• G Lainé, J C Le Huec, B Blondel, S Fuentes, V Fiere, H Parent, F Lucas, P Roussouly, O Tassa, E Bravant, J Berthiller, and C Y Barrey.
• Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France. gaetan.laine@neurochirurgie.fr.
• Eur Spine J. 2022 Dec 1; 31 (12): 367336863673-3686.

PurposeSpinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies.MethodsThe study consisted of a blinded retrospective analysis of prospectively collected data from a large multicenter cohort of patients who underwent 3-columns (3C) spinal osteotomy, between January 2010 and January 2017. Clinical and radiological data were compared pre- and post-operatively. Complications and their risk factors were analyzed.ResultsTwo hundred eighty-six 3C osteotomies were performed in 273 patients. At 1 year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p < 0.001). A total of 164 patients (59.2%) experienced at least 1 complication (277 complications). Complications-free survival rates were only 30% at 5 years. Most of those were mechanical (35.2%), followed by general (17.6%), surgical site infection (17.2%) and neurological (10.9%). Pre-operative neurological status [RR = 2.3 (1.32-4.00)], operative time (+ 19% of risk each additional hour) and combined surgery [RR = 1.76 (1.08-2.04)] were assessed as risk factors for overall complication (p < 0.05). The use of patient-specific rods appeared to be significantly associated with less overall complications [RR = 0.5 (0.29-0.89)] (p = 0.02).ConclusionSpinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

19 keywords...

hide…