title: Clinical and radiographic outcomes after 3-column osteotomies with 5-year follow-up.
abstract: METHODS
  Retrospective review of prospective database.
  
  
  OBJECTIVE
  To investigate long-term results after 3-column osteotomies (3-CO).
  
  
  BACKGROUND
  Short-term studies have noted improved outcomes and alignment after 3-CO, but there is a paucity of long-term studies with a large group of patients.
  
  
  METHODS
  An analysis of 126 patients who underwent a 3-CO (pedicle subtraction osteotomy [N = 101]/vertebral column resection [N = 25]) with minimum 5-year follow-up was performed at a single institution. The mean age was 48 years (range, 8-79 yr) and average follow-up was for 7 years (range, 5-14 yr). Oswestry Disability Index and Scoliosis Research Society (SRS) scores and radiographical parameters were assessed at baseline, 6 weeks, and 1, 2, 3, and/or 5 years postoperatively and complications were recorded.
  
  
  RESULTS
  Sagittal alignment improved at all postoperative time points from baseline (mean, 117 mm), but diminished from 6 weeks (mean, 24 mm) to 5 years (mean, 41 mm; P = 0.03). Average coronal alignment was improved from baseline (27 mm) at 6 weeks (18 mm; P = 0.003) and 5 years postoperatively (19 mm; P = 0.007), with no deterioration between 6 weeks and 5 years postoperatively (P = 0.9). Major surgical complications occurred in 36% (n = 45) and major repeat surgery was performed in 28% (n = 35). Significant improvements (P < 0.05) in Oswestry Disability Index and all SRS domain scores were found at each time point. All mean outcome scores at 5 years postoperatively exceeded minimal clinically important difference thresholds except the SRS function domain. Improvement in outcomes at 5 years postoperatively was similar in groups with major surgical complications versus those without and in those with reoperation versus those without.
  
  
  CONCLUSIONS
  This study of 126 patients undergoing 3-CO found significant and sustained improvements in Oswestry Disability Index and SRS scores and sagittal alignment at a minimum 5 years postoperatively. This demonstrates the durability of these complex spinal reconstructions, even surprisingly in those patients having a major complication and/or revision surgery.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Orthopaedics, Washington University, St. Louis, MO.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Oʼneill
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hyun
authors.forename: Brian
authors.initials: B
authors.lastname: Neuman
authors.forename: Ian
authors.initials: I
authors.lastname: Dorward
authors.forename: Linda
authors.initials: L
authors.lastname: Koester
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult