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Posterior column reconstruction improves fusion rates at the level of osteotomy in three-column posterior-based osteotomies

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Abstract

Purpose

To determine the incidence of pseudarthrosis at the osteotomy site after three-column spinal osteotomies (3-COs) with posterior column reconstruction.

Methods

82 consecutive adult 3-COs (66 patients) with a minimum of 2-year follow-up were retrospectively reviewed. All cases underwent posterior 3-COs with two-rod constructs. The inferior facets of the proximal level were reduced to the superior facets of the distal level. If that was not possible, a structural piece of bone graft either from the local resection or a local rib was slotted in the posterior column defect to re-establish continual structural posterior bone across the lateral margins of the resection. No interbody cages were used at the level of the osteotomy.

Results

There were 34 thoracic osteotomies, 47 lumbar osteotomies and one sacral osteotomy with a mean follow-up of 52 (24–126) months. All cases underwent posterior column reconstructions described above and the addition of interbody support or additional posterior rods was not performed for fusion at the osteotomy level. Among them, 29 patients underwent one or more revision surgeries. There were three definite cases of pseudarthrosis at the osteotomy site (4%). Six revisions were also performed for pseudarthrosis at other levels.

Conclusion

Restoration of the structural integrity of the posterior column in three-column posterior-based osteotomies was associated with > 95% fusion rate at the level of the osteotomy. Pseudarthrosis at other levels was the second most common reason for revision following adjacent segment disease in the long-term follow-up.

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Acknowledgements

REB approval was granted prior to start of the research.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room 442, First Floor, East Wing, Toronto, ON, M5T 2S8, Canada

    Stephen J. Lewis, Chandan Mohanty, Aaron M. Gazendam, So Kato, Sam G. Keshen, Noah D. Lewis, Sofia P. Magana, David Perlmutter & Jennifer Cape

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  1. Stephen J. Lewis
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  2. Chandan Mohanty
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  3. Aaron M. Gazendam
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  4. So Kato
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  5. Sam G. Keshen
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  6. Noah D. Lewis
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  7. Sofia P. Magana
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  8. David Perlmutter
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  9. Jennifer Cape
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Corresponding author

Correspondence to Stephen J. Lewis.

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Conflict of interest

SJL: consulting for Stryker and Medtronic; receives payment for lectures and travel for meetings from Medtronic, Stryker and AO. He is a stockholder in Augmedics and Thompson Surgical. CM: nothing to disclose. AMG: nothing to disclose. SK: nothing to disclose. SGK: nothing to disclose. NDL: nothing to disclose. SPM: nothing to disclose. DP: nothing to disclose. JC: nothing to disclose.

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None of the authors received financial support in relation to this manuscript.

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Lewis, S.J., Mohanty, C., Gazendam, A.M. et al. Posterior column reconstruction improves fusion rates at the level of osteotomy in three-column posterior-based osteotomies. Eur Spine J 27, 636–643 (2018). https://doi.org/10.1007/s00586-017-5299-9

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  • DOI: https://doi.org/10.1007/s00586-017-5299-9

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