title: Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year?
abstract: Spinal surgery for adult spinal deformity (ASD) may require the use of osteotomies, which may have high complication rates (up to 80 %). These may be expected to affect health-related quality of life (HRQOL) in the early postoperative phase but little is known about the clinical course of these patients in the first year following surgery. The aim of the study is to evaluate the radiological results and HRQOL in patients undergoing a spinal osteotomy for ASD within the first year following surgery with special reference to the effect of complications.
  
  
  
  From a prospective multicenter ASD database, patients who had undergone a Smith-Petersen osteotomy (SPO), pedicle substraction osteotomy (PSO), vertebral column resection (VCR) or any combination of these were reviewed for radiological sagittal alignment parameters [sagittal vertical axis (SVA), global tilt, lumbar lordosis, T2-sagittal tilt (ST)] as well as HRQOL [Oswestry Disability Index (ODI), short form-36 items (SF-36) Physical Component Score (PCS), SF-36 mental CS (MCS), Scoliosis Research Society (SRS)-22 questionnaire (SRS-22) subtotal] preoperatively and at the 6th- and 12th-month follow-ups with special reference to complications classified as major (life threatening or requiring additional surgery) and minor and their effects on HRQOL.
  
  
  
  121 patients (85 F, 36 M) with a total of 71 SPOs, 45 PSOs and 13 VCRs were evaluated. Osteotomy resulted in correction of the major coronal Cobb angle from 43.0 ± 3.7° to 24.8 ± 2.8° (p < 0.001) and the SVA from 69.0 ± 10.3 to 52.4 ± 6.6 mm (p = 0.001). Other radiological parameters showed no significant changes. Remarkable improvements in HRQOL scores with a strong age effect (p ≤ 0.01), for all instruments except SF-36 MCS, were found. Most of these HRQOL improvements have been achieved within the first 6 months. A total of 114 complications (59 major, 55 minor) that had a lesser effect on the age-adjusted HRQOL scores (p < 0.05) (except for the SF-36 PCS) and 1 death were observed.
  
  
  
  Osteotomies were moderately effective in radiological improvement but resulted in a significant increase in HRQOL. They were associated with a high rate of complications but these had no/minimal effect on the clinical outcome. Contrary to the general perception, the greatest improvements in HRQOL were seen to take place during the first 6 months after surgery, even in the presence of complications.
authors.affiliation: Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, Cankaya, Ankara, 06700, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Ayhan
authors.affiliation: Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, Cankaya, Ankara, 06700, Turkey.
authors.forename: Bilal
authors.initials: B
authors.lastname: Aykac
authors.affiliation: Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Selcen
authors.initials: S
authors.lastname: Yuksel
authors.affiliation: Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, Cankaya, Ankara, 06700, Turkey.
authors.forename: Umit Ozgur
authors.initials: UO
authors.lastname: Guler
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellise
authors.affiliation: Acibadem Maslak Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alanay
authors.affiliation: Hospital Universitari La Paz, Madrid, Spain.
authors.forename: Francisco Javier Sanchez
authors.initials: FJ
authors.lastname: Perez-Grueso
authors.affiliation: Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, Cankaya, Ankara, 06700, Turkey. acaroglue@gmail.com.
authors.forename: Emre
authors.initials: E
authors.lastname: Acaroglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008141:Lordosis; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011184:Postoperative Period; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult spinal deformity; Complications; HRQOL; Osteotomy; Outcomes