Improved scores after 3-column osteotomies show procedure’s durability

The first long-term study of its kind showed that patients with spinal deformity who underwent 3-column osteotomies experienced significant improvements in the Oswestry Disability Index and Scoliosis Research Society scores at 5 years follow-up.

“This is the largest study of 3-column osteotomy procedures with long-term follow-up. We found significant and sustained improvements in radiographic spinal alignment as well as patient reported outcomes. This study documents the durability of these complex spinal operations in terms of radiographic and outcome measures,” Kevin R. O’Neill, MD, said in a presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.

Osteotomies improved scores

O’Neill and colleagues analyzed the results of 3-column osteotomies performed in 118 patients (mean age 48 years) who had a minimum follow-up of 5 years. The Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) scores and radiographic parameters were reported at baseline and at the five postoperative points of 6 weeks, 1 year, 2 years, 3 years and/or 5 years.

Eighty-five percent of patients had previous spine surgery and the average follow up was 7 years (range, 5 years to 14 years), O’Neill said. “We collected surgical information, measured radiographic parameters, and measured complications and reoperations during the follow up.”

The mean operative time for patients undergoing the procedure was 569 minutes, which ranged from 300 minutes to 1,128 minutes. Patients lost 2 liters of blood on average during each operation, according to the study abstract.
Fixed sagittal imbalance was present in 98% of patients, O’Neill and colleagues noted, and single stage surgery was performed in 56% of patients.

Complications were evident

There were no cases of paraplegia, however major complications occurred in 58% of patients and 23% of procedures required a revision. In the early postoperative period prior to 3 months “the most common complication was temporary motor radiculopathy and the most common operation then [was] a revision decompression.”
The most common type of revision surgery at later time points was posterior fusion which was performed in 16% of patients, according to the findings.

O’Neill said, “ODI scores were found to have statistically significant improvement at each postop time point, which was maintained between 1 year and 5 years postoperatively. Similarly, SRS scores had statistically significant improvements at each postoperative time point and no deterioration [was] noted at 1 and 5 years postop.”

The investigators found final scores were positively associated with presence of adolescent idiopathic scoliosis, improved major Cobb angle, improved sagittal alignment and pelvic tilt improved to less than 30°.

O’Neill and colleagues noted in the study that this type of complex spine reconstruction even proved durable in patients who had a major complication or required revision surgery. – by Robert Linnehan

References:

O’Neill KR. Paper #104. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
O’Neill KR. Spine. 2014;doi: 10.1097/BRS.0000000000000156.

For more information:

Kevin R. O’Neill, MD, can be reached at the Department of Neurological Surgery, Vanderbilt University Medical Center, 215 Light Hall, Nashville, TN 37232; email: kevin.oneill@vanderbilt.edu. Disclosure: O’Neill has no relevant financial disclosures.