Sagittal alignment and complications following lumbar 3-column osteotomy

does the level of resection matter?

Emmanuelle Ferrero, Barthelemy Liabaud, Jensen K. Henry, Christopher P. Ames, Khaled M Kebaish, Gregory M. Mundis, Richard Hostin, Munish C. Gupta, Oheneba Boachie-Adjei, Justin S. Smith, Robert A. Hart, Ibrahim Obeid, Bassel G. Diebo, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Three-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions. METHODS In this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery. RESULTS A total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1° and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2° per more caudal level, R = -0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026). CONCLUSIONS In this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.

Original languageEnglish (US)
Pages (from-to)560-569
Number of pages10
JournalJournal of neurosurgery. Spine
Volume27
Issue number5
DOIs
StatePublished - Nov 1 2017

Fingerprint

Lordosis
Osteotomy
Pseudarthrosis
Intraoperative Complications
Reoperation
Body Mass Index
Retrospective Studies
Logistic Models
Regression Analysis
Databases

Keywords

  • 3-column osteotomy
  • 3CO = 3-column osteotomy
  • adult spinal deformity
  • ASD = adult spinal deformity
  • BMI = body mass index
  • complications
  • EBL = estimated blood loss
  • LL = lumbar lordosis
  • lumbar lordosis
  • PI = pelvic incidence
  • PT = pelvic tilt
  • sagittal alignment
  • SVA = sagittal vertical axis
  • T1SPi = T-1 spinopelvic inclination
  • TK = thoracic kyphosis

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Sagittal alignment and complications following lumbar 3-column osteotomy : does the level of resection matter? / Ferrero, Emmanuelle; Liabaud, Barthelemy; Henry, Jensen K.; Ames, Christopher P.; Kebaish, Khaled M; Mundis, Gregory M.; Hostin, Richard; Gupta, Munish C.; Boachie-Adjei, Oheneba; Smith, Justin S.; Hart, Robert A.; Obeid, Ibrahim; Diebo, Bassel G.; Schwab, Frank J.; Lafage, Virginie.

In: Journal of neurosurgery. Spine, Vol. 27, No. 5, 01.11.2017, p. 560-569.

Research output: Contribution to journalArticle

Ferrero, E, Liabaud, B, Henry, JK, Ames, CP, Kebaish, KM, Mundis, GM, Hostin, R, Gupta, MC, Boachie-Adjei, O, Smith, JS, Hart, RA, Obeid, I, Diebo, BG, Schwab, FJ & Lafage, V 2017, 'Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?', Journal of neurosurgery. Spine, vol. 27, no. 5, pp. 560-569. https://doi.org/10.3171/2017.3.SPINE16357
Ferrero, Emmanuelle ; Liabaud, Barthelemy ; Henry, Jensen K. ; Ames, Christopher P. ; Kebaish, Khaled M ; Mundis, Gregory M. ; Hostin, Richard ; Gupta, Munish C. ; Boachie-Adjei, Oheneba ; Smith, Justin S. ; Hart, Robert A. ; Obeid, Ibrahim ; Diebo, Bassel G. ; Schwab, Frank J. ; Lafage, Virginie. / Sagittal alignment and complications following lumbar 3-column osteotomy : does the level of resection matter?. In: Journal of neurosurgery. Spine. 2017 ; Vol. 27, No. 5. pp. 560-569.
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T1 - Sagittal alignment and complications following lumbar 3-column osteotomy

T2 - does the level of resection matter?

AU - Ferrero, Emmanuelle

AU - Liabaud, Barthelemy

AU - Henry, Jensen K.

AU - Ames, Christopher P.

AU - Kebaish, Khaled M

AU - Mundis, Gregory M.

AU - Hostin, Richard

AU - Gupta, Munish C.

AU - Boachie-Adjei, Oheneba

AU - Smith, Justin S.

AU - Hart, Robert A.

AU - Obeid, Ibrahim

AU - Diebo, Bassel G.

AU - Schwab, Frank J.

AU - Lafage, Virginie

PY - 2017/11/1

Y1 - 2017/11/1

N2 - OBJECTIVE Three-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions. METHODS In this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery. RESULTS A total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1° and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2° per more caudal level, R = -0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026). CONCLUSIONS In this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.

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KW - LL = lumbar lordosis

KW - lumbar lordosis

KW - PI = pelvic incidence

KW - PT = pelvic tilt

KW - sagittal alignment

KW - SVA = sagittal vertical axis

KW - T1SPi = T-1 spinopelvic inclination

KW - TK = thoracic kyphosis

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