Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients

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Abstract

Purpose: Three-column osteotomy (3CO), including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), can provide powerful alignment correction for adult cervical deformity (ACD). Our objective was to assess alignment changes and early complications associated with 3CO for ACD. Methods: ACD patients treated with 3CO with minimum 90-day follow-up were identified from a prospectively collected multicenter ACD database. Complications within 90-days of surgery and pre- and postoperative radiographs were collected. Results: All 23 ACD patients treated with 3CO (14 PSO/9 VCR) had minimum 90-day follow-up (mean age 62.3 years, previous cervical/cervicothoracic instrumentation in 52.2% and thoracic/thoracolumbar instrumentation in 47.8%). The primary diagnosis was kyphosis in 91.3% and coronal deformity in 8.7%. The mean number of fusion levels was 12 (range 6–18). The most common 3CO levels were T1 (39.1%), T2 (30.4%) and T3 (21.7%). Eighteen (12 major/6 minor) complications affected 13 (56.5%) patients. The most common complications were neurologic deficit (17.4%), wound infection (8.7%), distal junctional kyphosis (DJK 8.7%), and cardiorespiratory failure (8.7%). Three (13.0%) patients required re-operation within 90-days (1 each for nerve root motor deficit, DJK, and implant pain/prominence). Cervical alignment improved significantly following 3CO, including cervical lordosis (−2.8° to −12.9°, p = 0.036), C2-7 sagittal vertical axis (64.6–42.3 mm, p < 0.001), and T1 slope minus cervical lordosis (46.4°–27.0°, p < 0.001). Conclusions: Among 23 ACD patients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5%) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalEuropean Spine Journal
DOIs
StateAccepted/In press - Mar 30 2017

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Osteotomy
Lordosis
Kyphosis
Neurologic Manifestations
Spine
Wound Infection
Ambulatory Surgical Procedures
Thorax
Databases
Pain
Infection

Keywords

  • Adult
  • Cervical deformity
  • Kyphosis
  • Osteotomy
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{5c061019a6ed4d3d8bc774ec9f3727b1,
title = "Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients",
abstract = "Purpose: Three-column osteotomy (3CO), including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), can provide powerful alignment correction for adult cervical deformity (ACD). Our objective was to assess alignment changes and early complications associated with 3CO for ACD. Methods: ACD patients treated with 3CO with minimum 90-day follow-up were identified from a prospectively collected multicenter ACD database. Complications within 90-days of surgery and pre- and postoperative radiographs were collected. Results: All 23 ACD patients treated with 3CO (14 PSO/9 VCR) had minimum 90-day follow-up (mean age 62.3 years, previous cervical/cervicothoracic instrumentation in 52.2{\%} and thoracic/thoracolumbar instrumentation in 47.8{\%}). The primary diagnosis was kyphosis in 91.3{\%} and coronal deformity in 8.7{\%}. The mean number of fusion levels was 12 (range 6–18). The most common 3CO levels were T1 (39.1{\%}), T2 (30.4{\%}) and T3 (21.7{\%}). Eighteen (12 major/6 minor) complications affected 13 (56.5{\%}) patients. The most common complications were neurologic deficit (17.4{\%}), wound infection (8.7{\%}), distal junctional kyphosis (DJK 8.7{\%}), and cardiorespiratory failure (8.7{\%}). Three (13.0{\%}) patients required re-operation within 90-days (1 each for nerve root motor deficit, DJK, and implant pain/prominence). Cervical alignment improved significantly following 3CO, including cervical lordosis (−2.8° to −12.9°, p = 0.036), C2-7 sagittal vertical axis (64.6–42.3 mm, p < 0.001), and T1 slope minus cervical lordosis (46.4°–27.0°, p < 0.001). Conclusions: Among 23 ACD patients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5{\%}) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.",
keywords = "Adult, Cervical deformity, Kyphosis, Osteotomy, Surgery",
author = "ISSG and Smith, {Justin S.} and Shaffrey, {Christopher I.} and Renaud Lafage and Virginie Lafage and Schwab, {Frank J.} and Kim, {Han Jo} and Scheer, {Justin K.} and Themistocles Protopsaltis and Peter Passias and Gregory Mundis and Robert Hart and Brian Neuman and Klineberg, {Eric Otto} and Richard Hostin and Shay Bess and Vedat Deviren and Ames, {Christopher P.}",
year = "2017",
month = "3",
day = "30",
doi = "10.1007/s00586-017-5071-1",
language = "English (US)",
pages = "1--10",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Three-column osteotomy for correction of cervical and cervicothoracic deformities

T2 - alignment changes and early complications in a multicenter prospective series of 23 patients

AU - ISSG

AU - Smith, Justin S.

