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Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity

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Abstract

Purpose

Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD).

Methods

Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA < 4 cm, PT < 25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated.

Results

A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P < 0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P > 0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P < 0.05).

Conclusions

Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater pre-operative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.

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Acknowledgments

Study group support provided by Depuy Spine.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. New York University Hospital for Joint Diseases, 306 East 15th Street, 10003, New York, NY, USA

    Virginie Lafage & Frank J. Schwab

  2. Department of Neurological Surgery, University of Virginia, PO Box 800212, Charlottesville, VA, USA

    Justin S. Smith & Christopher I. Shaffrey

  3. Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, 2055 High Street Suite 130, Denver, CO, USA

    Shay Bess

  4. Department of Neurosurgery, University of California San Francisco, 400 Parnassus Street, San Francisco, CA, USA

    Christopher P. Ames

  5. Department of Orthopaedic Surgery, University of California, Davis, 3301 C St, Suite 1500, Sacramento, CA, USA

    Eric Klineberg

  6. Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA, USA

    Vincent Arlet

  7. Baylor Scoliosis Center, 4708 Alliance Blvd, #810, Plano, TX, USA

    Richard Hostin

  8. Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, USA

    Douglas C. Burton

Authors
  1. Virginie Lafage
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  2. Justin S. Smith
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  3. Shay Bess
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  4. Frank J. Schwab
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  6. Eric Klineberg
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  7. Vincent Arlet
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  8. Richard Hostin
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  9. Douglas C. Burton
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  10. Christopher I. Shaffrey
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The International Spine Study Group

Corresponding author

Correspondence to Justin S. Smith.

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Lafage, V., Smith, J.S., Bess, S. et al. Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity. Eur Spine J 21, 698–704 (2012). https://doi.org/10.1007/s00586-011-1967-3

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  • DOI: https://doi.org/10.1007/s00586-011-1967-3

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