Three column osteotomy for adult spine deformity: comparison of outcomes and complications between kyphosis and kyphoscoliosis

Abstract

Background: To compare the surgical outcomes and complications between kyphosis and kyphoscoliosis when using three-column osteotomies.

Methods: Adult spine deformity (ASD) patients with three column osteotomies from March 2005 to December 2014 in our center were retrospectively reviewed. Pre- and postoperative standing postero-anterior and lateral radiographs of the entire spine were obtained. Scoliosis Research Society-22 questionnaire [SRS-22] and Oswestry Disability Index [ODI] were administered preoperatively, postoperatively (surveys within 2 months after surgery), and at final follow-up. Patients were assigned to one of two groups according to pre-operative coronal curve magnitude: (1) if coronal curve <10°, patients were assigned to kyphosis group (K group); (2) if coronal curve >40°, patients were assigned to kyphoscoliosis group (S group).

Results: 33 ASD patients were assigned to the kyphosis group (K group), of which 26 received PSO (pedicle subtraction osteotomy) and 7 VCR (vertebral column resection). 76 patients were assigned to kyphoscoliosis group (S group), of which 50 received PSO and 26 VCR. Patients in the K group were significantly older than in the S group (42.8 vs. 33.7 years, p < .05). Significantly longer OT (operation time) and more EBL (estimated blood loss) were observed in the S group as compared to K group (OT: 282 vs. 205 min, p < .05; EBL: 1827 vs. 1214ml, p < .05). No significant difference was noted for number of fusion levels between the groups (12.4 vs. 12.7, p > .05). Pre-operative radiographic parameters demonstrated no difference of GK (global kyphosis) and SVA (sagittal vertical axis) between the two groups (GK: 74.7° vs 76.2°, p > .05; SVA:53.2 vs. 55.7mm, p > .05). K group had larger KF than S group (26% vs. 15%, p < .05). Overall complication rate was higher in S group than in K group (30.3% vs. 18.2%, p < .05). No difference of neurological complication rates between the two groups (9.1% vs. 10.5%, p > .05).

Conclusions: Kyphoscoliosis group had less KF, GK correction and more OT, EBL and surgical complications when receiving three column osteotomies.

Keywords:

• Three column osteotomy
• kyphosis
• kyphoscoliosis
• complications

Acknowledgements

We would like to thank all participating patients, and MS Zhang Linlin for radiograph collecting.

Disclosures statement

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (81501932) and China Postdoctoral Science Foundation (2015M570440) and Science Foundation of Jiangsu Province (BK20150107)