Clinical and Radiographic Outcomes After 3-Column Osteotomies With 5-Year Follow-up
| Autor: | Lawrence G. Lenke, Ian G. Dorward, Keith H. Bridwell, Linda A. Koester, Seung-Jae Hyun, Brian J. Neuman, Kevin R. OʼNeill |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Time Factors 5 year follow up Adolescent Radiography medicine.medical_treatment Kaplan-Meier Estimate Scoliosis Osteotomy Disability Evaluation Young Adult Postoperative Complications Humans Medicine Orthopedics and Sports Medicine Child Aged Retrospective Studies business.industry Minimal clinically important difference Middle Aged medicine.disease Spine Surgery Oswestry Disability Index Treatment Outcome medicine.anatomical_structure Coronal plane Female Neurology (clinical) business Vertebral column Follow-Up Studies |
| Zdroj: | Spine. 39:424-432 |
| ISSN: | 0362-2436 |
| DOI: | 10.1097/brs.0000000000000156 |
| Popis: | STUDY DESIGN Retrospective review of prospective database. OBJECTIVE To investigate long-term results after 3-column osteotomies (3-CO). SUMMARY OF BACKGROUND DATA Short-term studies have noted improved outcomes and alignment after 3-CO, but there is a paucity of long-term studies with a large group of patients. METHODS An analysis of 126 patients who underwent a 3-CO (pedicle subtraction osteotomy [N = 101]/vertebral column resection [N = 25]) with minimum 5-year follow-up was performed at a single institution. The mean age was 48 years (range, 8-79 yr) and average follow-up was for 7 years (range, 5-14 yr). Oswestry Disability Index and Scoliosis Research Society (SRS) scores and radiographical parameters were assessed at baseline, 6 weeks, and 1, 2, 3, and/or 5 years postoperatively and complications were recorded. RESULTS Sagittal alignment improved at all postoperative time points from baseline (mean, 117 mm), but diminished from 6 weeks (mean, 24 mm) to 5 years (mean, 41 mm; P = 0.03). Average coronal alignment was improved from baseline (27 mm) at 6 weeks (18 mm; P = 0.003) and 5 years postoperatively (19 mm; P = 0.007), with no deterioration between 6 weeks and 5 years postoperatively (P = 0.9). Major surgical complications occurred in 36% (n = 45) and major repeat surgery was performed in 28% (n = 35). Significant improvements (P < 0.05) in Oswestry Disability Index and all SRS domain scores were found at each time point. All mean outcome scores at 5 years postoperatively exceeded minimal clinically important difference thresholds except the SRS function domain. Improvement in outcomes at 5 years postoperatively was similar in groups with major surgical complications versus those without and in those with reoperation versus those without. CONCLUSION This study of 126 patients undergoing 3-CO found significant and sustained improvements in Oswestry Disability Index and SRS scores and sagittal alignment at a minimum 5 years postoperatively. This demonstrates the durability of these complex spinal reconstructions, even surprisingly in those patients having a major complication and/or revision surgery. LEVEL OF EVIDENCE 4. |
| Databáze: | OpenAIRE |
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