title: 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.
abstract: 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.
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, University of California Davis, Sacramento.
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
authors.forename: Renaud
authors.initials: R
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.affiliation: San Diego Spine Foundation, La Jolla;
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: Department of Orthopaedic Surgery, Washington University, St Louis, Missouri.
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
authors.forename: Barthelemy
authors.initials: B
authors.lastname: Liabaud
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Illinois.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York.
authors.forename: Bassel G
authors.initials: BG
authors.lastname: Diebo
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.affiliation: Department of Orthopaedic Surgery, Washington University, St Louis, Missouri.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Departments of 9 Orthopaedic Surgery and.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.affiliation: Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon; and.
authors.forename: Robert
authors.initials: R
authors.lastname: Hart
authors.affiliation: Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Doug
authors.initials: D
authors.lastname: Burton
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Neurosurgery, University of California San Francisco, California.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
keywords: 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; adult spinal deformity; complications; osteotomy; pedicle subtraction osteotomy; prospective; vertebral column resection