European Spine Journal

, Volume 24, Supplement 1, pp 23–30 | Cite as

Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients

  • Alexander A. Theologis
  • Ehsan Tabaraee
  • Haruki Funao
  • Justin S. Smith
  • Shane Burch
  • Bobby Tay
  • Khaled Kebaish
  • Vedat Deviren
  • Christopher Ames
Original Article

Abstract

Purpose

To evaluate and compare early radiographic and clinical outcomes of lower cervical and upper thoracic three-column osteotomies (3CO) for cervicothoracic kyphosis correction.

Methods

Patients who underwent 3CO at the cervicothoracic junction at two institutions were retrospectively reviewed. Patients were divided into two groups: lower cervical osteotomy (LCO) and upper thoracic osteotomy (UTO: T1–T5). Operative data, radiographic alignment, peri-operative complications, and clinical outcomes were compared between the groups.

Results

Forty-eight patients [male: 24; female: 24; average age 61 years (range 18–92 years); mean follow-up: 22 months] met inclusion criteria. A total of 24 pedicle subtraction osteotomies and 24 vertebral column resections were performed. Compared to UTO, LCO operative time was significantly shorter, average ICU and hospital stays were significantly longer, and the average pre-operative cervical sagittal vertical axis (SVA) and kyphosis were significantly greater (p < 0.05). For both groups, there was significant improvement in cervical SVA, cervical lordosis, segmental angle, Neck Disability Index (NDI), SRS Activity, and pain visual analog score (p < 0.05). Reoperation rates were similar between the groups (LCO: 33.3 %; UTO: 18 %, p = 0.28). Significantly, more patients required tracheostomy/gastrostomy tubes after LCO (3 vs. 0 in the UTO group, p = 0.03).

Conclusions

Three-column posterior osteotomies at the cervicothoracic junction restored regional sagittal alignment and improved quality of life in this series of patients with rigid cervicothoracic deformity, albeit with high complication rates. Lower cervical osteotomies provided greater cervical SVA correction and were shorter operations, although they were associated with more complications and longer hospital and ICU stays compared to upper thoracic osteotomies.

Keywords

Pedicle subtraction osteotomy Vertebral column resection Cervicothoracic Kyphosis Chin-on-chest Clinical outcomes 

References

  1. 1.
    Abumi K, Shono Y, Taneichi H, Ito M, Kaneda K (1999) Correction of cervical kyphosis using pedicle screw fixation systems. Spine (Phila Pa 1976) 24:2389–2396CrossRefGoogle Scholar
  2. 2.
    Ames CP, Blondel B, Scheer JK et al (2013) Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 38:S149–S160CrossRefGoogle Scholar
  3. 3.
    McMaster MJ (1997) Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br 79:197–203PubMedCrossRefGoogle Scholar
  4. 4.
    Simmons ED, DiStefano RJ, Zheng Y, Simmons EH (2006) Thirty-six years experience of cervical extension osteotomy in ankylosing spondylitis: techniques and outcomes. Spine (Phila Pa 1976) 31:3006–3012CrossRefGoogle Scholar
  5. 5.
    Ferch RD, Shad A, Cadoux-Hudson TAD, Teddy PJ (2004) Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 100:13–19PubMedGoogle Scholar
  6. 6.
    Tokala DP, Lam KS, Freeman BJC, Webb JK (2007) C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J 16:1471–1478PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Mummaneni PV, Dhall SS, Rodts GE, Haid RW (2008) Circumferential fusion for cervical kyphotic deformity. J Neurosurg Spine 9:515–521PubMedCrossRefGoogle Scholar
  8. 8.
    Nottmeier EW, Deen HG, Patel N, Birch B (2009) Cervical kyphotic deformity correction using 360-degree reconstruction. J Spinal Disord Tech 22:385–391PubMedCrossRefGoogle Scholar
  9. 9.
    Deviren V, Scheer JK, Ames CP (2011) Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine 15:174–181PubMedCrossRefGoogle Scholar
  10. 10.
    Samudrala S, Vaynman S, Thiayananthan T et al (2010) Cervicothoracic junction kyphosis: surgical reconstruction with pedicle subtraction osteotomy and Smith-Petersen osteotomy. Presented at the 2009 Joint Spine Section Meeting. Clinical article. J Neurosurg Spine 13(6):695–706PubMedCrossRefGoogle Scholar
  11. 11.
    Hoh DJ, Khoueir P, Wang MY (2008) Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus 24:E9PubMedCrossRefGoogle Scholar
  12. 12.
    Scheer JK, Tang JA, Deviren V et al (2011) Biomechanical analysis of cervicothoracic junction osteotomy in cadaveric model of ankylosing spondylitis: effect of rod material and diameter. J Neurosurg Spine 14:330–335PubMedCrossRefGoogle Scholar
  13. 13.
    Wollowick AL, Kelly MP, Riew KD (2012) Pedicle subtraction osteotomy in the cervical spine. Spine (Phila Pa 1976) 37(5):E342–E348CrossRefGoogle Scholar
  14. 14.
    Paulus MC, Kalantar SB, Radcliff K (2014) Cost and value of spinal deformity surgery. Spine (Phila Pa 1976) 39(5):388–393CrossRefGoogle Scholar
  15. 15.
    Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A(suppl 1):44–50PubMedGoogle Scholar
  16. 16.
    Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD (2009) Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J 9:802–808PubMedCrossRefGoogle Scholar
  17. 17.
    Ware J, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRefGoogle Scholar
  18. 18.
    Liu S, Schwab F, Smith JS et al (2014) Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J 14:67–77PubMedCentralPubMedGoogle Scholar
  19. 19.
    Ames CP, Smith JS, Scheer JK et al (2013) A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine 19(3):269–278PubMedCrossRefGoogle Scholar
  20. 20.
    Scheer JK, Tang J a, Smith JS et al (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19:141–159PubMedCrossRefGoogle Scholar
  21. 21.
    Tang JA, Scheer JK, Smith JS et al (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71:662–669PubMedCrossRefGoogle Scholar
  22. 22.
    Villavicencio AT, Babuska JM, Ashton A et al (2011) Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery 68:1309–1316PubMedGoogle Scholar
  23. 23.
    Etame AB, Wang AC, Than KD, La Marca F, Park P (2010) Outcomes after surgery for cervical spine deformity: review of the literature. Neurosurg Focus 28:E14PubMedCrossRefGoogle Scholar
  24. 24.
    Koller H, Meier O, Zenner J, Mayer M, Hitzl W (2013) Non-instrumented correction of cervicothoracic kyphosis in ankylosing spondylitis: a critical analysis on the results of open-wedge osteotomy C7–T1 with gradual Halo-Thoracic-Cast based correction. Eur Spine J 22:819–832PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Heller JG, Silcox DH, Sutterlin CE (1995) Complications of posterior cervical plating. Spine (Phila Pa 1976) 20:2442–2448CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alexander A. Theologis
    • 1
  • Ehsan Tabaraee
    • 1
  • Haruki Funao
    • 2
  • Justin S. Smith
    • 3
  • Shane Burch
    • 1
  • Bobby Tay
    • 1
  • Khaled Kebaish
    • 2
  • Vedat Deviren
    • 1
  • Christopher Ames
    • 4
  1. 1.Department of Orthopaedic SurgeryUniversity of California at San Francisco (UCSF)San FranciscoUSA
  2. 2.Department of Orthopaedic SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.Department of Neurologic SurgeryUniversity of VirginiaCharlottesvilleUSA
  4. 4.Department of Neurologic SurgeryUCSFSan FranciscoUSA

Personalised recommendations