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Vertebral subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications

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Abstract

Purpose

To investigate incidence, risk factors, and complications of vertebral subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity.

Methods

Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and subluxation vs. non-subluxation) were compared.

Results

171 ASD patients were recruited, 18 of which (10.5%) developed sagittal vertebral subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal vertebral subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal vertebral subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P < 0.05). VS group had less kyphosis flexibility (11 vs. 23%, P < 0.05). More patients in VS group had preoperative sagittal VS as compared to non-VS group (77.8 vs. 20.9%, P < 0.05). VS group had more neurological complications than non-VS group (25 vs. 5.4%, P < 0.05).

Conclusion

VS occurred in one-tenth of patients receiving three-column osteotomies, one-fourth of which would develop neurological deficits. Older age, rigid kyphosis, and the pre-existence of VS were risk factors for developing VS.

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Acknowledgements

Funding was supported by the National Natural Science Foundation of China (81501932), Natural Science Foundation of Jiangsu Province (BK20150107), China Postdoctoral Science Foundation (2015M570440).

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Author notes

  1. Jun Qiao and Lingyan Xiao contributed equally to this study.

Authors and Affiliations

  1. Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

    Jun Qiao, Xu Sun, Benlong Shi, Zhen Liu, Leilei Xu, Zezhang Zhu, Bangping Qian & Yong Qiu

  2. Intensive Care Unit, The Second Hospital of Nanjing, Southeast University, Nanjing, China

    Lingyan Xiao

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  1. Jun Qiao
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  2. Lingyan Xiao
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  3. Xu Sun
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  4. Benlong Shi
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  5. Zhen Liu
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  6. Leilei Xu
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  7. Zezhang Zhu
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  8. Bangping Qian
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Correspondence to Jun Qiao or Zezhang Zhu.

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Qiao, J., Xiao, L., Sun, X. et al. Vertebral subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications. Eur Spine J 27, 630–635 (2018). https://doi.org/10.1007/s00586-017-5285-2

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  • DOI: https://doi.org/10.1007/s00586-017-5285-2

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