After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries With 2-Year Follow-up.

Abstract

Background

In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies reflects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO.

Objective

To investigate if performance of 3CO surgeries improves with years of practice.

Methods

Patients who underwent 3CO for spinal deformity with intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis.

Results

Five hundred seventy-three patients were stratified into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P = .001), and received a larger osteotomy resection (G4 = 26° vs G1 = 20°, P = .011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P = .039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P = .007). Major complication rates also decreased (57%, 50%, 46%, 39%, P = .023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P = .023) and bladder/bowel deficit (4.2% vs 0.7% P = .002). Successful outcomes (no complications or revision) significantly increased (P = .001).

Conclusion

Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.

Department

Description

Provenance

Subjects

International Spine Study Group (ISSG) of Denver, Colorado, Humans, Spinal Diseases, Postoperative Complications, Treatment Outcome, Osteotomy, Retrospective Studies, Adult, Aged, Middle Aged, Female, Male

Citation

Published Version (Please cite this version)

10.1093/neuros/nyx338

Publication Info

Diebo, Bassel G, Virginie Lafage, Jeffrey J Varghese, Munish Gupta, Han Jo Kim, Christopher Ames, Khaled Kebaish, Christopher Shaffrey, et al. (2018). After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries With 2-Year Follow-up. Neurosurgery, 83(1). pp. 69–75. 10.1093/neuros/nyx338 Retrieved from https://hdl.handle.net/10161/28326.

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