title: Factors associated with long-term patient-reported outcomes after three-column osteotomies.
abstract: BACKGROUND
  Studies have demonstrated sustained improvements in patient-reported outcomes (PROs) after three-column osteotomies (three-COs), but no study has evaluated what factors impact long-term outcomes.
  
  
  OBJECTIVE
  The aim was to investigate factors associated with PROs in patients who underwent three-CO at minimum 5 years postoperatively.
  This was a retrospective review of prospective database.
  
  
  METHODS
  All patients who had a three-CO at a single institution and completed clinical evaluations after at least 5 years postoperative were included.
  
  
  METHODS
  Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) scores, and radiographic parameters were assessed at baseline and a minimum 5 years postoperatively.
  
  
  METHODS
  Analysis of 120 patients who underwent three-CO (96-pedicle subtraction osteotomy/24-vertebral column resection) was performed. The mean age was 48 years (range 8-79), and clinical follow-up was 7 years (range 5-14). Separate multivariable linear regression analyses were performed to determine factors associated with ODI, SRS average, and SRS satisfaction while controlling for time since surgery and baseline outcome scores.
  
  
  RESULTS
  Average PROs were significantly improved from baseline at a minimum 5-year follow-up (ODI: 48-28, p<.01; SRS: 2.8-3.5, p<.01). The average SRS satisfaction score was 4.0. Average sagittal alignment (C7 plumb) improved 74 mm, with 81% of patients' alignment less than 95 mm. Major surgical complications occurred in 32 patients (27%) with major reoperations in 30 patients (25%). Multivariable regression analysis found that prior surgery and major reoperations were risk factors for worse ODI scores. A diagnosis of adult idiopathic scoliosis and final sagittal alignment less than 95 mm were associated with improved SRS scores. Improvement in major coronal Cobb and final pelvic tilt less than 30° were associated with increased SRS satisfaction.
  
  
  CONCLUSIONS
  With a minimum 5-year follow-up, PROs in patients undergoing three-CO were associated with improvements in radiographic alignment but negatively affected by prior surgery and complications necessitating revision surgery.
authors.affiliation: Vanderbilt Orthopaedic Institute, Suite 4200, Medical Center East South Tower, 1215 21st Ave. S., Nashville, TN 37232-8774, USA. Electronic address: kevin.oneill@vanderbilt.edu.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: O'Neill
authors.affiliation: Department of Orthopaedics, Washington University, 425 S. Euclid Avenue, Suite 5505 Campus Box 8233, St. Louis, MO, 63110, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.affiliation: Department of Orthopaedics, Washington University, 425 S. Euclid Avenue, Suite 5505 Campus Box 8233, St. Louis, MO, 63110, USA.
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.affiliation: Department of Orthopaedics, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Neuman
authors.affiliation: Department of Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Vanderbilt Orthopaedic Institute, Suite 4200, Medical Center East South Tower, 1215 21st Ave. S., Nashville, TN 37232-8774, USA.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012600:Scoliosis / Q000453:epidemiology / Q000601:surgery*
keywords: Adult spine deformity; Kyphosis; Patient-reported outcomes; Scoliosis; Spine osteotomies; Surgical complications; Three-column osteotomies