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Neurologic Adverse Events Following Three-Column Osteotomy for Adult Spine Deformities: A Prospective Multicenter

Andrew H Kim1, Ahmed Sulieman1, Wesley M Durand1

  • 1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

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Summary

Adult spinal deformity patients undergoing 3-column osteotomy (3CO) face higher risks of neurologic adverse events and complications. However, long-term motor function remains comparable to those without 3CO.

Keywords:
adult spinal deformityadverse eventscomplicationskyphosislower extremity motor scoresmultivariate analysisneurologic deficitprospective multicenter studyscoliosisthree-column osteotomy

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Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Deformity correction

Background:

  • 3-column osteotomy (3CO) is associated with increased neurologic risks in adult spinal deformity (ASD) surgery.
  • Limited data exists comparing neurologic complications specifically in ASD patients undergoing 3CO versus those who do not.

Purpose of the Study:

  • To compare and characterize the incidence and types of complications, particularly neurologic ones, in adult spinal deformity patients who underwent 3-column osteotomy (3CO) versus those who did not.

Main Methods:

  • A prospective, multicenter study involving 553 adult spinal deformity patients.
  • Collected data included demographics, surgical characteristics, and neurologic complications.
  • Compared lower extremity motor scores (LEMS) and performed multivariate analysis to identify risk factors for neurologic adverse events.

Main Results:

  • Patients undergoing 3CO (23.5%) were more likely to be revision cases, have sagittal deformity, longer operative times, and greater estimated blood loss (EBL).
  • The incidence of neurologic adverse events was significantly higher in the 3CO group (23.1% vs. 15.4%).
  • Older age and longer operative time predicted neurologic adverse events; however, no significant difference in LEMS was observed at 6-week or 1-year follow-up between groups.

Conclusions:

  • While 3CO in ASD patients is linked to increased operative complexity and a higher likelihood of neurologic adverse events, long-term motor deficits are similar to non-3CO patients.
  • The study highlights the need for careful patient selection and management in complex ASD cases requiring 3CO.