Risk factors for distal junctional failure following three-column osteotomy for cervical deformity correction.

Area of Science:

• Spine surgery
• Orthopedics
• Deformity correction

Background:

• Cervical deformity correction often involves complex surgical techniques like three-column osteotomy (3CO).
• Distal junctional failure (DJF) is a potential complication, necessitating revision surgery and impacting patient outcomes.

Purpose of the Study:

• To identify risk factors associated with distal junctional failure (DJF) after three-column osteotomy (3CO) for cervical deformity.
• To evaluate the impact of lowest instrumented vertebra (LIV) selection on DJF incidence.

Main Methods:

• Retrospective review of 114 patients undergoing cervical or upper thoracic 3CO for cervical deformity (2008-2023).
• DJF defined as revision surgery with construct extension; minimum 1-year follow-up.
• Exclusion criteria included sacropelvic LIV and pre-existing distal spinal fusion.

Main Results:

• Ten patients (24%) experienced DJF, requiring distal extension of the fusion construct.
• Univariable analysis indicated female sex, lower LIV Hounsfield units, and LIV proximity to the first lordotic vertebra as potential risk factors.
• Multivariable analysis identified LIV placement closer to the first lordotic vertebra as the sole significant predictor of DJF (OR 0.49, p=0.013).

Conclusions:

• Cervical deformity patients undergoing 3CO face increased DJF risk when constructs terminate near the first lordotic vertebra.
• Strategic LIV selection, at least two levels above the first lordotic vertebra, may mitigate DJF risk.