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Clinical and Radiographic Outcomes After 3-Column Osteotomies With 5-Year Follow-up

O'Neill, Kevin R. MD, MS; Lenke, Lawrence G. MD; Bridwell, Keith H. MD; Hyun, Seung-Jae MD; Neuman, Brian MD; Dorward, Ian MD; Koester, Linda BS

doi: 10.1097/BRS.0000000000000156

Study Design. Retrospective review of prospective database.

Objective. To investigate long-term results after 3-column osteotomies (3-CO).

Summary of Background Data. Short-term studies have noted improved outcomes and alignment after 3-CO, but there is a paucity of long-term studies with a large group of patients.

Methods. An analysis of 126 patients who underwent a 3-CO (pedicle subtraction osteotomy [N = 101]/vertebral column resection [N = 25]) with minimum 5-year follow-up was performed at a single institution. The mean age was 48 years (range, 8–79 yr) and average follow-up was for 7 years (range, 5–14 yr). Oswestry Disability Index and Scoliosis Research Society (SRS) scores and radiographical parameters were assessed at baseline, 6 weeks, and 1, 2, 3, and/or 5 years postoperatively and complications were recorded.

Results. Sagittal alignment improved at all postoperative time points from baseline (mean, 117 mm), but diminished from 6 weeks (mean, 24 mm) to 5 years (mean, 41 mm; P = 0.03). Average coronal alignment was improved from baseline (27 mm) at 6 weeks (18 mm; P = 0.003) and 5 years postoperatively (19 mm; P = 0.007), with no deterioration between 6 weeks and 5 years postoperatively (P = 0.9). Major surgical complications occurred in 36% (n = 45) and major repeat surgery was performed in 28% (n = 35). Significant improvements (P < 0.05) in Oswestry Disability Index and all SRS domain scores were found at each time point. All mean outcome scores at 5 years postoperatively exceeded minimal clinically important difference thresholds except the SRS function domain. Improvement in outcomes at 5 years postoperatively was similar in groups with major surgical complications versus those without and in those with reoperation versus those without.

Conclusion. This study of 126 patients undergoing 3-CO found significant and sustained improvements in Oswestry Disability Index and SRS scores and sagittal alignment at a minimum 5 years postoperatively. This demonstrates the durability of these complex spinal reconstructions, even surprisingly in those patients having a major complication and/or revision surgery.

Level of Evidence: 4

An analysis of 126 patients who underwent a 3-column osteotomy was performed. Patients were found to have significant and sustained improvements in Oswestry Disability Index and Scoliosis Research Society scores and radiographical alignment at a minimum 5-year follow-up.

From the Department of Orthopaedics, Washington University, St. Louis, MO.

Address correspondence and reprint requests to Lawrence G. Lenke, MD, Washington University School of Medicine 660 S Euclid Ave, Campus Box 8233, Saint Louis, MO 63110-1010, E-mail:

Acknowledgment date: September 9, 2013. First revision date: November 9, 2013. Acceptance date: November 30, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants/grants pending, payment for lectures, royalties, travel/accommodations/meeting expenses, and fellowship grant.

© 2014 by Lippincott Williams & Wilkins