Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients

Smith, Justin S.; Shaffrey, Christopher I.; Lafage, Renaud; Lafage, Virginie; Schwab, Frank J.; Kim, Hee Jin; Scheer, Justin K.; Protopsaltis, Themistocles S.; Passias, Peter G.; Mundis, Gregory M.; Hart, Robert A.; Neuman, Brian J.; Klineberg, Eric O.; Hostin, Richard A.; Bess, Shay; Deviren, Vedat; Ames, Christopher P.; Issg,

doi:10.1007/s00586-017-5071-1

Cited by 51 publications

(64 citation statements)

References 25 publications

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“…The findings of Theologis [1] and Smith [30] echo those of the current study. Here, several patients showed postop improvement of both cervical compensatory alignment, such as at C0-C2, and thoracic kyphosis (C7S) (Fig.…”

Section: Cervical Spinal Alignment Changes and Balancesupporting

confidence: 88%

“…The current study is one of the largest to focus on the surgical treatment of rigid CK and includes a multitude of etiologies. Sample characteristics regarding age, ASA-score, fusion levels, blood loss, and use of anterior and/or posterior and combined approaches were similar to previous studies on CK with a representative sample [1,23,[27][28][29][30][31]. Our study was designed to address all facets of treating rigid CK and serves as a good basis to characterize future research needs.…”

Section: Complicationsmentioning

confidence: 91%

“…No change was noted in thoracolumbar and lumbo-pelvic variables. If osteotomy correction includes the cervicothoracic junction, the postop changes of C7 and T1 slope and thoracic kyphosis differ: In a study by Smith [30] on 23 CK patients with both cervical and upper thoracic 3CO, the authors noted an average decrease of T1-slope while thoracic kyphosis was maintained and C7-S1 SVA slightly decreased. Lumbo-pelvic measures did not change.…”

Section: Cervical Spinal Alignment Changes and Balancementioning

confidence: 99%

“…In a retrospective study on 23 patients from 13 centres with cervicothoracic and upper thoracic 3CO, the incidence of major complications was 52% with 39% of patients being affected [30], 22% had neurological root-related major complications. In a study of Langeloo [66] revision surgery was indicated in 13%.…”

Section: Complicationsmentioning

confidence: 99%

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Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project

et al. 2018

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Introduction and purpose Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study. Methods Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types AD). Results Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001). Conclusions Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.

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Section: Cervical Spinal Alignment Changes and Balancesupporting

confidence: 88%

Section: Complicationsmentioning

confidence: 91%

Section: Cervical Spinal Alignment Changes and Balancementioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project

et al. 2018

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“…However, they did not find any risk factors that predicted the occurrence of complications. Interestingly, similar complications have also been found in the correction of cervical and cervicothoracic deformities [34], suggesting a high complication rate is to be expected when performing deformity correction irrespective of the anatomical site along the spine.…”

Section: Discussionmentioning

confidence: 60%

Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

et al. 2018

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Purpose Accurate information regarding the expected complications of complex adult spinal deformity (ASD) is important for shared decision making and informed consent. The purpose of the present study was to investigate the rate and types of non-neurologic adverse events after complex ASD surgeries, and to identify risk factors that affect their occurrence. Methods The details and occurrence of all non-neurologic adverse events were reviewed in a prospective cohort of 272 patients after complex ASD surgical correction in a mulitcentre database of the Scoli-RISK-1 study with a planned followup of 2 years. Logistic regression analyses were used to identify potential risk factors for non-neurologic adverse events. Results Of the 272 patients, 184 experienced a total of 515 non-neurologic adverse events for an incidence of 67.6%. 121 (44.5%) patients suffered from more than one adverse event. The most frequent non-neurologic adverse events were surgically related (27.6%), of which implant failure and dural tear were most common. In the unadjusted analyses, significant factors for non-neurologic adverse events were age, previous spine surgery performed, number of documented non-neurologic comorbidities and ASA grade. On multivariable logistic regression analysis, previous spine surgery was the only independent risk factor for non-neurologic adverse events. Conclusions The incidence of non-neurologic adverse events for patients undergoing corrective surgeries for ASD was 67.6%. Previous spinal surgery was the only independent risk factor predicting the occurrence of non-neurologic adverse events. These findings complement the earlier report of neurologic complications after ASD surgeries from the Scoli-RISK-1 study.Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key points 1. Non-neurologic adverse events after complex adult spinal deformity surgical correction in a prospective cohort of 272 patients (Scoli-RISK-1 study) were reported.2. 184 of the 272 patients experienced a total of 515 non-neurologic adverse events for an incidence of 67.6%.3. The most frequent non-neurologic adverse events were surgically-related (27.6%), of which implant failure and dural tear were most common.4. On multivariable logistic regression analysis, previous spine surgery was the only independent risk factor for non-neurologic adverse events. Kenny Yat Hong Kwan et al. (2018) Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study. Eur Spine J;1. The incidence of non-neurologic adverse events for patients undergoing corrective surgeries for ASD was 67.6%.2. Previous spinal surgery was the only independent risk factor predicting the occurrence of non-neurologic adverse events.3. These findings complement the earlier report of neurologic complications after ASD surgeries from the Scoli-RISK-1 study. Kenny Yat Hong Kwan et al. (2018) Non-neurologic adverse events after complex adult spinal deformity surgery: results fr...

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Anterior cervical osteotomy: operative technique

Tan

Riew

2017

Eur Spine J

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Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients

Abstract: Among 23 ACD patients treated with 3CO, cervical alignment improved significantly following surgery. Thirteen (56.5%) patients had at least one complication. The most common complications were neurologic deficit, infection, DJK, and cardiorespiratory failure.

Cited by 51 publications

References 25 publications

Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project

Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project

Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

Anterior cervical osteotomy: operative technique

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