Three-Column Osteotomies in the Treatment of Spinal Deformity in Adult Patients 60 Years Old and Older

Abstract

Retrospective review. To report and analyze the perioperative complications, radiographical results, and functional outcomes in elderly patients undergoing pedicle subtraction osteotomy (PSO) and/or vertebral column resection (VCR) procedures for spinal deformity correction. To our knowledge, no studies have focused on 3-column osteotomies in the elderly. We retrospectively reviewed prospectively collected data for 51 consecutive patients 60 years or older undergoing 3-column osteotomies for spinal deformity correction (PSO, 36 patients; VCR, 13 patients; PSO and VCR, 2 patients) and who had at least 2 years' follow-up. We analyzed the perioperative complications; the preoperative, postoperative, and final follow-up radiographical measurements; and the preoperative, postoperative, and final follow-up functional outcome scores (using the Scoliosis Research Society-22 questionnaire and Oswestry Disability Index). Hotelling's t2 test and the χ2 test were used for analysis (statistical significance, P < 0.05). There were 9 (18%) major complications (5 with PSO and 4 with VCR) and 20 (39%) minor complications (14 with PSO and 6 with VCR). Compared with preoperative values, improvement at 6 weeks after surgery averaged 16° (range, 0°-42°) in thoracic scoliosis, 14° (range, 2°-25°) in lumbar scoliosis, 9° (range, 5°-35°) in thoracic kyphosis, -24° (range, -12° to -68°) in lumbar lordosis, 2.4 cm (range, 0-12 cm) in coronal balance, and 6.9 cm (range, -2 to 20 cm) in sagittal balance. At final follow-up, improvements in the coronal and sagittal balance were maintained. By final follow-up, compared with preoperative state, there were significant improvements in all 5 Scoliosis Research Society-22 domains and in the Oswestry Disability Index. In the elderly patient, PSO and VCR can achieve significant restoration of sagittal and coronal balance and significant improvement in quality of life. However, both techniques can lead to serious complications and should be selectively used.