Abstract
Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 698-704 |
| Number of pages | 7 |
| Journal | European Spine Journal |
| Volume | 21 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2012 |
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Keywords
- Osteotomy
- Pedicle subtraction osteotomy
- Sagittal vertical axis
- Spinopelvic alignment
- Thoracic
- Vertebral column resection
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
Cite this
Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity. / Lafage, Virginie; Smith, Justin S.; Bess, Shay; Schwab, Frank J.; Ames, Christopher P.; Klineberg, Eric Otto; Arlet, Vincent; Hostin, Richard; Burton, Douglas C.; Shaffrey, Christopher I.
In: European Spine Journal, Vol. 21, No. 4, 04.2012, p. 698-704.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity
AU - Lafage, Virginie
AU - Smith, Justin S.
AU - Bess, Shay
AU - Schwab, Frank J.
AU - Ames, Christopher P.
AU - Klineberg, Eric Otto
AU - Arlet, Vincent
AU - Hostin, Richard
AU - Burton, Douglas C.
AU - Shaffrey, Christopher I.
PY - 2012/4
Y1 - 2012/4
N2 - Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.
AB - Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.
KW - Osteotomy
KW - Pedicle subtraction osteotomy
KW - Sagittal vertical axis
KW - Spinopelvic alignment
KW - Thoracic
KW - Vertebral column resection
UR - http://www.scopus.com/inward/record.url?scp=84862850518&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862850518&partnerID=8YFLogxK
U2 - 10.1007/s00586-011-1967-3
DO - 10.1007/s00586-011-1967-3
M3 - Article
C2 - 21837411
AN - SCOPUS:84862850518
VL - 21
SP - 698
EP - 704
JO - European Spine Journal
JF - European Spine Journal
SN - 0940-6719
IS - 4
ER -