Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases

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  • 1 Departments of Neurological Surgery and
  • 2 Orthopedic Surgery, University of California, San Francisco, California
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OBJECTIVE

The correction of severe cervicothoracic sagittal deformities can be very challenging and can be associated with significant morbidity. Often, soft-tissue releases and osteotomies are warranted to achieve the desired correction. There is a paucity of studies that examine the difference in morbidity and complication profiles for Smith-Petersen osteotomy (SPO) versus 3-column osteotomy (3CO) for cervical deformity correction.

METHODS

A retrospective comparison of complication profiles between posterior-based SPO (Ames grade 2 SPO) and 3CO (Ames grade 5 opening wedge osteotomy and Ames grade 6 closing wedge osteotomy) was performed by examining a single-surgeon experience from 2011 to 2018. Patients of interest were individuals who had a cervical sagittal vertical axis (cSVA) > 4 cm and/or cervical kyphosis > 20° and who underwent corrective surgery for cervical deformity. Multivariate analysis was utilized.

RESULTS

A total of 95 patients were included: 49 who underwent 3CO and 46 who underwent SPO. Twelve of the SPO patients underwent an anterior release procedure. The patients’ mean age was 63.2 years, and 60.0% of the patients were female. All preoperative radiographic parameters showed significant correction postoperatively: cSVA (6.2 cm vs 4.5 cm [preoperative vs postoperative values], p < 0.001), cervical lordosis (6.8° [kyphosis] vs −7.5°, p < 0.001), and T1 slope (40.9° and 35.2°, p = 0.026). The overall complication rate was 37.9%, and postoperative neurological deficits were seen in 16.8% of patients. The surgical and medical complication rates were 17.9% and 23.2%, respectively. Overall, complication rates were higher in patients who underwent 3CO compared to those who underwent SPO, but this was not statistically significant (total complication rate 42.9% vs 32.6%, p = 0.304; surgical complication rate 18.4% vs 10.9%, p = 0.303; and new neurological deficit rate 20.4% vs 13.0%, p = 0.338). Medical complication rates were similar between the two groups (22.4% [3CO] vs 23.9% [SPO], p = 0.866). Independent risk factors for surgical complications included male sex (OR 10.88, p = 0.014), cSVA > 8 cm (OR 10.36, p = 0.037), and kyphosis > 20° (OR 9.48, p = 0.005). Combined anterior-posterior surgery was independently associated with higher odds of medical complications (OR 10.30, p = 0.011), and preoperative kyphosis > 20° was an independent risk factor for neurological deficits (OR 2.08, p = 0.011).

CONCLUSIONS

There was no significant difference in complication rates between 3CO and SPO for cervicothoracic deformity correction, but absolute surgical and neurological complication rates for 3CO were higher. A preoperative cSVA > 8 cm was a risk factor for surgical complications, and kyphosis > 20° was a risk factor for both surgical and neurological complications. Additional studies are warranted on this topic.

ABBREVIATIONS ACD = adult cervical deformity; CL = cervical lordosis; cSVA = cervical sagittal vertical axis; PSO = pedicle subtraction osteotomy; SPO = Smith-Petersen osteotomy; 3CO = 3-column osteotomy.

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Contributor Notes

Correspondence Darryl Lau: University of California, San Francisco, CA. darryl.lau@ucsf.edu.

INCLUDE WHEN CITING Published online May 8, 2020; DOI: 10.3171/2020.3.SPINE191330.

Disclosures Dr. Deviren reports being a consultant for NuVasive, Zimmer Biomet, SeaSpine, Alphatec/Atec, and Medicrea; and receiving royalties from NuVasive. Dr. Ames reports being an employee of UCSF and a consultant for DePuy Synthes, Medtronic, Stryker, Medicrea, K2M, and Zimmer Biomet; receiving royalties from Stryker, Zimmer Biomet, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, and Medicrea; receiving research support from Titan Spine, DePuy Synthes, and ISSG; being on the editorial board of Operative Neurosurgery; receiving grant funding from SRS; being on the executive committee of ISSG; and being the director of Global Spine Analytics.

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