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Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients

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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.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville, VA, 22908, USA

    Justin S. Smith & Christopher I. Shaffrey

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Renaud Lafage, Virginie Lafage, Frank J. Schwab & Han Jo Kim

  3. School of Medicine, University of California San Diego, San Diego, CA, USA

    Justin K. Scheer

  4. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA

    Themistocles Protopsaltis, Peter Passias & Shay Bess

  5. San Diego Center for Spinal Disorders, La Jolla, CA, USA

    Gregory Mundis

  6. Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA

    Robert Hart

  7. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Brian Neuman

  8. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA

    Eric Klineberg

  9. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA

    Richard Hostin

  10. Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA

    Vedat Deviren

  11. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Christopher P. Ames

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  1. Justin S. Smith
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  2. Christopher I. Shaffrey
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  3. Renaud Lafage
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  4. Virginie Lafage
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  14. Richard Hostin
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Corresponding author

Correspondence to Justin S. Smith.

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Disclosure of funding

The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes.

Conflict of interest

Please see following 3 pages for COI disclosures for each author. Justin S. Smith, MD, PhD, Zimmer Biomet: consultant, honorarium for teaching, royalties; Nuvasive- consultant, honorarium for teaching; Cerapedics: consultant; K2 M: honorarium for teaching; AOSpine: fellowship funding; NREF: fellowship funding. Christopher Shaffrey, MD, Medtronic: royalties, patents, consultant; Nuvasive: royalties, patents, consultant, stock holder; Zimmer Biomet: royalties, patents, consultant; K2 M: consultant; Stryker: consultant; In Vivo: consultant; NIH: grants; Department of Defense: grants; ISSG: grants; DePuy Synthes: grants; AO: grants. Renaud Lafage, MS, none. Virginie Lafage, PhD, Depuy Synthes: paid lectures; Nuvasive: paid lectures; K2 M: paid lectures; Medtronic: paid lectures; Nemaris: Board member and shareholder. Frank Schwab, MD, Grants: SRS, DePuy Spine (through ISSGF); Speaking/teaching arrangements, consulting: Zimmer-Biomet, NuVasive, K2 M, MSD, Medicrea; Board of Directors, Share holder: Nemaris INC; Royalties: K2 M, MSD. Han Jo Kim, MD, K2 M: consultant; Zimmer Biomet: consultant; ISSGF: research funding; CSRS: research funding; HSS Journal: board membership; ASJ: board membership; GSJ: board membership. Justin Scheer, MD: none Themi Protopsaltis, MD, Consulting: Medicrea, Globus, Innovasis (money paid to me); Research support paid to my institution: Zimmer Spine. Peter Passias, MD, Medicrea: consultant. Gregory Mundis, MD, Nuvasive: consulting, royalties, research funding (not paid to Dr. Mundis); K2 M: consulting, royalties; DePuy Synthes: honorarium; DePuy Synthes/ISSG: research funding (not paid to Dr. Mundis). Robert Hart, MD, Globus: personal fees; Medtronic: grants; Seaspine: personal fees; DePuy Synthes: personal fees; CSRS: board member; ISSG:Executive Committee; ISSLS:board member; OHSU: patent. Brian Neuman, MD, Depuy Synthes: research grant. Eric Klineberg, MD, DePuy: consulting, Stryker: consulting, AOSpine: paid speaker, fellowship support, K2 M: paid speaker. Richard Hostin, MD, DePuy Synthes: consultant; Nuvasive: research support; Seeger: research support; DJO: research support. Shay Bess, MD, K2 Medical: consultant, royalties, research support; Allosource: consultant; Pioneer: royalties; Innovasis: royalties, research support; Nuvasive: royalties, research support; DePuy Synthes Spine: research support; Stryker: research support. Vedat Deviren, MD, Nuvasive: consultant, grants; Guidepoint: consultant; OREF: grants; AOSpine: grants; Globus: grants. Christopher P. Ames, MD, DePuy Synthes: consultant; Medtronic: consultant; Stryker: consultant, royalties; Zimmer Biomet: royalties; Fish & Richardson, PC: patents.

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Smith, J.S., Shaffrey, C.I., Lafage, R. et al. Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients. Eur Spine J 26, 2128–2137 (2017). https://doi.org/10.1007/s00586-017-5071-1

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  • DOI: https://doi.org/10.1007/s00586-017-5071-1

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