Factors influencing complications after 3-columns spinal osteotomies for fixed sagittal imbalance from multiple etiologies: a multicentric cohort study about 286 cases in 273 patients,European Spine Journal

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Factors influencing complications after 3-columns spinal osteotomies for fixed sagittal imbalance from multiple etiologies: a multicentric cohort study about 286 cases in 273 patients
European Spine Journal ( IF 2.6 ) Pub Date : 2022-10-03 , DOI: 10.1007/s00586-022-07410-9
G Lainé ₁ , J C Le Huec ₂ , B Blondel ₃ , S Fuentes ₃ , V Fiere ₄ , H Parent ₅ , F Lucas ₆ , P Roussouly ₇ , O Tassa ₈ , E Bravant ₈ , J Berthiller ₈ , C Y Barrey _{1,

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Affiliation

Purpose

Spinal 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.

Methods

The 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.

Results

Two 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).

Conclusion

Spinal 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.

中文翻译：

影响多病因固定矢状面失衡的三柱脊柱截骨术后并发症的因素：一项涉及 273 名患者 286 例的多中心队列研究

目的

用于治疗固定脊柱畸形的脊柱截骨术技术要求很高，并且并发症发生率很高。本研究的主要目的是分析因多种病因导致的固定矢状失衡而进行脊柱截骨术时的并发症及其危险因素。

方法

该研究对 2010 年 1 月至 2017 年 1 月期间接受 3 柱 (3C) 脊柱截骨术的大型多中心患者队列前瞻性收集的数据进行盲法回顾性分析。比较术前和术后的临床和放射学数据。分析并发症及其危险因素。

结果

对 273 名患者进行了 286 次 3C 截骨术。 1 年随访时，临床（VAS 疼痛、ODI 和 SRS-22 评分）和放射学（SVA、SSA、脊柱前凸丧失和骨盆版本）参数均显着改善 ( p < 0.001)。共有 164 名患者 (59.2%) 经历了至少 1 种并发症（277 种并发症）。 5 年无并发症生存率仅为 30%。其中大多数是机械性感染（35.2%），其次是一般性感染（17.6%）、手术部位感染（17.2%）和神经性感染（10.9%）。术前神经系统状态 [RR = 2.3 (1.32–4.00)]、手术时间（每增加一小时增加 19% 的风险）和联合手术 [RR = 1.76 (1.08–2.04)] 被评估为总体并发症的危险因素（ p < 0.05）。使用患者特异性棒似乎与较少的总体并发症显着相关 [RR = 0.5 (0.29–0.89)] ( p = 0.02)。