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15.01.2024 | Original Article

Three-column osteotomy in long constructs has lower rates of proximal junctional kyphosis and better restoration of lumbar lordosis than anterior column realignment

verfasst von: Elliot Pressman, Molly Monsour, Deborah Liaw, Ryan D. Screven, Jay I. Kumar, Adolfo Viloria Hidalgo, Alexander M. Haas, Erik G. Hayman, Puya Alikhani

Erschienen in: European Spine Journal | Ausgabe 2/2024

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Abstract

Purpose

Three-column osteotomies (TCOs) and minimally invasive techniques such as anterior column realignment (ACR) are powerful tools used to restore lumbar lordosis and sagittal alignment. We aimed to appraise the differences in construct and global spinal stability between TCOs and ACRs in long constructs.

Methods

We identified consecutive patients who underwent a long construct lumbar or thoracolumbar fusion between January 2016 and November 2021. “Long construct” was any construct where the uppermost instrumented vertebra (UIV) was L2 or higher and the lowermost instrumented vertebra (LIV) was in the sacrum or ileum.

Results

We identified 69 patients; 14 (20.3%) developed PJK throughout follow-up (mean 838 days). Female patients were less likely to suffer PJK (p = 0.009). TCO was more associated with open (versus minimally invasive) screw/rod placement, greater number of levels, higher UIV, greater rate of instrumentation to the ilium, and posterior (versus anterior) L5-S1 interbody placement versus the ACR cohort (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, respectively). Patients who developed PJK were more likely to have undergone ACR (12 (32.4%) versus 2 (6.3%, p = 0.007)). The TCO cohort had better improvement of lumbar lordosis despite similar preoperative measurements (ACR: 16.8 ± 3.78°, TCO: 23.0 ± 5.02°, p = 0.046). Pelvic incidence–lumbar lordosis mismatch had greater improvement after TCO (ACR: 14.8 ± 4.02°, TCO: 21.5 ± 5.10°, p = 0.042). By multivariate analysis, ACR increased odds of PJK by 6.1-times (95% confidence interval: 1.20–31.2, p = 0.29).

Conclusion

In patients with long constructs who undergo ACR or TCO, we experienced a 20% rate of PJK. TCO decreased PJK 6.1-times compared to ACR. TCO demonstrated greater improvement of some spinopelvic parameters.

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Titel: Three-column osteotomy in long constructs has lower rates of proximal junctional kyphosis and better restoration of lumbar lordosis than anterior column realignment
verfasst von: Elliot Pressman
Molly Monsour
Deborah Liaw
Ryan D. Screven
Jay I. Kumar
Adolfo Viloria Hidalgo
Alexander M. Haas
Erik G. Hayman
Puya Alikhani
Publikationsdatum: 15.01.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 2/2024
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-08115-3

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Three-column osteotomy in long constructs has lower rates of proximal junctional kyphosis and better restoration of lumbar lordosis than anterior column realignment