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Pressman E, Monsour M, Liaw D, Screven RD, Kumar JI, Hidalgo AV, Haas AM, Hayman EG, Alikhani P. Three-column osteotomy in long constructs has lower rates of proximal junctional kyphosis and better restoration of lumbar lordosis than anterior column realignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:590-598. [PMID: 38224408 DOI: 10.1007/s00586-023-08115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Three-column osteotomies (TCOs) and minimally invasive techniques such as anterior column realignment (ACR) are powerful tools used to restore lumbar lordosis and sagittal alignment. We aimed to appraise the differences in construct and global spinal stability between TCOs and ACRs in long constructs. METHODS We identified consecutive patients who underwent a long construct lumbar or thoracolumbar fusion between January 2016 and November 2021. "Long construct" was any construct where the uppermost instrumented vertebra (UIV) was L2 or higher and the lowermost instrumented vertebra (LIV) was in the sacrum or ileum. RESULTS We identified 69 patients; 14 (20.3%) developed PJK throughout follow-up (mean 838 days). Female patients were less likely to suffer PJK (p = 0.009). TCO was more associated with open (versus minimally invasive) screw/rod placement, greater number of levels, higher UIV, greater rate of instrumentation to the ilium, and posterior (versus anterior) L5-S1 interbody placement versus the ACR cohort (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, respectively). Patients who developed PJK were more likely to have undergone ACR (12 (32.4%) versus 2 (6.3%, p = 0.007)). The TCO cohort had better improvement of lumbar lordosis despite similar preoperative measurements (ACR: 16.8 ± 3.78°, TCO: 23.0 ± 5.02°, p = 0.046). Pelvic incidence-lumbar lordosis mismatch had greater improvement after TCO (ACR: 14.8 ± 4.02°, TCO: 21.5 ± 5.10°, p = 0.042). By multivariate analysis, ACR increased odds of PJK by 6.1-times (95% confidence interval: 1.20-31.2, p = 0.29). CONCLUSION In patients with long constructs who undergo ACR or TCO, we experienced a 20% rate of PJK. TCO decreased PJK 6.1-times compared to ACR. TCO demonstrated greater improvement of some spinopelvic parameters.
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Affiliation(s)
- Elliot Pressman
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Molly Monsour
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Deborah Liaw
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Ryan D Screven
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Jay I Kumar
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Adolfo Viloria Hidalgo
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Alexander M Haas
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Erik G Hayman
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Puya Alikhani
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA.
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