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.
OBJECTIVE Although 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. METHODS This 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. RESULTS Of 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. CONCLUSIONS Among 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.
['Smith|Justin S|JS|', 'Shaffrey|Christopher I|CI|', 'Klineberg|Eric|E|', 'Lafage|Virginie|V|', 'Schwab|Frank|F|', 'Lafage|Renaud|R|', 'Kim|Han Jo|HJ|', 'Hostin|Richard|R|', 'Mundis|Gregory M|GM|', 'Gupta|Munish|M|', 'Liabaud|Barthelemy|B|', 'Scheer|Justin K|JK|', 'Diebo|Bassel G|BG|', 'Protopsaltis|Themistocles S|TS|', 'Kelly|Michael P|MP|', 'Deviren|Vedat|V|', 'Hart|Robert|R|', 'Burton|Doug|D|', 'Bess|Shay|S|', 'Ames|Christopher P|CP|', '|||']
D016208:Databases, Factual D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D010027:Osteotomy D011183:Postoperative Complications D011446:Prospective Studies D012042:Registries D012189:Retrospective Studies D013997:Time Factors D014481:United States
complications osteotomy adult spinal deformity prospective pedicle subtraction osteotomy vertebral column resection 3CO = 3-column osteotomy ASA = American Society of Anesthesiologists ASD = adult spinal deformity ASIA = American Spinal Injury Association BMI = body mass index CCI = Charlson Comorbidity Index EBL = estimated blood loss LEMS = Lower Extremity Motor Score LL = lumbar lordosis PI = pelvic incidence PI-LL = mismatch between PI and LL PJK = proximal junctional kyphosis PSO = pedicle subtraction osteotomy PT = pelvic tilt SRS = Scoliosis Research Society SVA = sagittal vertical axis TK = thoracic kyphosis VCR = vertebral column resection