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.
Similar content being viewed by others
References
Scheer JK, Tang JA, Smith JS, Acosta FL Jr, Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP, International Spine Study G (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19:141–159. doi:10.3171/2013.4.SPINE12838
Ames CP, Smith JS, Scheer JK, Bess S, Bederman SS, Deviren V, Lafage V, Schwab F, Shaffrey CI (2012) Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine 16:547–564. doi:10.3171/2012.2.SPINE11320
Ames CP, Smith JS, Eastlack R, Blaskiewicz DJ, Shaffrey CI, Schwab F, Bess S, Kim HJ, Mundis GM Jr, Klineberg E, Gupta M, O’Brien M, Hostin R, Scheer JK, Protopsaltis TS, Fu KG, Hart R, Albert TJ, Riew KD, Fehlings MG, Deviren V, Lafage V, International Spine Study G (2015) Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. doi:10.3171/2014.12.SPINE14780
Ames CP, Smith JS, Scheer JK, Shaffrey CI, Lafage V, Deviren V, Moal B, Protopsaltis T, Mummaneni PV, Mundis GM Jr, Hostin R, Klineberg E, Burton DC, Hart R, Bess S, Schwab FJ, International Spine Study G (2013) A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine 19:269–278. doi:10.3171/2013.5.SPINE121067
Belanger TA, Milam RA, Roh JS, Bohlman HH (2005) Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Jt Surg Am 87:1732–1738
Theologis AA, Tabaraee E, Funao H, Smith JS, Burch S, Tay B, Kebaish K, Deviren V, Ames C (2015) Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients. Eur Spine J 24(Suppl 1):S23–S30. doi:10.1007/s00586-014-3655-6
Wollowick AL, Kelly MP, Riew KD (2012) Pedicle subtraction osteotomy in the cervical spine. Spine 37:E342–E348. doi:10.1097/BRS.0b013e318245bcd4
Smith JS, Sansur CA, Donaldson WF 3rd, Perra JH, Mudiyam R, Choma TJ, Zeller RD, Knapp DR Jr, Noordeen HH, Berven SH, Goytan MJ, Boachie-Adjei O, Shaffrey CI (2011) Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine 36:958–964. doi:10.1097/BRS.0b013e3181eabb26
Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM Jr, Errico TJ, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Soroceanu A, Kelly MP, Line B, Gupta M, Deviren V, Hart R, Burton DC, Bess S, Ames CP, International Spine Study G (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine. doi:10.3171/2015.11.SPINE151036
Mason C, Cozen L, Adelstein L (1953) Surgical correction of flexion deformity of the cervical spine. Calif Med 79:244–246
Simmons EH (1972) The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res 86:132–143
Urist MR (1958) Osteotomy of the cervical spine; report of a case of ankylosing rheumatoid spondylitis. J Bone Jt Surg Am 40(4):833–843
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 15:174–181. doi:10.3171/2011.3.SPINE10536
Grosso MJ, Hwang R, Krishnaney AA, Mroz TE, Benzel EC, Steinmetz MP (2015) Complications and outcomes for surgical approaches to cervical kyphosis. J Spinal Disord Tech 28:E385–E393. doi:10.1097/BSD.0b013e318299953f
Han K, Lu C, Li J, Xiong GZ, Wang B, Lv GH, Deng YW (2011) Surgical treatment of cervical kyphosis. Eur Spine J 20:523–536. doi:10.1007/s00586-010-1602-8
Champain S, Benchikh K, Nogier A, Mazel C, Guise JD, Skalli W (2006) Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies. Eur Spine J 15:982–991. doi:10.1007/s00586-005-0927-1
Ames CP, Blondel B, Scheer JK, Schwab FJ, Le Huec JC, Massicotte EM, Patel AA, Traynelis VC, Kim HJ, Shaffrey CI, Smith JS, Lafage V (2013) Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine 38:S149–S160. doi:10.1097/BRS.0b013e3182a7f449
Tokala DP, Lam KS, Freeman BJ, Webb JK (2007) C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J 16:1471–1478. doi:10.1007/s00586-006-0290-x
Samudrala S, Vaynman S, Thiayananthan T, Ghostine S, Bergey DL, Anand N, Pashman RS, Johnson JP (2010) Cervicothoracic junction kyphosis: surgical reconstruction with pedicle subtraction osteotomy and Smith-Petersen osteotomy. Presented at the 2009 Joint Spine Section Meeting. Clincal article. J Neurosurg Spine 13:695–706. doi:10.3171/2010.5.SPINE08608
Etame AB, Than KD, Wang AC, La Marca F, Park P (2008) Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine 33:E559–E564. doi:10.1097/BRS.0b013e31817c6c64
Simmons EH, Brown ME (1972) Surgery for kyphosis in ankylosing spondylitis. Can Nurse 68:24–29
Scheer JK, Tang JA, Buckley JM, Deviren V, Pekmezci M, McClellan RT, Ames CP (2011) Biomechanical analysis of osteotomy type and rod diameter for treatment of cervicothoracic kyphosis. Spine 36:E519–E523. doi:10.1097/BRS.0b013e3181f65de1
Kim HJ, Nemani VM, Daniel Riew K (2015) Cervical osteotomies for neurological deformities. Eur Spine J 24(Suppl 1):S16–S22. doi:10.1007/s00586-014-3656-5
Lee SH, Kim KT, Seo EM, Suk KS, Kwack YH, Son ES (2012) The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech 25:E41–E47. doi:10.1097/BSD.0b013e3182396301
Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP, Issg (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71:662–669. doi:10.1227/NEU.0b013e31826100c9 discussion 669
Klineberg E, Schwab F, Ames C, Hostin R, Bess S, Smith JS, Gupta MC, Boachie O, Hart RA, Akbarnia BA, Burton DC, Lafage V (2011) Acute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment. Adv Orthop 2011:415946. doi:10.4061/2011/415946
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-017-5071-1