Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity intercenter variability and risk factors

Stephen P. Maier, Justin S. Smith, Frank J. Schwab, Ibrahim Obeid, Gregory M. Mundis, Eric Klineberg, Richard Hostin, Robert Hart, Douglas Burton, Oheneba Boachie-Adjei, Munish Gupta, Christopher Ames, Themistocles S. Protopsaltis, Virginie Lafage

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Study Design: Multicenter, retrospective review. Objective: To assess rates, site variability, and risk factors for revision surgery (RS) after 3-column osteotomy (3CO). Summary of Background Data: Complex spinal osteotomies, including 3CO, are being increasingly performed in the setting of patients with adult spinal deformity with sagittal plane deformity. Three-column osteotomy procedures are associated with high complication and RS rates, but risk factors for complications and variability across centers for revision have not been well defined. Methods. The incidence and indications for RS in 335 patients with adult spinal deformity were analyzed. RS indications were classified as "mechanical" (MR: implant failure, pseudarthrosis, junctional failure, and loss/lack of correction) or "nonmechanical" (NMR: neurological deficit, infection, wound dehiscence, and stenosis). Risks factors for RS were analyzed using generalized linear models. Results: Three-month and 1-year RS incidences were 12.3% and 17.6%, respectively. Single-level 3CO (n = 311) had lower RS rates than multilevel 3CO (n = 24, 15.8% vs. 41.7%, P = 0.001). The 16.7% rate for single-level lumbar 3CO included 11.4% for MR and 5.7% for NMR. For all RS, 50% of MR and 78.6% of NMR occurred within 3 months of the index surgery. There was significant variation in rates across sites (range = 6.3%-31.9%, P = 0.001), however low- and high-volume sites had similar rates (18.2% vs. 16.2%, P = 0.503). Patients with MR were more likely to be sagittally undercorrected at 3 months (sagittal vertical axis = 7 cm vs. 3.2 cm, P = 0.003). Patients with NMR had more caudal 3CO levels (L4 vs. L3, P = 0.014) and larger 3CO bone resections than patients who did not (34 ° vs. 24.5 °, P = 0.003). Conclusion: Three-column osteotomy procedures for adult spinal deformity surgery can provide significant deformity correction and lead to marked improvement in function despite established complication and revision rates. This study shows that RS is associated with lower level osteotomy and higher residual sagittal vertical axis. There is significant variability in revision rates across sites independent of site volume, suggesting potential systems and practice variations that warrant further study.

Original languageEnglish (US)
Pages (from-to)881-885
Number of pages5
JournalSpine
Volume39
Issue number11
DOIs
StatePublished - 2014

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Osteotomy
Reoperation
Pseudarthrosis
Incidence
Wound Infection
Multicenter Studies
Linear Models
Pathologic Constriction
Bone and Bones

Keywords

  • 3-Column osteotomy
  • Adult spinal deformity
  • Complications
  • Pedicle subtraction osteotomy
  • Revision surgery
  • Variability
  • Vertebral column resection

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Maier, S. P., Smith, J. S., Schwab, F. J., Obeid, I., Mundis, G. M., Klineberg, E., ... Lafage, V. (2014). Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity intercenter variability and risk factors. Spine, 39(11), 881-885. https://doi.org/10.1097/BRS.0000000000000304

Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity intercenter variability and risk factors. / Maier, Stephen P.; Smith, Justin S.; Schwab, Frank J.; Obeid, Ibrahim; Mundis, Gregory M.; Klineberg, Eric; Hostin, Richard; Hart, Robert; Burton, Douglas; Boachie-Adjei, Oheneba; Gupta, Munish; Ames, Christopher; Protopsaltis, Themistocles S.; Lafage, Virginie.

In: Spine, Vol. 39, No. 11, 2014, p. 881-885.

