The effect of lower level three-column osteotomies(L-3COs)on the reconstruction of coronal and sagittal balance in adult spinal deformity
10.3969/j.issn.1004-406X.2025.06.06
- VernacularTitle:低位三柱截骨术对成人脊柱畸形冠矢状面平衡重建的疗效分析
- Author:
Ming WANG
1
;
Jie LI
1
;
Saihu MAO
1
Author Information
1. 南京大学医学院附属鼓楼医院骨科脊柱外科 210008 南京市
- Publication Type:Journal Article
- Keywords:
Lower level three-column osteotomies;
Adult spinal deformity;
Kyphoscoliosis;
Coronal imbal-ance;
Sagittal imbalance
- From:
Chinese Journal of Spine and Spinal Cord
2025;35(6):606-613
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To investigate the effect of lower-level three-column osteotomies(L-3COs)on the restoration of coronal and sagittal balance in adult spinal deformity(ASD).Methods:The clinical data of ASD patients treated with L-3COs(L4,L5 level)in our hospital between January 2012 and May 2022 were retrospectively analyzed.A total of 34 patients were included in this study,including 7 males and 27 females,aged 51.4±16.2 years(range 18-72 years).According to the Qiu classification,10 cases were classifies as type A,13 cases as type B,and 11 cases as type C;9 cases were of congenital spinal deformity,3 cases were of idiopathic scoliosis,20 cases were of degenerative scoliosis,and 2 cases were of neurogenic scoliosis;7 patients underwent subsequent revision.All the patients underwent L-3COs+pelvic fixation and were followed up for ≥2 years.Imaging parameters assessing coronal and sagittal spine and trunk balance were measured at preoperation,immediate postoperatively,and at the final follow-up to evaluate the corrective outcomes.Coronal parameters included the Cobb angle,coronal balance distance(CBD),and L4 tilt angle.Sagittal parameters included sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),lumbar lordosis(LL),L4-Sl lordosis,thoracic kyphosis(TK),and sagittal vertical axis(SVA).The operative time,intraoperative blood loss,osteotomy level,and complications were documented,and clinical outcomes were appraised using the Scoliosis Research Society-22(SRS-22)questionnaire.Results:The operative time was 5.7±0.9h(4.6-7.0h),and the intraoperative blood loss was 1870±550mL(1320-3840mL).The osteotomy level was L4 in 25 cases and L5 in 9 cases.Except for PI,all the coronal and sagittal parameters significantly improved postoperatively compared to preoperative values(P＜0.05).The CBD of the patients was 24.52±19.60mm preoperatively and was corrected to 11.94±10.74mm immediately postoperatively(P=0.032).The SVA was 98.25±48.40mm preoperatively and reconstructed to 31.26±36.06mm immediately postoperatively(P＜0.001).The LL was 8.59°±11.76° preoperatively and was significantly corrected to 36.82°±10.73° immediately postoperatively(P＜0.001).8 patients suffered with postoperative mechanical complication,no revision for complications,and there were 2 cases of proximal junctional kyphosis(PJK),5 instances of rod or screw breakage,1 case of screw loosening or pullout,and 1 case of coronal imbalance(1 case presented with both PJK and coronal imbalance).The scores of all dimensions of SRS-22 questionaire(function,pain,self-image,mental health,total score)at final follow-up were significantly higher than those preoperatively(P＜0.001).Conclusions:L-3COs demonstrate significant correction effects for ASD patients with severe coronal and sagittal imbalance and loss of LL,which successfully alleviates pain and enhances long-term quality of life,with a relatively low incidence of postoperative mechanical complications,making it an effective orthopaedic technique.
