Three-Column Osteotomy for the Treatment of Rigid Cervical Deformity

Abstract

Adult cervical deformity (ACD) has been shown to have a substantial impact on quality of life and overall health, with moderate to severe deformities resulting in significant disability and dysfunction. Fortunately, surgical management and correction of cervical sagittal imbalance can offer significant benefits and improvement in pain and disability. ACD is a heterogenous disease and specific surgical correction strategies should reflect deformity type (driver of deformity) and patient-related factors. Spinal rigidity is one of the most important considerations as soft tissue releases and osteotomies play a crucial role in cervical deformity correction. For ankylosed, fixed, and severe deformity, 3-column osteotomy (3CO) is often warranted. A 3CO can be done through combined anteriorposterior (vertebral body resection) and posterior-only approaches (open or closed wedge pedicle subtraction osteotomies [PSOs]). This article reviews the literature for currently published studies that report results on the use of 3CO for ACD, with a special concentration on posterior based 3CO (open and closed wedge PSO). More specifically, this review discusses the indications, radiographic corrective ability, and associated complications.

Defining Cervical Sagittal Plane Deformity – When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?

“…1,9 The question of when cervical sagittal realignment procedures are needed is important because CSD procedures are typically more extensive than procedures for degenerative cervical pathology, require fusion of a greater number of motion segments, more often involve combined anterior and posterior approaches, more commonly require osteotomies, and have a higher rate of complications. [10][11][12][13][14][15] On the other hand, while operations to simply treat radiculopathy and/or myelopathy are often less invasive than CSD procedures, they may potentially have the risk of undertreating the problem and not addressing all potential pain generators or dynamic neurologic compression. In this study, we found that no single radiographic or clinical criteria by itself was sufficient to establish a diagnosis of CSD.…”

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

“…This result was likely because among patients with CP, surgical invasiveness, need for surgical release, and utilization of osteotomies significantly increased in those with fixed cervical kyphosis than in those with semi-rigid or flexible kyphosis. In patients with CP, fixed cervical kyphosis is often accompanied by severe degenerative changes; thus, surgical treatment of such patients is challenging and requires invasive surgery to correct and stabilize the deformity while decompressing neural elements and restoring sagittal alignment [ 11 , 13 , 15 ]. Hence, patients with CSM and CP tend to undergo staged operations or combined approaches.…”

Classification(s) of Cervical Deformity

“…[33][34][35][36] Subsequent literature has also demonstrated the clinical importance of stratifying deformities by rigidity, achieving global sagittal balance with regional alignment, and correcting of cervical alignment in extension. 32,37,38 system for patients with CSD. This followed similar attempts to unify nomenclature for cervical spine osteotomies and soft tissue releases.…”

“…Since the publication of the Ames criteria, several validations studies have demonstrated the correlation between advanced Ames deformity modifiers and progressive deformity [ 33 - 36 ]. Subsequent literature has also demonstrated the clinical importance of stratifying deformities by rigidity, achieving global sagittal balance with regional alignment, and correcting of cervical alignment in extension [ 32 , 37 , 38 ].…”