Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity...

Area of Science:

• Spine surgery
• Orthopedic surgery
• Surgical complications

Background:

• Three-column spinal osteotomies, such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), are established procedures for correcting severe spinal deformities.
• These complex surgeries carry inherent risks of complications, necessitating an understanding of associated risk factors and their impact on patient outcomes.

Purpose of the Study:

• To identify risk factors associated with major complications in 3-column spinal osteotomies.
• To evaluate the effect of major complications on long-term clinical outcomes following PSO and VCR procedures.

Main Methods:

• A retrospective review of 240 consecutive PSO (n=156) and VCR (n=84) procedures performed between 1995 and 2008.
• Analysis included 105 patients with complete 2-year postoperative data, assessing major/minor and surgical/medical complications.
• Risk factors and impact on Scoliosis Research Society (SRS) outcomes were evaluated.

Main Results:

• Major complications occurred in 35% of cases (38% PSO, 22% VCR).
• Key risk factors for major complications included preoperative sagittal imbalance (≥40 mm), age (≥60 years), and multiple medical comorbidities (≥3).
• Despite complication occurrence, all patient groups showed significant improvement in SRS outcomes from baseline, with no significant differences in long-term clinical results.

Conclusions:

• Major complications are relatively common in 3-column osteotomies but occur at similar rates for PSO and VCR.
• The development of major complications does not appear to adversely affect the ultimate clinical outcomes at 2 years or more post-surgery.