Determining the utility of three-column osteotomies in revision surgery compared with primary surgeries in the thoracolumbar spine: a retrospective cohort study in the United States
- Author:
Tyler Kade WILLIAMSON
1
;
Oluwatobi O ONAFOWOKAN
;
Ankita DAS
;
Jamshaid Mahmood MIR
;
Oscar KROL
;
Peter TRETIAKOV
;
Rachel JOUJON-ROCHE
;
Bailey IMBO
;
Salman AHMAD
;
Stephane OWUSU-SARPONG
;
Jordan LEBOVIC
;
Shaleen VIRA
;
Andrew J SCHOENFELD
;
Muhammad Burhan JANJUA
;
Bassel DIEBO
;
Renaud LAFAGE
;
Virginie LAFAGE
;
Peter Gust PASSIAS
Author Information
- Publication Type:Clinical Study
- From:Asian Spine Journal 2024;18(5):673-680
- CountryRepublic of Korea
- Language:English
-
Abstract:
Methods:Patients ASD having 2-year data were included and divided into 3CO and non-3CO (remaining ASD cohort) groups. For the subanalysis, patients were stratified based on whether they were undergoing primary (P3CO) or revision (R3CO) surgery. Multivariate analysis controlling for age, Charlson comorbidity index, body mass index, baseline pelvic incidence–lumbar lordosis, and fused levels evaluated the complication rates and radiographic and patient-reported outcomes between the 3CO and non-3CO groups.
Results:Of the 436 patients included, 20% had 3COs. 3COs were performed in 16% of P3COs and 51% of R3COs. Both 3CO groups had greater severity in deformity and disability at baseline; however, only R3COs improved more than non-3COs. Despite greater segmental correction, 3COs had much lower rates of aligning in the lumbar distribution index (LDI), higher mechanical complications, and more reoperations when performed below L3. When comparing P3COs and R3COs, baseline lumbopelvic and global alignments, as well as disability, were different. The R3CO group had greater clinical improvements and global correction (both p<0.04), although the P3CO group achieved alignment in LDI more often (odds ratio, 3.9; 95% confidence interval, 1.3–6.2; p=0.006). The P3CO group had more neurological complications (30% vs. 13%, p=0.042), whereas the R3CO tended to have higher mechanical complication rates (25% vs. 15%, p=0.2).
Conclusions:3COs showed greater improvements in realignment while failing to demonstrate the same clinical improvement as primaries without a 3CO. Overall, when suitably indicated, a 3CO offers superior utility for achieving optimal realignment across primary and revision surgeries for ASD correction.
