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Three-Column Osteotomies in the Treatment of Spinal Deformity in Adult Patients 60 Years Old and Older: Outcome and Complications.
MedLine Citation:
PMID:  23138408     Owner:  NLM     Status:  Publisher    
ABSTRACT: Study Design. Retrospective review.Objective. To report and analyze the perioperative complications, radiographic results, and functional outcomes in elderly patients undergoing pedicle subtraction osteotomy (PSO) and/or vertebral column resection (VCR) procedures for spinal deformity correction.Summary of Background Data. To our knowledge, no studies have focused on 3-column osteotomies in the elderly.Methods. We retrospectively reviewed prospectively collected data for 51 consecutive patients ≥60 years undergoing 3-three 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 radiographic measurements; and the preoperative, postoperative, and final follow-up functional outcome scores (using SRS-22 and Oswestry Disability Index). Hotelling's t-square test and the χ test were used for analysis (statistical significance, P < 0.05).Results. 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 to preoperative state, there were significant improvements in all 5 SRS-22 domains and in the Oswestry Disability Index.Conclusion. 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.
Hamid Hassanzadeh; Amit Jain; Mostafa H El Dafrawy; Michael C Ain; Addisu Mesfin; Richard L Skolasky; Khaled M Kebaish
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-7
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
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