Research output: Contribution to journalArticle

Maier, SP, Smith, JS, Schwab, FJ, Obeid, I, Mundis, GM, Klineberg, E, Hostin, R, Hart, R, Burton, D, Boachie-Adjei, O, Gupta, M, Ames, C, Protopsaltis, TS & Lafage, V 2014, 'Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity intercenter variability and risk factors', Spine, vol. 39, no. 11, pp. 881-885. https://doi.org/10.1097/BRS.0000000000000304
Maier, Stephen P. ; Smith, Justin S. ; Schwab, Frank J. ; Obeid, Ibrahim ; Mundis, Gregory M. ; Klineberg, Eric ; Hostin, Richard ; Hart, Robert ; Burton, Douglas ; Boachie-Adjei, Oheneba ; Gupta, Munish ; Ames, Christopher ; Protopsaltis, Themistocles S. ; Lafage, Virginie. / Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity intercenter variability and risk factors. In: Spine. 2014 ; Vol. 39, No. 11. pp. 881-885.
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abstract = "Study Design: Multicenter, retrospective review. Objective: To assess rates, site variability, and risk factors for revision surgery (RS) after 3-column osteotomy (3CO). Summary of Background Data: Complex spinal osteotomies, including 3CO, are being increasingly performed in the setting of patients with adult spinal deformity with sagittal plane deformity. Three-column osteotomy procedures are associated with high complication and RS rates, but risk factors for complications and variability across centers for revision have not been well defined. Methods. The incidence and indications for RS in 335 patients with adult spinal deformity were analyzed. RS indications were classified as {"}mechanical{"} (MR: implant failure, pseudarthrosis, junctional failure, and loss/lack of correction) or {"}nonmechanical{"} (NMR: neurological deficit, infection, wound dehiscence, and stenosis). Risks factors for RS were analyzed using generalized linear models. Results: Three-month and 1-year RS incidences were 12.3{\%} and 17.6{\%}, respectively. Single-level 3CO (n = 311) had lower RS rates than multilevel 3CO (n = 24, 15.8{\%} vs. 41.7{\%}, P = 0.001). The 16.7{\%} rate for single-level lumbar 3CO included 11.4{\%} for MR and 5.7{\%} for NMR. For all RS, 50{\%} of MR and 78.6{\%} of NMR occurred within 3 months of the index surgery. There was significant variation in rates across sites (range = 6.3{\%}-31.9{\%}, P = 0.001), however low- and high-volume sites had similar rates (18.2{\%} vs. 16.2{\%}, P = 0.503). Patients with MR were more likely to be sagittally undercorrected at 3 months (sagittal vertical axis = 7 cm vs. 3.2 cm, P = 0.003). Patients with NMR had more caudal 3CO levels (L4 vs. L3, P = 0.014) and larger 3CO bone resections than patients who did not (34 ° vs. 24.5 °, P = 0.003). Conclusion: Three-column osteotomy procedures for adult spinal deformity surgery can provide significant deformity correction and lead to marked improvement in function despite established complication and revision rates. This study shows that RS is associated with lower level osteotomy and higher residual sagittal vertical axis. There is significant variability in revision rates across sites independent of site volume, suggesting potential systems and practice variations that warrant further study.",
keywords = "3-Column osteotomy, Adult spinal deformity, Complications, Pedicle subtraction osteotomy, Revision surgery, Variability, Vertebral column resection",
author = "Maier, {Stephen P.} and Smith, {Justin S.} and Schwab, {Frank J.} and Ibrahim Obeid and Mundis, {Gregory M.} and Eric Klineberg and Richard Hostin and Robert Hart and Douglas Burton and Oheneba Boachie-Adjei and Munish Gupta and Christopher Ames and Protopsaltis, {Themistocles S.} and Virginie Lafage",
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T1 - Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity intercenter variability and risk factors

AU - Maier, Stephen P.

AU - Smith, Justin S.

AU - Schwab, Frank J.

AU - Obeid, Ibrahim

AU - Mundis, Gregory M.

AU - Klineberg, Eric

AU - Hostin, Richard

AU - Hart, Robert

AU - Burton, Douglas

AU - Boachie-Adjei, Oheneba

AU - Gupta, Munish

AU - Ames, Christopher

AU - Protopsaltis, Themistocles S.

