Early Clinical Outcomes and Medical Complications Following Long Segment Fusion for Adult Spinal Deformity with and Without Three Column Osteotomy

Introduction: Adult spinal deformities frequently require long segment fusion with three column osteotomies (3CO) to provide adequate correction of sagittal and coronal balance. While some studies have demonstrated high rates of complications when three column osteotomies are utilized, these prior studies are limited by small sample sizes. Here within, we compared early outcomes and adverse events in adult spinal deformity patients following long segment posterior spinal fusion with and without 3CO.

Methods: A retrospective review was conducted using the American College of National Surgical Quality Improvement Program (NSQIP) database of patients undergoing elective long segment posterior spinal fusion identified by CPT code 22842, 22843, and 22844 from 2015 to 2020. 3CO was identified with CPT code 22206 and 22207. Patients were stratified based upon long segment fusion with and without 3CO. Only patients with ICD 9 and 10 codes corresponding to adult spine deformity cases were included. Student’s t-tests and exact fisher’s test were used to compared differences between the two groups for continuous and categorical variables.

Results: In total, 340 cases met inclusion criteria. Of these, 184 were without 3CO and 156 cases required 3CO. Patients who required 3CO had lower rates of preoperative diabetes (22.3% vs 10.3%,p=0.003), higher rates of non-home discharge (26.2% vs 57.1%, p< 0.001), longer operation time (245.62+/-9.45 vs. 434.40+/-11.65,p < 0.001), and longer length of stay (4.17+/-0.66 vs. 7.76+/-0.83,p < 0.001). 3CO patients had higher rates of deep surgical site infection (0% vs 3.2%, p=0.02), reintubation (0% vs 4.5%, p=0.004), inability to wean off ventilator (0% vs 2.6%, p=0.04), and perioperative blood transfusion (20.1% vs 76.3%,p < 0.001). There was no significant difference in 30 day readmission rate (6.0% vs 6.4%, p=1.00).

Conclusion : In conclusion, posterior three column osteotomy is frequently necessary for correction of adult spinal deformity, however is associated with a higher risk of adverse events.