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Posterior Versus Three-Column Osteotomy for Late Correction of Residual Coronal Deformity in Patients With Previous Fusions for Idiopathic Scoliosis

  • Case Series
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Abstract

Study Design

Retrospective case series.

Objective

To compare the early results of posterior column (PCO) and three-column (3CO) osteotomies performed in patients with previously fused idiopathic scoliosis and review their abilities to achieve coronal correction of residual deformities.

Summary of Background Data

Residual deformity of previously fused AIS can accelerate adjacent segment degeneration secondary to lowest instrumented vertebra (LIV) tilt and rotation. Many of these patients are not satisfied with their cosmetic appearance and would choose revising the deformity when future surgery is indicated.

Methods

The data from 29 consecutive patients who underwent PCOs or 3COs for late revisions of idiopathic scoliosis were reviewed. Measurements included Cobb angle, focal osteotomy angle, and coronal balance. Perioperative data, complications, and patient-reported outcomes were also reviewed.

Results

Fourteen patients were treated with PCOs and 15 with 3COs. Global coronal correction was equal between the two groups. In the PCO group, where patients underwent a mean of 2.4 osteotomies, 20.2° of correction was obtained compared to 19.5° in the 3CO group (p = .33), which all underwent single osteotomies. The average coronal correction was 9.2°/osteotomy for the PCO group and 14.1°/osteotomy for the 3CO group (p < .01). Estimated blood loss was 1,417.5 mL in the PCO group compared to 3,199.3 in the 3CO group (p < .01). Five patients (36%) had intraoperative complications in the PCO group compared to 12 (80%) in the 3CO group (p < .05). There were no differences in operative times, length of stay, or patient-reported outcomes between groups.

Conclusion

PCOs and 3COs performed in patients with previously fused spines for idiopathic scoliosis are effective in achieving residual deformity correction. In cases of posterior fusions, where the patient has a mobile anterior column, PCOs should be considered over 3COs because of their decreased risk of blood loss and complications.

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References

  1. Winter RB, Lonstein JE, Denis F. How much correction is enough? Spine 2007;32:2641–3.

    Article  Google Scholar 

  2. Clements DH, Betz RR, Newton PO, et al. Correlation of scoliosis curve correction with the number and type of fixation anchors. Spine 2009;34:2147–50.

    Article  Google Scholar 

  3. Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 2007;32:448–52.

    Article  Google Scholar 

  4. Anderson G, Johnson A. Revision Surgery Following Spinal Osteotomy. In: Wang Y, Boachie-Adjei O, Lenke L, editors. Spinal Osteotomy. Netherlands: Springer; 2015. p. 261–7.

    Google Scholar 

  5. Glassman SD, Dimar JR, Carreon LY. Revision rate after adult deformity surgery. Spine Deform 2015;3:199–203.

    Article  Google Scholar 

  6. Martin BI, Mirza SK, Comstock BA, et al. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine 2007;32:382–7.

    Article  Google Scholar 

  7. Mok JM, Cloyd JM, Bradford DS, et al. Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing. Spine 2009;34:832–9.

    Article  Google Scholar 

  8. Pichelmann MA, Lenke LG, Bridwell KH, et al. Revision rates following primary adult spinal deformity surgery. Spine 2010;35:219–26.

    Article  Google Scholar 

  9. Lewis SJ, David K, Singer S, et al. A technique of anterior screw removal through a posterior costotransversectomy approach for posterior-based osteotomies. Spine 2010;35:E471–4.

    Article  Google Scholar 

  10. Schwab F, Lafage V, Patel A, Farcy JP. Sagittal plane considerations and the pelvis in the adult patient. Spine 2009;34:1828–33.

    Article  Google Scholar 

  11. Booth KC, Bridwell KH, Lenke LG, et al. Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 1999;24:1712–20.

    Article  CAS  Google Scholar 

  12. Mehta VA, Amin A, Omeis I, et al. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 2012;70:707–21.

    Article  Google Scholar 

  13. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 2010;468:687–99.

    Article  Google Scholar 

  14. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 2005;30:1682–7.

    Article  Google Scholar 

  15. Toyone T, Shiboi R, Ozawa T, et al. Asymmetrical pedicle subtraction osteotomy for rigid degenerative lumbar kyphoscoliosis. Spine 2012;37:1847–52.

    Article  Google Scholar 

  16. Oshima Y, Lenke LG, Koester L, Takeshita K. Revision versus primary patients undergoing vertebral column resection for severe spinal deformities. Spine Deform 2014;2:350–7.

    Article  Google Scholar 

  17. Lewis SJ, Goldstein S, Bodrogi A, et al. Comparison of pedicle subtraction and Smith-Petersen osteotomies in correcting thoracic kyphosis when closed with a central hook-rod construct. Spine 2014;39:1217–24.

    Article  Google Scholar 

  18. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 2005;30:2030–7.

    Article  Google Scholar 

  19. Gupta MC, Ferrero E, Mundis G, et al. Pedicle subtraction osteotomy in the revision versus primary adult spinal deformity patient: is there a difference in correction and complications? Spine (Phila Pa 1976) 2015;40:E1169–75.

    Article  Google Scholar 

  20. O’Shaughnessy BA, Kuklo TR, Hsieh PC, et al. Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity. Spine 2009;34:2893–9.

    Article  Google Scholar 

  21. Yang JH, Suh SW, Cho WT, et al. Effect of posterior multilevel vertebral osteotomies on coronal and sagittal balance in fused scoliosis deformity caused by previous surgery: preliminary results. Spine (Phila Pa 1976) 2014;39:1840–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Toronto Western Hospital, Department of Surgery, Division of Orthopaedics, University Health Network, 399 Bathurst St., Toronto, ON, M5T2S8, Canada

    Stephen J. Lewis MD, MSc, FRCS(C), Sam G. Keshen BSc, So Kato MD & Aaron M. Gazendam BSc

Authors
  1. Stephen J. Lewis MD, MSc, FRCS(C)
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  2. Sam G. Keshen BSc
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  3. So Kato MD
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  4. Aaron M. Gazendam BSc
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Corresponding author

Correspondence to Stephen J. Lewis MD, MSc, FRCS(C).

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Author disclosures

SJL (is a consultant for Stryker and Medtronic and receives payment for lectures and travel for meetings from Medtronic, Stryker and AO); SGK (none); SK (none); AMG (none).

IRB approval: This study was reviewed and approved by University Health Network Research Ethics Board.

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Lewis, S.J., Keshen, S.G., Kato, S. et al. Posterior Versus Three-Column Osteotomy for Late Correction of Residual Coronal Deformity in Patients With Previous Fusions for Idiopathic Scoliosis. Spine Deform 5, 189–196 (2017). https://doi.org/10.1016/j.jspd.2017.01.004

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  • DOI: https://doi.org/10.1016/j.jspd.2017.01.004

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