PURPOSE: Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). METHODS: Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA < 4 cm, PT < 25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. RESULTS: A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P < 0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P > 0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P < 0.05). CONCLUSIONS: Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater pre-operative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.
PURPOSE: Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). METHODS: Multicenter, retrospective radiographic analysis of ASDpatients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA < 4 cm, PT < 25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. RESULTS: A total of 41 consecutive ASDpatients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P < 0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P > 0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P < 0.05). CONCLUSIONS: Poor SPA occurred in 22% of TCTOpatients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater pre-operative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.
Authors: Abdelkrim Benchikh El Fegoun; Frank Schwab; Lorenzo Gamez; Nicolas Champain; Wafa Skalli; Jean-Pierre Farcy Journal: Spine (Phila Pa 1976) Date: 2005-07-01 Impact factor: 3.468
Authors: C Boulay; C Tardieu; J Hecquet; C Benaim; B Mouilleseaux; C Marty; D Prat-Pradal; J Legaye; G Duval-Beaupère; J Pélissier Journal: Eur Spine J Date: 2005-09-23 Impact factor: 3.134
Authors: Steven D Glassman; Sigurd Berven; Keith Bridwell; William Horton; John R Dimar Journal: Spine (Phila Pa 1976) Date: 2005-03-15 Impact factor: 3.468
Authors: Steven D Glassman; Keith Bridwell; John R Dimar; William Horton; Sigurd Berven; Frank Schwab Journal: Spine (Phila Pa 1976) Date: 2005-09-15 Impact factor: 3.468
Authors: William C Horton; Courtney W Brown; Keith H Bridwell; Steven D Glassman; Se-Il Suk; Charles W Cha Journal: Spine (Phila Pa 1976) Date: 2005-02-15 Impact factor: 3.468
Authors: Keith H Bridwell; Stephen J Lewis; Lawrence G Lenke; Christy Baldus; Kathy Blanke Journal: J Bone Joint Surg Am Date: 2003-03 Impact factor: 5.284
Authors: Ibrahim Obeid; Bassel G Diebo; Louis Boissiere; Anouar Bourghli; Derek T Cawley; Daniel Larrieu; Vincent Pointillart; Vincent Challier; Jean Marc Vital; Virginie Lafage Journal: Oper Neurosurg (Hagerstown) Date: 2018-05-01 Impact factor: 2.703
Authors: Peter G Passias; Cyrus M Jalai; Bassel G Diebo; Dana L Cruz; Gregory W Poorman; Aaron J Buckland; Louis M Day; Samantha R Horn; Barthélemy Liabaud; Renaud Lafage; Alexandra Soroceanu; Joseph F Baker; Shearwood McClelland; Jonathan H Oren; Thomas J Errico; Frank J Schwab; Virginie Lafage Journal: Int J Spine Surg Date: 2019-04-30