The Comprehensive Anatomical Spinal Osteotomy Classification

Schwab, Frank J.; Blondel, Benjamin; Chay, Edward; Demakakos, Jason; Lenke, Lawrence G.; Tropiano, Patrick; Ames, Christopher P.; Smith, Justin S.; Shaffrey, Christopher I.; Glassman, Steven D.; Farcy, Jean-Pierre; Lafage, Virginie

doi:10.1227/01.neu.0000462076.73701.09

Cited by 127 publications

(56 citation statements)

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“…The second technique disseminated in the literature in recent years is the posterior vertebral column resection (pVCR), published by Suk et al 5 This technique has lower morbidity because of its use of a single access, through which Schwab grade V or VI 6 vertebral body osteotomies at the apex of the curve can be performed, which permits good correction of the deformity through this region, but generates at this point an area of high instability that increases the risk of accidental spinal cord lesion during the execution of the correction maneuvers. Scoliosis is corrected mostly through this region, with two rigid blocks remaining proximal and distal to the apical region.…”

Section: Introductionmentioning

confidence: 99%

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

et al. 2017

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Objective: To report a new technique for extrapleural interbody release with transcorporal osteotomy of the inferior vertebral plateau (LIEPO) and to evaluate the correction potential of this technique and its complications. Method: We included patients with scoliosis with Cobb angle greater than 90° and flexibility less than 25% submitted to surgical treatment between 2012 and 2016 by the technique LIEPO at the National Institute of Traumatology and Orthopedics (INTO). Sagittal and coronal alignment, and the translation of the apical vertebra were measured and the degree of correction of the deformity was calculated through the pre and postoperative radiographs, and the complications were described. Results: Patients had an average bleed of 1,525 ml, 8.8 hours of surgical time, 123° of scoliosis in the preoperative period, and a mean correction of 66%. There was no case of permanent neurological damage and no surgical revision. Conclusion: The LIEPO technique proved to be effective and safe in the treatment of severe stiff scoliosis, reaching a correction potential close to the PEISR (Posterior extrapleural intervertebral space release) technique and superior to that of the pVCR (posterior Vertebral Column Resection) with no presence of infection and permanent neurological deficit. New studies are needed to validate this promising technique.Keywords: Scoliosis/surgery; Spine/surgery; Osteotomy; Treatment outcome. RESUMO

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Section: Introductionmentioning

confidence: 99%

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

et al. 2017

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“…21 These techniques involve Grade 3-5 resections and encompass pedicle subtraction osteotomies (PSOs), vertebral column resections (VCRs), and kyphectomies. When purely posteriorly based, 3COs involve resection of pedicles and a portion of or the entire vertebral body, as well as the possibility of intervertebral disc removal.…”

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confidence: 99%

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Bianco

Norton

Schwab

et al. 2014

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Object Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL.

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“…2,4 Their use is only justified because sagittal correction is of great importance in the context of adult deformities, since it has been shown that pain and disability are directly related to an increased SVA and changes in sagittal spinopelvic parameters. [13][14][15] When considering a three-column osteotomy, the decision making process should take the possibility of not achieving sufficient correction or of having postoperative loss of correction into account, [5][6][7][8] since the procedure is subject to various complications and mechanical failures, and may also be impacted by reinterventions that may occur. 16 However, this point is addressed by few articles, which usually originate in centers of excellence where osteotomy procedures have been developed and perfected, and it is not reasonable to expect the technique to spread to smaller centers.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid confusion with the various nomenclatures present in the literature, the types of osteotomies performed were described as grade three, four, or five, according to the classification of Schwab et al 7 ( Figure 1) Only those cases that presented SVA ≤ 5cm, PI-LL ≤ ± 10˚, and PT ≤ 24˚8 -12 were considered to be ideal corrections. Loss of correction was defined as any angular variation greater than 5˚ or an increase in SVA of 2cm or more.…”

Section: Methodsmentioning

confidence: 99%

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

2017

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Objectives: To observe the degree of correction and postoperative evolution of the spinopelvic parameters in patients with sagittal imbalance submitted to 3-column osteotomies. Methods: Retrospective analysis of 20 cases of 3-column osteotomies in patients with evident sagittal imbalance and minimum follow-up of one year, computing evolution of radiological data as a function of time, complications and reinterventions, and classification into subgroups by preoperative spinopelvic measures and complications. The variation of measures, quantitative and categorical variables, and differences between groups were evaluated using the Wilcoxon, Spearman, Fischer's exact test, Kruskal-Wallis and Mann-Whitney tests. Results: There was improvement of all the sagittal parameters, ideal correction in 55% of the cases and maintained until the end of the follow-up in 40% of the cases. No correlation was found between obtaining optimal correction and data or preoperative measurements. Clinical and infectious complications did not affect the maintenance of the correction. The most common mechanical complications were pseudoarthrosis-related rod fracture at osteotomy (30%) and failures at the lower fixation level (15%). There was no significant difference in the maintenance of the correction between the groups with and without mechanical complications treated. In the untreated mechanical complications there was a significantly higher radiological worsening (p<0.05) in the maintenance parameters of the curve correction (loss of 27. MECHANICAL COMPLICATIONS AND LOSS OF CORRECTION IN OSTEOTOMIES OF THE THREE COLUMNS COMPLICAÇÕES MECÂNICAS E PERDA DE CORREÇÃO EM OSTEOTOMIAS DAS TRÊS COLUNAS COMPLICACIONES MECÁNICAS Y PÉRDIDA DE CORRECCIÓN EN OSTEOTOMÍAS DE LAS TRES COLUMNAS

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The Comprehensive Anatomical Spinal Osteotomy Classification

Cited by 127 publications

References 14 publications

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

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