformities is generally limited to more disabled individuals undergoing the most severe sagittal and coronal realignment procedures. While there is an increased perioperative cost and prolongation of length of stay with usage, these techniques represent the most powerful realignment techniques available with a dramatic impact on normalization at operative levels and reciprocal changes.
KW - Adult spine deformity
KW - Osteotomy
KW - Sagittal alignment
KW - Three-column osteotomy
UR - http://www.scopus.com/inward/record.url?scp=85196183323&partnerID=8YFLogxK
U2 - 10.1007/s43390-024-00906-y
DO - 10.1007/s43390-024-00906-y
M3 - Article
C2 - 38878235
AN - SCOPUS:85196183323
SN - 2212-134X
VL - 12
SP - 1793
EP - 1801
JO - Spine deformity
JF - Spine deformity
IS - 6
ER -