Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Compared with Pedicle Subtraction Osteotomy

• Published in: World neurosurgery 2017-11, Vol.107, p.839-845
• Main Authors: Han, Sanghyun, Hyun, Seung-Jae, Kim, Ki-Jeong, Jahng, Tae-Ahn, Kim, Hyun-Jib, Lee, Byoung Hun, Choi, Ho Yong
• Format: Article
• Language: English
• Subjects: Adult spinal deformity; Clinical outcome; Pedicle subtraction osteotomy; Posterior column osteotomy; Radiographic outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.08.116

Posterior column osteotomy (PCO) has been used for the correction of various spinal deformities. However, little evidence is available regarding the effects of multilevel PCO in adult spinal deformity (ASD) surgery. This study aimed to show the usefulness of PCO in rigid ASD surgery by assessing radiographic and clinical outcomes. We also aimed to assess the corrective potential of multilevel PCOs compared with a single-level pedicle subtraction osteotomy (PSO). Between 2012 and 2016, the medical records of 70 consecutive patients who underwent a multilevel PCO (35 patients) or a single-level PSO (35 patients) for ASD in a single institute were reviewed. Baseline data, radiographic measurements, and clinical outcomes using the Scoliosis Research Society-22 (SRS-22) questionnaire were compared between groups. The following variables were no different between the groups: age at surgery, sex, level fused, preoperative and postoperative radiologic parameters, and bone mineral density T score. However, operation time (380.0 vs. 483.6 minutes), estimated blood loss (1175.7 vs. 1362.6 mL), and the number of complications (8 vs. 20) were significantly reduced in the PCO group compared with the PSO group. A significant improvement in the SRS-22 score was seen in both groups after surgery, although no difference was observed between the groups postoperatively. Multilevel PCOs for the correction of rigid ASD were slightly superior to PSO, regarding clinical outcomes. Radiographic outcomes were similar between groups. Thus, multilevel PCOs may be a viable option for the treatment of rigid ASD with a mobile segment.