Justin S Smith1, Christopher I Shaffrey2, Renaud Lafage3, Virginie Lafage3, Frank J Schwab3, Han Jo Kim3, Justin K Scheer4, Themistocles Protopsaltis5, Peter Passias5, Gregory Mundis6, Robert Hart7, Brian Neuman8, Eric Klineberg9, Richard Hostin10, Shay Bess5, Vedat Deviren11, Christopher P Ames12. 1. Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville, VA, 22908, USA. jss7f@virginia.edu. 2. Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville, VA, 22908, USA. 3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. 4. School of Medicine, University of California San Diego, San Diego, CA, USA. 5. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA. 6. San Diego Center for Spinal Disorders, La Jolla, CA, USA. 7. Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA. 8. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA. 9. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA. 10. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA. 11. Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA. 12. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Abstract
PURPOSE: Three-column osteotomy (3CO), including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), can provide powerful alignment correction for adult cervical deformity (ACD). Our objective was to assess alignment changes and early complications associated with 3CO for ACD. METHODS: ACD patients treated with 3CO with minimum 90-day follow-up were identified from a prospectively collected multicenter ACD database. Complications within 90-days of surgery and pre- and postoperative radiographs were collected. RESULTS: All 23 ACD patients treated with 3CO (14 PSO/9 VCR) had minimum 90-day follow-up (mean age 62.3 years, previous cervical/cervicothoracic instrumentation in 52.2% and thoracic/thoracolumbar instrumentation in 47.8%). The primary diagnosis was kyphosis in 91.3% and coronal deformity in 8.7%. The mean number of fusion levels was 12 (range 6-18). The most common 3CO levels were T1 (39.1%), T2 (30.4%) and T3 (21.7%). Eighteen (12 major/6 minor) complications affected 13 (56.5%) patients. The most common complications were neurologic deficit (17.4%), wound infection (8.7%), distal junctional kyphosis (DJK 8.7%), and cardiorespiratory failure (8.7%). Three (13.0%) patients required re-operation within 90-days (1 each for nerve root motor deficit, DJK, and implant pain/prominence). Cervical alignment improved significantly following 3CO, including cervical lordosis (-2.8° to -12.9°, p = 0.036), C2-7 sagittal vertical axis (64.6-42.3 mm, p < 0.001), and T1 slope minus cervical lordosis (46.4°-27.0°, p < 0.001). CONCLUSIONS: Among 23 ACD patients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5%) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.
PURPOSE: Three-column osteotomy (3CO), including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), can provide powerful alignment correction for adult cervical deformity (ACD). Our objective was to assess alignment changes and early complications associated with 3CO for ACD. METHODS:ACDpatients treated with 3CO with minimum 90-day follow-up were identified from a prospectively collected multicenter ACD database. Complications within 90-days of surgery and pre- and postoperative radiographs were collected. RESULTS: All 23 ACDpatients treated with 3CO (14 PSO/9 VCR) had minimum 90-day follow-up (mean age 62.3 years, previous cervical/cervicothoracic instrumentation in 52.2% and thoracic/thoracolumbar instrumentation in 47.8%). The primary diagnosis was kyphosis in 91.3% and coronal deformity in 8.7%. The mean number of fusion levels was 12 (range 6-18). The most common 3CO levels were T1 (39.1%), T2 (30.4%) and T3 (21.7%). Eighteen (12 major/6 minor) complications affected 13 (56.5%) patients. The most common complications were neurologic deficit (17.4%), wound infection (8.7%), distal junctional kyphosis (DJK 8.7%), and cardiorespiratory failure (8.7%). Three (13.0%) patients required re-operation within 90-days (1 each for nerve root motor deficit, DJK, and implant pain/prominence). Cervical alignment improved significantly following 3CO, including cervical lordosis (-2.8° to -12.9°, p = 0.036), C2-7 sagittal vertical axis (64.6-42.3 mm, p < 0.001), and T1 slope minus cervical lordosis (46.4°-27.0°, p < 0.001). CONCLUSIONS: Among 23 ACDpatients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5%) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.
Entities:
Keywords:
Adult; Cervical deformity; Kyphosis; Osteotomy; Surgery
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