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Mostafa H. El Dafrawy, Owoicho Adogwa, Adam M. Wegner, Nicholas A. Pallotta, Michael P. Kelly, Khaled M. Kebaish, Keith H. Bridwell, and Munish C. Gupta

I mplant failure is a common complication of long spinal fusions in adult spinal deformity (ASD) surgery 1 , 2 that often leads to revision surgery. 3 , 4 The rate of rod fractures ranges from 14.9% 5 to 18.5%, 6 with a higher prevalence observed across three-column osteotomy (3CO) sites. Several techniques are currently used to mitigate this high implant failure rate, such as larger rod diameters, durable rod material, 7 and use of multirod constructs (MRCs). 6 , 8–14 MRCs in ASD surgery can be variable and modular. 9–20 Previous studies reported a lower

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Darryl Lau, Lanjun Guo, Vedat Deviren, and Christopher P. Ames

classification. 7 Positive sagittal imbalance secondary to subaxial cervical kyphosis would typically benefit from an anterior osteotomy via anterior cervical discectomy, uncinate joint resection, or corpectomy and further supplemented by a posterior approach if needed. 8 However, ACD with sagittal imbalance driven mainly by a lower cervical or upper thoracic deformity (high T1 slope) typically requires a posterior-based three-column osteotomy (3CO) via grade 5 or 6 osteotomy (open wedge or closed wedge pedicle subtraction osteotomy [PSO]). 8 , 9 There is a paucity of

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Zirun Zhao, Saman Shabani, Nitin Agarwal, Praveen V. Mummaneni, and Dean Chou

( B ), and CT myelogram ( C ) demonstrating arachnoid web at T6. Operative Description After general anesthesia and prone positioning, the posterior thoracic spine was exposed in the usual standard fashion. Pedicle screws were placed into the pedicles of T4, T5, T7, and T8, and laminectomies at T5 to T7 were performed. Subsequently, a three-column osteotomy of T6 was performed by removing the pedicles, the cancellous bone, the lateral cortical walls, and the posterior cortical wall. A temporary rod was placed at this point to prevent collapse. The ventral

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Kristina Bianco, Robert Norton, Frank Schwab, Justin S. Smith, Eric Klineberg, Ibrahim Obeid, Gregory Mundis Jr., Christopher I. Shaffrey, Khaled Kebaish, Richard Hostin, Robert Hart, Munish C. Gupta, Douglas Burton, Christopher Ames, Oheneba Boachie-Adjei, Themistocles S. Protopsaltis, and Virginie Lafage

sagittal planes leads to disability and reduced self-image. 14 , 23 Fixed and rigid sagittal deformity may result in sagittal imbalance with secondary compensatory mechanisms within the pelvis. Pelvic parameters are highly correlated with the disability of patients and provide a guide for patient assessment and surgical planning. 12 , 14 , 22 , 23 Three-column osteotomies are powerful surgical techniques used for deformity correction and restoration of global balance; however, they can be associated with major complications, especially in the elderly population

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Alexandria C. Marino, Thomas J. Buell, Rebecca M. Burke, Tony R. Wang, Chun-Po Yen, Christopher I. Shaffrey, and Justin S. Smith

Transcript Three-column osteotomies are useful for revision spine surgery but have high complication rates. To avoid this morbid technique, we used a staged anterior-posterior approach with L5–S1 ALIF and multilevel Smith-Petersen osteotomies for deformity correction. 0:42 History and physical A 67-year-old male presented with back and leg pain. He had three prior lumbar surgeries including a posterior instrumented arthrodesis from L3 to L5. Standing scoliosis films demonstrated global coronal alignment and a thoracolumbar major curve measuring approximately 17

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Darryl Lau, Joseph A. Osorio, Vedat Deviren, and Christopher P. Ames

osteotomies. Several spinal osteotomy techniques have been described throughout the literature, and more recently thoracolumbar osteotomies were classified based on extent of bony resection and anatomical location. 37 In cases in which substantial corrections are needed, 3-column osteotomies such as pedicle subtraction osteotomy (PSO; grade 4 osteotomy) or vertebral column resection (VCR; grade 5 and 6 osteotomy) are used to maximize destabilizing potential to achieve maximal spinal mobility and correction. Three-column osteotomies have proven to be powerful techniques; a

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Jin-Sung Park, Chong-Suh Lee, Youn-Taek Choi, and Se-Jun Park

S urgery for adult spinal deformity (ASD) has recently garnered greater attention due to the increase in life expectancy and greater demand for higher quality of life in the elderly population. 1–3 Several studies have reported that sagittal spinal alignment can greatly impact the patient’s clinical symptoms as well as the quality of life. 4–7 Sagittal alignment, therefore, should play a central role in surgical treatment for ASD. The traditional method of correcting ASD is three-column osteotomy (3CO), such as pedicle subtraction osteotomy (PSO), and

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Darryl Lau, Vedat Deviren, Rushikesh S. Joshi, and Christopher P. Ames

osteotomy for ankylosing spondylitis utilizing the Jackson operating table: technical note . Spine (Phila Pa 1976) . 2007 ; 32 ( 17 ): 1926 – 1929 . 24 Scheer JK , Tang JA , Buckley JM , Biomechanical analysis of osteotomy type and rod diameter for treatment of cervicothoracic kyphosis . Spine (Phila Pa 1976) . 2011 ; 36 ( 8 ): E519 – E523 . 25 Smith JS , Shaffrey CI , Lafage R , Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23

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Justin K. Scheer, Virginie Lafage, Justin S. Smith, Vedat Deviren, Richard Hostin, Ian M. McCarthy, Gregory M. Mundis, Douglas C. Burton, Eric Klineberg, Munish C. Gupta, Khaled M. Kebaish, Christopher I. Shaffrey, Shay Bess, Frank Schwab, Christopher P. Ames, and the International Spine Study Group (ISSG)

S pinal osteotomies for adult spinal deformity correction may include the resection of all 3 spinal columns. Three-column osteotomies, including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), 7 , 10 , 17 , 20 , 25 , 30 allow for the extensive correction of severe rigid spinal deformity in the sagittal, coronal, and axial planes simultaneously through a posterior-only approach. 4 , 7 , 10 , 17 , 20 , 25 , 27 , 28 , 30 Although these osteotomies can have powerful corrective effects, they also have significant risks of morbidity

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Varun Puvanesarajah, Sandesh S. Rao, Hamid Hassanzadeh, and Khaled M. Kebaish

pRBC units 4.8 ± 3.7  Postop allogeneic pRBC units 2.4 ± 1.5 ASA = American Society of Anesthesiologists. Values are number (%) or mean ± SD. * Patients treated with ≥ 3 Schwab grade 2 osteotomies. Surgical Factors Fifty percent of the surgeries performed were primary fusions. The mean operative time was 403 minutes (range 231–606 minutes). The mean (± SD) number of levels fused was 9 ± 4. Three-column osteotomies were used in 71 (43%) patients. The mean EBL was 2220 ± 1708 ml. An antifibrinolytic agent was used in 58 (35%) patients ( Table 1 ). Of the patients