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Complication Rates and Utilization Trends of 3-Level Posterior Column Osteotomy Compared to Single-Level Pedicle
Emily S Mills1, Kevin Mertz1, Ethan Faye1
1Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA.
Neurospine
|July 4, 2023
Summary
Three-level posterior column osteotomy (PCO) shows fewer respiratory and renal complications than single-level pedicle subtraction osteotomy (PSO). Both spinal surgeries offer similar sagittal correction, but PCO presents a better safety profile.
Area of Science:
- Spine surgery
- Orthopedic surgery
- Surgical outcomes
Background:
- Posterior column osteotomy (PCO) and pedicle subtraction osteotomy (PSO) are surgical techniques used for spinal deformity correction.
- Both PCO and PSO aim to achieve similar degrees of sagittal spinal correction.
- Understanding the complication profiles of these procedures is crucial for surgical decision-making.
Purpose of the Study:
- To compare the complication rates between 3-level PCO and single-level PSO in patients undergoing surgery for degenerative spine disease.
- To determine if differences in complication profiles exist despite similar sagittal correction capabilities.
Main Methods:
- Retrospective analysis of the PearlDiver database using ICD and CPT codes.
- Inclusion of patients aged 18 or older with degenerative spine disease, excluding those with malignancy, infection, or trauma.
- 1:1 matching of 631 patients in the 3-level PCO cohort with 631 patients in the single-level PSO cohort based on age, sex, comorbidity index, and fusion segments.
- Comparison of 30-day systemic and procedure-related complications between the matched cohorts.
Main Results:
- Patients undergoing 3-level PCO demonstrated significantly lower odds of respiratory complications (OR, 0.58; p = 0.001) and renal complications (OR, 0.59; p = 0.009) compared to those undergoing single-level PSO.
- No statistically significant differences were observed in cardiac complications, sepsis, pressure ulcers, dural tears, delirium, neurologic injuries, postoperative hematoma, postoperative anemia, or overall complications between the two groups.
- The study included 631 patients in each matched cohort.
Conclusions:
- Three-level PCO is associated with a reduced risk of respiratory and renal complications when compared to single-level PSO for degenerative spine disease.
- The safety profile of 3-level PCO appears to be more favorable than single-level PSO, particularly concerning respiratory and renal adverse events.
- Surgeons can consider the improved safety profile of 3-level PCO when planning spinal correction procedures that require similar degrees of sagittal alignment.
