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J Neurosurg Spine. 2017 Nov;27(5):560-569. doi: 10.3171/2017.3.SPINE16357. Epub 2017 Sep 8.

Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?

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Hôpital Européen Georges-Pompidou, APHP, Paris V University, Paris, France.
Department of Orthopaedic Surgery, Spine Division, Hospital for Special Surgery, New York, New York.
Department of Neurosurgery, University of California, San Francisco Medical Center, San Francisco, California.
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland.
San Diego Center for Spinal Disorders, La Jolla, California.
Baylor Scoliosis Center, Plano, Texas.
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
Department of Orthopedic Surgery, University of Oregon Health Sciences Center, Portland, Oregon; and.
Centre Hospitalier Universitaire de Bordeaux, France.


OBJECTIVE Three-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions. METHODS In this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery. RESULTS A total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1° and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2° per more caudal level, R = -0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026). CONCLUSIONS In this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.


3-column osteotomy; 3CO = 3-column osteotomy; ASD = adult spinal deformity; BMI = body mass index; EBL = estimated blood loss; LL = lumbar lordosis; PI = pelvic incidence; PT = pelvic tilt; SVA = sagittal vertical axis; T1SPi = T-1 spinopelvic inclination; TK = thoracic kyphosis; adult spinal deformity; complications; lumbar lordosis; sagittal alignment

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