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. 2023 Jun;20(2):662-668.
doi: 10.14245/ns.2346222.111. Epub 2023 Jun 30.

Complication Rates and Utilization Trends of 3-Level Posterior Column Osteotomy Compared to Single-Level Pedicle Subtraction Osteotomy

Emily S Mills  1 , Kevin Mertz  1 , Ethan Faye  1 , Jennifer A Bell  1 , Andy T Ton  1 , Jeffrey C Wang  1 , Ram K Alluri  1 , Raymond J Hah  1
Affiliations

Complication Rates and Utilization Trends of 3-Level Posterior Column Osteotomy Compared to Single-Level Pedicle Subtraction Osteotomy

Emily S Mills et al. Neurospine. 2023 Jun.

Abstract

Objective: The objective of this study is to assess differences in complication profiles between 3-level posterior column osteotomy (PCO) and single-level pedicle subtraction osteotomy (PSO) as both are reported to provide similar degrees of sagittal correction.

Methods: The PearlDiver database was queried retrospectively using International Classification of Disease, 9th and 10th edition and Current Procedural Terminology codes to identify patients who underwent PCO or PSO for degenerative spine disease. Patients under age 18 or with history of spinal malignancy, infection, or trauma were excluded. Patients were separated into 2 cohorts, 3-level PCO or single-level PSO, matched at a 1:1 ratio based on age, sex, Elixhauser comorbidity index, and number of fused posterior segments. Thirtyday systemic and procedure-related complications were compared.

Results: Matching resulted in 631 patients for each cohort. PCO patients had decreased odds of respiratory (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.43-0.82; p = 0.001) and renal complications (OR, 0.59; 95% CI, 0.40-0.88; p = 0.009) compared to PSO patients. There was no significant difference in cardiac complications, sepsis, pressure ulcer, dural tear, delirium, neurologic injuries, postoperative hematoma, postoperative anemia, or overall complications.

Conclusion: Patients who undergo 3-level PCO have decreased respiratory and renal complications compared to single-level PSO. No differences were found in the other complications studied. Considering both procedures achieve similar sagittal correction, surgeons should be aware that 3-level PCO offers an improved safety profile compared to single-level PSO.

Keywords: Kyphosis; Osteotomy; Postoperative complications.

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Conflict of interest statement

Conflict of Interest

Emily S. Mills MD, Kevin Mertz BS, Ethan Faye BS, Jennifer A. Bell MD, Andy T. Ton BS have nothing to disclose. Jeffrey C. Wang has received intellectual property royalties from Zimmer Biomet, NovApproach, SeaSpine, and DePuy Synthes. Ram K. Alluri, MD discloses has received grant funding from NIH, consulting fees from HIA Technologies, and payment from Eccentrial Robotics for lectures and presentations. Raymond J. Hah MD has received grant funding from SI bone, consulting fees from NuVasive, and support from the North American Spine Society to attend meetings.

Figures

Fig. 1.
Fig. 1.
Yearly trends in 3-level posterior column osteotomy (PCO) versus single-level pedicle subtraction osteotomy (PSO) from 2010–2020.
See this image and copyright information in PMC

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