TY - JOUR
T1 - Sagittal alignment and complications following lumbar 3-column osteotomy
T2 - Does the level of resection matter?
AU - Ferrero, Emmanuelle
AU - Liabaud, Barthelemy
AU - Henry, Jensen K.
AU - Ames, Christopher P.
AU - Kebaish, Khaled
AU - Mundis, Gregory M.
AU - Hostin, Richard
AU - Gupta, Munish C.
AU - Boachie-Adjei, Oheneba
AU - Smith, Justin S.
AU - Hart, Robert A.
AU - Obeid, Ibrahim
AU - Diebo, Bassel G.
AU - Schwab, Frank J.
AU - Lafage, Virginie
N1 - Funding Information:
consultant for Stryker, DePuy, and Medtronic; patent holder with Fish & Richardson, PC; and royalties from Biomet Spine and Stryker. Dr. Mundis: consultant for NuVaisve and K2M; patent holder with NuVasive and K2M; clinical or research support for this study from NuVasive, DePuy Synthes, and ISSGF; and board member of SDSF, GSO, NuVasive, and Solas. Dr. Hostin: consultant for DePuy; and support of non–study-related clinical/ research effort from NuVasive, Seeger, DJO, DePuy, and K2M. Dr. Gupta: stock options in DePuy, Johnson and Johnson, Pfizer, and Pioneer. Dr. Boachie-Adjei: consultant for K2M and Weigao Co.; direct stock ownership in K2M; and grant/research support and speakers’ bureau for K2M. Dr. Smith: consultant for NuVa-sive and Zimmer Biomet, clinical/research support for this study from DePuy Synthes and ISSG, support of non–study-related clinical/research effort from DePuy Synthes and ISSG, royalties from Zimmer Biomet, and fellowship support from NREF and AOSpine. Dr. Obeid: consultant for DePuy Synthes and Medtron-ic, patent holder with Alphatec Spine and Spineart, and clinical/ research support for this study from DePuy Synthes. Dr. Schwab: consultant for Medicrea, MSD, K2M, Zimmer Biomet, and NuVa-sive; direct stock ownership in Nemaris Inc.; patent holder with K2M and MSD; support of non–study-related clinical/research effort from SRS and DePuy Spine (paid through ISSGF); and speaking/teaching arrangements with Zimmer Biomet, K2M, Medicrea, and NuVasive. Dr. Lafage: consultant for NuVasive; direct stock ownership in Nemaris Inc.; support of non–study-related clinical/research effort from SRS, NIH, and DePuy Spine (paid through ISSGF); and speaking/teaching arrangements with NuVasive, DePuy Spine Synthes, Medicrea, and Nemaris Inc.
Publisher Copyright:
© AANS, 2017.
PY - 2017/11
Y1 - 2017/11
N2 - OBJECTIVE: Three-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions. METHODS: In this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery. RESULTS: A total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1° and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2° per more caudal level, R = -0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026). CONCLUSIONS: In this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.
AB - OBJECTIVE: Three-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions. METHODS: In this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery. RESULTS: A total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1° and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2° per more caudal level, R = -0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026). CONCLUSIONS: In this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.
KW - 3-column osteotomy
KW - Adult spinal deformity
KW - Complications
KW - Lumbar lordosis
KW - Sagittal alignment
UR - http://www.scopus.com/inward/record.url?scp=85032687456&partnerID=8YFLogxK
U2 - 10.3171/2017.3.SPINE16357
DO - 10.3171/2017.3.SPINE16357
M3 - Article
C2 - 28885128
AN - SCOPUS:85032687456
SN - 1547-5654
VL - 27
SP - 560
EP - 569
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 5
ER -