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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

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Abstract

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.

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Abbreviations

3C:

3 Columns

ALIF:

Anterior lumbar interbody fusion

ASA:

American society of anesthesiologists

ASIA:

American spinal cord injury association

BMI:

Body mass index

ODI:

Oswestry disability index

OLIF:

Oblique lumbar interbody fusion

PJK:

Proximal junction kyphosis

PSO:

Pedicle subtraction osteotomy

SFCR:

Société française de chirurgie rachidienne

SPO:

Smith-Peterson osteotomies

SRS-22:

Scoliosis research society-22

SSA:

Spino sacral angle

SSI:

Surgical site infection

SVA:

Sagittal vertical axis

TPA:

T1 pelvic angle

VAS:

Visual analogue scale

VCR:

Vertebral column resection

XLIF:

eXtreme lateral interbody fusion

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Acknowledgements

The authors sincerely thank all the persons who participated in the data collection.

Funding

None.

Author information

Authors and Affiliations

  1. 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

    G. Lainé & C. Y. Barrey

  2. Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux University, Bordeaux, France

    J. C. Le Huec

  3. Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France

    B. Blondel & S. Fuentes

  4. Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France

    V. Fiere

  5. Clinique Saint Léonard, Trélazé, France

    H. Parent

  6. Hopital Privé Saint Martin, Ramsay Générale de Santé, Caen, France

    F. Lucas

  7. Centre Médico-Chirurgical Des Massues, Croix Rouge, Lyon, France

    P. Roussouly

  8. Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France

    O. Tassa, E. Bravant & J. Berthiller

  9. Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l’Hôpital, 75013, Paris, France

    C. Y. Barrey

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  1. G. Lainé
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Correspondence to G. Lainé.

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Lainé, G., Le Huec, J.C., Blondel, B. et al. 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. Eur Spine J 31, 3673–3686 (2022). https://doi.org/10.1007/s00586-022-07410-9

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