AU - Shaffrey, Christopher I.

AU - Lafage, Renaud

AU - Lafage, Virginie

AU - Schwab, Frank J.

AU - Kim, Han Jo

AU - Scheer, Justin K.

AU - Protopsaltis, Themistocles

AU - Passias, Peter

AU - Mundis, Gregory

AU - Hart, Robert

AU - Neuman, Brian

AU - Klineberg, Eric Otto

AU - Hostin, Richard

AU - Bess, Shay

AU - Deviren, Vedat

AU - Ames, Christopher P.

PY - 2017/3/30

Y1 - 2017/3/30

N2 - Purpose: Three-column osteotomy (3CO), including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), can provide powerful alignment correction for adult cervical deformity (ACD). Our objective was to assess alignment changes and early complications associated with 3CO for ACD. Methods: ACD patients treated with 3CO with minimum 90-day follow-up were identified from a prospectively collected multicenter ACD database. Complications within 90-days of surgery and pre- and postoperative radiographs were collected. Results: All 23 ACD patients treated with 3CO (14 PSO/9 VCR) had minimum 90-day follow-up (mean age 62.3 years, previous cervical/cervicothoracic instrumentation in 52.2% and thoracic/thoracolumbar instrumentation in 47.8%). The primary diagnosis was kyphosis in 91.3% and coronal deformity in 8.7%. The mean number of fusion levels was 12 (range 6–18). The most common 3CO levels were T1 (39.1%), T2 (30.4%) and T3 (21.7%). Eighteen (12 major/6 minor) complications affected 13 (56.5%) patients. The most common complications were neurologic deficit (17.4%), wound infection (8.7%), distal junctional kyphosis (DJK 8.7%), and cardiorespiratory failure (8.7%). Three (13.0%) patients required re-operation within 90-days (1 each for nerve root motor deficit, DJK, and implant pain/prominence). Cervical alignment improved significantly following 3CO, including cervical lordosis (−2.8° to −12.9°, p = 0.036), C2-7 sagittal vertical axis (64.6–42.3 mm, p < 0.001), and T1 slope minus cervical lordosis (46.4°–27.0°, p < 0.001). Conclusions: Among 23 ACD patients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5%) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.

AB - Purpose: Three-column osteotomy (3CO), including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), can provide powerful alignment correction for adult cervical deformity (ACD). Our objective was to assess alignment changes and early complications associated with 3CO for ACD. Methods: ACD patients treated with 3CO with minimum 90-day follow-up were identified from a prospectively collected multicenter ACD database. Complications within 90-days of surgery and pre- and postoperative radiographs were collected. Results: All 23 ACD patients treated with 3CO (14 PSO/9 VCR) had minimum 90-day follow-up (mean age 62.3 years, previous cervical/cervicothoracic instrumentation in 52.2% and thoracic/thoracolumbar instrumentation in 47.8%). The primary diagnosis was kyphosis in 91.3% and coronal deformity in 8.7%. The mean number of fusion levels was 12 (range 6–18). The most common 3CO levels were T1 (39.1%), T2 (30.4%) and T3 (21.7%). Eighteen (12 major/6 minor) complications affected 13 (56.5%) patients. The most common complications were neurologic deficit (17.4%), wound infection (8.7%), distal junctional kyphosis (DJK 8.7%), and cardiorespiratory failure (8.7%). Three (13.0%) patients required re-operation within 90-days (1 each for nerve root motor deficit, DJK, and implant pain/prominence). Cervical alignment improved significantly following 3CO, including cervical lordosis (−2.8° to −12.9°, p = 0.036), C2-7 sagittal vertical axis (64.6–42.3 mm, p < 0.001), and T1 slope minus cervical lordosis (46.4°–27.0°, p < 0.001). Conclusions: Among 23 ACD patients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5%) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.

KW - Adult

KW - Cervical deformity

KW - Kyphosis

KW - Osteotomy

KW - Surgery

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U2 - 10.1007/s00586-017-5071-1

DO - 10.1007/s00586-017-5071-1

M3 - Article

C2 - 28361367

AN - SCOPUS:85016630007

SP - 1

EP - 10

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

ER -