Asymmetric Three-Column Osteotomy for Coronal Malalignment in Adult Patients with Prior Thoracic Fusion for Adolescent Idiopathic Scoliosis: Three-Year Follow-up

Objective: In the setting of a previous proximal fusion, an asymmetric 3-column osteotomy (3CO) can provide tremendous deformity correction. Our goal was to evaluate outcomes and complications of asymmetric 3CO through the proximal fusion mass, for coronal malalignment in patients with previous long thoracic fusion for adolescent idiopathic scoliosis. Methods: This was a retrospective case series. Thirteen individuals with a history of a long thoracic fusion underwent asymmetric 3CO for persistent coronal malalignment. Clinical chart review was conducted to determine perioperative complications and radiographs evaluated for alignment. Results: Thirteen patients (age: 57.8 ± 12.2 years; 0 male, 13 female) completed a mean follow-up of 42.4 months. There was significant improvement in coronal and sagittal alignment, and pelvic incidence–lumbar lordosis postoperatively (P < 0.05). One patient developed lower-extremity weakness requiring revision decompression 72 hours postoperatively; the weakness subsequently resolved. One patient had a foot drop postoperatively. At final follow-up, 12 of 13 patients had grade 1 fusion at the osteotomy site; 1 patient had a grade 2 fusion. None of the patients developed a pseudarthrosis, or superficial or deep infections. Conclusions: Patients with a history of previous thoracic fusion for adolescent idiopathic scoliosis and coronal malalignment may develop painful degeneration of the segments caudal to the fusion as adults. In this setting, extension of fusion to the sacropelvis alone may worsen the patient's coronal alignment. An asymmetric 3CO may be considered at the proximal fusion mass to achieve realignment objectives, with an acceptable complication rate and an expected improvement in outcomes.