AU - Lafage, Virginie

PY - 2014

Y1 - 2014

N2 - Study Design: Multicenter, retrospective review. Objective: To assess rates, site variability, and risk factors for revision surgery (RS) after 3-column osteotomy (3CO). Summary of Background Data: Complex spinal osteotomies, including 3CO, are being increasingly performed in the setting of patients with adult spinal deformity with sagittal plane deformity. Three-column osteotomy procedures are associated with high complication and RS rates, but risk factors for complications and variability across centers for revision have not been well defined. Methods. The incidence and indications for RS in 335 patients with adult spinal deformity were analyzed. RS indications were classified as "mechanical" (MR: implant failure, pseudarthrosis, junctional failure, and loss/lack of correction) or "nonmechanical" (NMR: neurological deficit, infection, wound dehiscence, and stenosis). Risks factors for RS were analyzed using generalized linear models. Results: Three-month and 1-year RS incidences were 12.3% and 17.6%, respectively. Single-level 3CO (n = 311) had lower RS rates than multilevel 3CO (n = 24, 15.8% vs. 41.7%, P = 0.001). The 16.7% rate for single-level lumbar 3CO included 11.4% for MR and 5.7% for NMR. For all RS, 50% of MR and 78.6% of NMR occurred within 3 months of the index surgery. There was significant variation in rates across sites (range = 6.3%-31.9%, P = 0.001), however low- and high-volume sites had similar rates (18.2% vs. 16.2%, P = 0.503). Patients with MR were more likely to be sagittally undercorrected at 3 months (sagittal vertical axis = 7 cm vs. 3.2 cm, P = 0.003). Patients with NMR had more caudal 3CO levels (L4 vs. L3, P = 0.014) and larger 3CO bone resections than patients who did not (34 ° vs. 24.5 °, P = 0.003). Conclusion: Three-column osteotomy procedures for adult spinal deformity surgery can provide significant deformity correction and lead to marked improvement in function despite established complication and revision rates. This study shows that RS is associated with lower level osteotomy and higher residual sagittal vertical axis. There is significant variability in revision rates across sites independent of site volume, suggesting potential systems and practice variations that warrant further study.

AB - Study Design: Multicenter, retrospective review. Objective: To assess rates, site variability, and risk factors for revision surgery (RS) after 3-column osteotomy (3CO). Summary of Background Data: Complex spinal osteotomies, including 3CO, are being increasingly performed in the setting of patients with adult spinal deformity with sagittal plane deformity. Three-column osteotomy procedures are associated with high complication and RS rates, but risk factors for complications and variability across centers for revision have not been well defined. Methods. The incidence and indications for RS in 335 patients with adult spinal deformity were analyzed. RS indications were classified as "mechanical" (MR: implant failure, pseudarthrosis, junctional failure, and loss/lack of correction) or "nonmechanical" (NMR: neurological deficit, infection, wound dehiscence, and stenosis). Risks factors for RS were analyzed using generalized linear models. Results: Three-month and 1-year RS incidences were 12.3% and 17.6%, respectively. Single-level 3CO (n = 311) had lower RS rates than multilevel 3CO (n = 24, 15.8% vs. 41.7%, P = 0.001). The 16.7% rate for single-level lumbar 3CO included 11.4% for MR and 5.7% for NMR. For all RS, 50% of MR and 78.6% of NMR occurred within 3 months of the index surgery. There was significant variation in rates across sites (range = 6.3%-31.9%, P = 0.001), however low- and high-volume sites had similar rates (18.2% vs. 16.2%, P = 0.503). Patients with MR were more likely to be sagittally undercorrected at 3 months (sagittal vertical axis = 7 cm vs. 3.2 cm, P = 0.003). Patients with NMR had more caudal 3CO levels (L4 vs. L3, P = 0.014) and larger 3CO bone resections than patients who did not (34 ° vs. 24.5 °, P = 0.003). Conclusion: Three-column osteotomy procedures for adult spinal deformity surgery can provide significant deformity correction and lead to marked improvement in function despite established complication and revision rates. This study shows that RS is associated with lower level osteotomy and higher residual sagittal vertical axis. There is significant variability in revision rates across sites independent of site volume, suggesting potential systems and practice variations that warrant further study.

KW - 3-Column osteotomy

KW - Adult spinal deformity

KW - Complications

KW - Pedicle subtraction osteotomy

KW - Revision surgery

KW - Variability

KW - Vertebral column resection

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