Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up

Author:

Smith Justin S.1,Shaffrey Christopher I.1,Klineberg Eric2,Lafage Virginie3,Schwab Frank3,Lafage Renaud3,Kim Han Jo3,Hostin Richard4,Mundis Gregory M.5,Gupta Munish6,Liabaud Barthelemy3,Scheer Justin K.7,Diebo Bassel G.3,Protopsaltis Themistocles S.8,Kelly Michael P.6,Deviren Vedat9,Hart Robert10,Burton Doug11,Bess Shay8,Ames Christopher P.12

Affiliation:

1. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;

2. Department of Orthopaedic Surgery, University of California Davis, Sacramento;

3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York;

4. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;

5. San Diego Spine Foundation, La Jolla;

6. Department of Orthopaedic Surgery, Washington University, St Louis, Missouri;

7. Department of Neurosurgery, University of Illinois at Chicago, Illinois;

8. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;

9. Departments of Orthopaedic Surgery and

10. Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon; and

11. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas

12. Neurosurgery, University of California San Francisco, California;

Abstract

OBJECTIVEAlthough 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.METHODSThis 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 identified 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.RESULTSOf 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 deficit (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 significantly 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.CONCLUSIONSAmong 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 deficit, PJK, pleural effusion, and deep wound infection. None of the assessed demographic or surgical parameters were significantly 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.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

Reference144 articles.

1. Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up;Bridwell;Spine (Phila Pa 1976),2010

2. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age;Smith;Spine (Phila Pa 1976),2011

3. Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic inter-body cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers;Uribe;J Neurosurg Spine,2012

4. [Validation of a tool to measure pelvic and spinal parameters of sagittal balance.];Rillardon;Rev Chir Orthop Reparatrice Appar Mot,2003

5. subtraction osteotomy in the lumbar indications technical aspects results and complications;BarreyC;spine Eur,2014

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