Tag: Three-column osteotomy

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Cervical deformity correction: comparison of neurological, radiographic, and patient-reported outcome measures by three-column osteotomy level

J Neurosurg Spine 43:433–442, 2025

Three-column osteotomy (3CO) for cervical deformity at C7–T1 is linked to higher neurological deficits, less radiographic correction, and worse Neck Disability Index outcomes compared to T2–6 levels. Surgeons should prefer 3CO below T1 when feasible for better neurological and functional results.

• Study compared outcomes of three-column osteotomy (3CO) for cervical deformity at C7–T1 vs T2–6 levels.

• Patients with 3CO at C7–T1 had higher rates of new postoperative neurological deficits (56% vs 18%).

• T2–6 3CO resulted in greater radiographic correction (T1 slope and C2–T4 SVA) than C7–T1 3CO.

• Neck Disability Index (NDI) improved after T2–6 3CO but worsened after C7–T1 3CO at 1 year.

• All patients with neurological deficits had at least partial recovery; 20% achieved complete recovery.

• 3CO level selection is multifactorial, but caudal to T1 is recommended when feasible due to better outcomes.

• Study limitations include retrospective design and single-institution data.

• Largest study to date comparing neurological, radiographic, and patient-reported outcomes by 3CO level.

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Usefulness of anterior column release for segmental lordosis restoration in degenerative lumbar kyphosis

J Neurosurg Spine 36:422–428, 2022

Three-column osteotomies (3COs) for surgical correction of lumbar kyphosis show a strong correction capacity, but this procedure carries high morbidity rates. The anterior column release (ACR) technique was developed as a less invasive procedure. In this study the authors aimed to evaluate sagittal alignment restoration using ACR and to determine factors that affect the degree of correction.

METHODS This study included 36 patients (68 cases) who underwent ACR of more than one level for adult spinal deformity. Parameters for regional sagittal alignment included segmental lordosis (SL). The parameters for global sagittal alignment included pelvic incidence, lumbar lordosis, sacral slope, pelvic tilt, and sagittal vertical axis (SVA). In addition, the interdiscal height (IDH) and difference of interdiscal angle (DIDA) were measured to evaluate the stiffness of the vertebra segment. The changes in SL were evaluated after ACR and the change of global sagittal alignment was also determined. Factors such as the location of the ACR level, IDH, DIDA, cage height, and additional posterior column osteotomy (PCO) were analyzed for correlation with the degree of SL correction.

RESULTS Thirty-six patients were included in this study. A total of 68 levels were operated with the ACR (8 levels at L2–3, 27 levels at L3–4, and 33 levels at L4–5). ACR was performed for 1 level in 10 patients, 2 levels in 20, and 3 levels in 6 patients (mean 1.9   0.7 levels per patient). Mean follow-up duration was 27.1   4.2 months. The mean SL of the total segment was 0.4    7.2  preoperatively and increased by 15.3    5.5  at the last follow-up (p < 0.001); thus, the mean increase of SL was 14.9    8.1  per one ACR. Global sagittal alignment was also improved following SL restoration with SVA from 101.9 mm to 31.4 mm. The degree of SL correction was correlated with the location of ACR level (p = 0.041) and was not correlated with IDH, DIDA, cage height and additional PCO.

CONCLUSIONS This study demonstrated that the mean correction angle of SL was 14.9 per one ACR. The degree of disc space collapse and stiffness of segment did not affect the degree of correction by ACR.

 

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The Mini-Open Pedicle Subtraction Osteotomy for Flat-Back Syndrome and Kyphosis Correction

Operative Neurosurgery 12:309–316, 2016

The pedicle subtraction osteotomy (PSO) has been a mainstay treatment for flat-back syndrome. The morbidity of open deformity correction can be high, and minimally invasive applications may reduce such morbidity.

OBJECTIVE: To describe an operative technique of the mini-open PSO.

METHODS: Two patients underwent percutaneous fixation above and below the PSO, and the PSO was performed in a mini-open fashion. The correction was obtained by cantilever.

RESULTS: The patient who underwent the L3 PSO had a prior fusion from T11 to L4 for scoliosis 35 years ago. On presentation at 62 years of age, he had a pelvic incidence of 54, lumbar lordosis of 23, sagittal vertical axis of 114 cm, and pelvic tilt of 25. He underwent an anterior lumbar interbody fusion at L5-S1 followed by a min-open L3 PSO. He had a postoperative lumbar lordosis of 64 (correction of 41), and his sagittal vertical axis went to 13 cm. His Oswestry Disability Index and visual analog scale scores decreased after surgery. The second patient was 64 years of age and underwent an L1 PSO. He had 43 of kyphosis from T10 to L2. He had a preoperative pelvic incidence of 63, lumbar lordosis of 35, pelvic tilt of 24, and sagittal vertical axis of 3 cm. His postoperative kyphosis improved from 43 to 32.

CONCLUSION: The mini-open PSO can achieve significant lordosis, although it is heavily reliant on anterior arthrodesis. Larger studies are needed to compare this approach with an open PSO.

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