General Session: Lumbar
Presented by: J. Varghese - View Audio/Video Presentation (Members Only)
B. Diebo(1), J.J. Varghese(1,2), V. Lafage(3), M. Gupta(4), D. Sciubba(5), C. Ames(6), K. Kebaish(5), C. Shaffrey(7), R. Hostin(8), I. Obeid(9), D. Burton(10), R. Hart(11), R. Lafage(1), T. Errico(12), F. Schwab(1), International Spine Study Group
(1) Hospital for Special Surgery, New York, NY, United States
(2) State University of New York, Downstate Medical Center, Brooklyn, NY, United States
(3) Hospital for Special Surgery, Spine Service, New York, NY, United States
(4) UC Davis Health System, Orthopaedic Surgery, Sacramento, CA, United States
(5) Johns Hopkins Hospital, Baltimore, MD, United States
(6) UCSF, San Francisco, CA, United States
(7) University of Virginia, Charlottesville, VA, United States
(8) Baylor Scott & White Health, Plano, TX, United States
(9) Bordeaux University Hospital, France, Bordeaux, France
(10) The University of Kansas Hospital, Kansas City, KS, United States
(11) OHSU, Portland, OR, United States
(12) NYU Hospital for Joint Diseases, New York, NY, United States
Purpose of the Study: Evaluating the performance curve including adverse events and OR metrics for three-column osteotomies performed by multi-center group between 2004 and 2013.
Introduction: In spinal deformity treatment, increased utilization of three-column (3CO) osteotomies reflects a greater comfort and better training. This study aims to evaluate performance curve and adverse events for multi-center group following a decade of 3CO.
Methods: Inclusion criteria were patients underwent 3CO for spinal deformity with intra/post-operative and revision data collected up to 2-year only. Patients were categorized evenly into four groups and reviewed retrospectively. Demographics, baseline deformity/correction, and surgical metrics were compared using Student T-Test. Postoperative and revision rates were compared using Chi-Square analysis.
Results: 573 patients stratified to: G1 (N=143, Feb 2004-Apr 2008), G2 (N=142, Apr 2008- Sep 2009), G3 (N=144, Sep 2009-Nov 2010), G4 (N=144 Nov 2010-Jan 2013). Demographics, primary/revision, baseline radiographic parameters, and 3CO levels were similar. Most recent patients were significantly more disabled by ODI (G4=49.2 vs. G1=38.3, p=0.001), and received a larger resection (G4=26° vs. G1=20°, p=0.011). There was significant decrease in revision rate (45%, 35%, 33%, 30%, p=0.039), notably revisions for pseudoarthrosis (16.7% G1 vs. 6.9% G4, p=0.007). Major complications rate significantly decreased (56.6%, 50.3%, 45.8%, 38.3%, p=0.023, Fig), as did Excessive blood loss (>4 liters, 27.2 vs. 16.6% p=0.023), and bladder/bowel deficit (4.2% vs. 0.7% p=0.002). Successful rate (no complications or revision) significantly increased (Figure, p=0.000). OR time significantly decreased (441, 431, 445, 397 mins, p = 0.024). Intra-operative complications were similar.
Conclusions: After 9 years, the surgeries performed are operating on a more disabled population with better technical ability reflected by increased bone resection angle. These surgeries are performed diminishing OR time by 48 minutes and reducing revisions and complications rate by 15% and 18.3 respectively.