Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?

Cristina Sacramento-Domínguez, Mitsuru Yagi, Jennifer Ayamga, Venu M. Nemani, Harry Akoto, Rufai Mahmud, Irene A. Wulff, Munish Gupta, Elias C. Papadopoulos, Ferran Pellisé, Francisco Sánchez-Pérez-Grueso, William F. Hess, Han Jo Kim, Richard Hodes, Oheneba Boachie-Adjei

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Posterior vertebral column resection (PVCR) is a challenging but effective technique for the correction of complex spinal deformity. However, it has a high complication rate and carries a substantial risk for neurologic injury. Purpose The aim was to test whether the apex of the deformity influences the clinical outcomes and complications in patients undergoing PVCR. Study design A historical cohort was recruited from a single center and evaluated preoperatively, postoperatively, and at final follow-up. Patient sample Ninety-eight hyperkyphotic patients undergoing PVCR were included. Inclusion criteria consisted of kyphoscoliosis and hyperkyphosis surgically treated with PVCR as a primary or revision procedure. Outcome measures The outcome measures included a number of neurologic complications. Methods Receiver operator characteristic (ROC) curve analysis and Youden index (J) were used to estimate the optimum cut-off to predict neurologic complications for each potential risk factor. In three ROC analyses, we included separately body mass index (BMI), kyphosis degree, and age as independent variables and neurologic complications as the dependent variable. Logistic regression was used to estimate the odds ratios (ORs) and construct 95% confidence intervals (CIs). Results Among the 98 patients, the etiologies were: post infectious (50), congenital (31), and others (17). The averages were: age 14±6.5 years, BMI 20±10 kg/m2, American Society of Anesthesiologists 3±0.7, forced vital capacity 76±23%, fusion levels 10±3, estimated blood loss 1,319±720 mL, surgical time 375±101 minutes, and preoperative localized kyphosis 104±30°. Thirty-three patients had abnormal preoperative neurologic status. Major complications occurred in 46 patients (neurologic in 25). The apex of kyphosis was proximal thoracic T1-T5 (five patients), thoracic (TH) T6-T9 (17 patients), thoracolumbar T10-L2 (55 patients), and lumbar L3-S1 (nine patients). The level of apex and BMI were independent risk factors for neurologic complications: TH apex (OR: 101.30, 95% CI: 1.420-infinite; p=.037); BMI (OR: 1.92, 95% CI: 1.110-infinite; p=.026). Conclusions Posterior vertebral column resection for severe spine deformity is technically demanding and carries a substantial risk. The apex is a variable that influences the occurrence of neurologic complications, and the presence of a TH apex in particular could be a preoperative risk factor for neurologic complications.

Original languageEnglish
Pages (from-to)2351-2359
Number of pages9
JournalSpine Journal
Volume15
Issue number11
DOIs
Publication statusPublished - 2015 Nov 1
Externally publishedYes

Fingerprint

Osteotomy
Nervous System
Spine
Kyphosis
Body Mass Index
Thorax
Odds Ratio
Confidence Intervals
Outcome Assessment (Health Care)
Nervous System Trauma
Vital Capacity
Operative Time
Logistic Models

Keywords

  • Kyphoscoliosis
  • Kyphosis
  • Neurologic complications
  • Pediatric deformity
  • Vertebral column resection osteotomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Sacramento-Domínguez, C., Yagi, M., Ayamga, J., Nemani, V. M., Akoto, H., Mahmud, R., ... Boachie-Adjei, O. (2015). Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications? Spine Journal, 15(11), 2351-2359. https://doi.org/10.1016/j.spinee.2015.07.010

Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications? / Sacramento-Domínguez, Cristina; Yagi, Mitsuru; Ayamga, Jennifer; Nemani, Venu M.; Akoto, Harry; Mahmud, Rufai; Wulff, Irene A.; Gupta, Munish; Papadopoulos, Elias C.; Pellisé, Ferran; Sánchez-Pérez-Grueso, Francisco; Hess, William F.; Kim, Han Jo; Hodes, Richard; Boachie-Adjei, Oheneba.

In: Spine Journal, Vol. 15, No. 11, 01.11.2015, p. 2351-2359.

Research output: Contribution to journalArticle

Sacramento-Domínguez, C, Yagi, M, Ayamga, J, Nemani, VM, Akoto, H, Mahmud, R, Wulff, IA, Gupta, M, Papadopoulos, EC, Pellisé, F, Sánchez-Pérez-Grueso, F, Hess, WF, Kim, HJ, Hodes, R & Boachie-Adjei, O 2015, 'Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?', Spine Journal, vol. 15, no. 11, pp. 2351-2359. https://doi.org/10.1016/j.spinee.2015.07.010
Sacramento-Domínguez, Cristina ; Yagi, Mitsuru ; Ayamga, Jennifer ; Nemani, Venu M. ; Akoto, Harry ; Mahmud, Rufai ; Wulff, Irene A. ; Gupta, Munish ; Papadopoulos, Elias C. ; Pellisé, Ferran ; Sánchez-Pérez-Grueso, Francisco ; Hess, William F. ; Kim, Han Jo ; Hodes, Richard ; Boachie-Adjei, Oheneba. / Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?. In: Spine Journal. 2015 ; Vol. 15, No. 11. pp. 2351-2359.
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title = "Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?",
abstract = "Background Posterior vertebral column resection (PVCR) is a challenging but effective technique for the correction of complex spinal deformity. However, it has a high complication rate and carries a substantial risk for neurologic injury. Purpose The aim was to test whether the apex of the deformity influences the clinical outcomes and complications in patients undergoing PVCR. Study design A historical cohort was recruited from a single center and evaluated preoperatively, postoperatively, and at final follow-up. Patient sample Ninety-eight hyperkyphotic patients undergoing PVCR were included. Inclusion criteria consisted of kyphoscoliosis and hyperkyphosis surgically treated with PVCR as a primary or revision procedure. Outcome measures The outcome measures included a number of neurologic complications. Methods Receiver operator characteristic (ROC) curve analysis and Youden index (J) were used to estimate the optimum cut-off to predict neurologic complications for each potential risk factor. In three ROC analyses, we included separately body mass index (BMI), kyphosis degree, and age as independent variables and neurologic complications as the dependent variable. Logistic regression was used to estimate the odds ratios (ORs) and construct 95{\%} confidence intervals (CIs). Results Among the 98 patients, the etiologies were: post infectious (50), congenital (31), and others (17). The averages were: age 14±6.5 years, BMI 20±10 kg/m2, American Society of Anesthesiologists 3±0.7, forced vital capacity 76±23{\%}, fusion levels 10±3, estimated blood loss 1,319±720 mL, surgical time 375±101 minutes, and preoperative localized kyphosis 104±30°. Thirty-three patients had abnormal preoperative neurologic status. Major complications occurred in 46 patients (neurologic in 25). The apex of kyphosis was proximal thoracic T1-T5 (five patients), thoracic (TH) T6-T9 (17 patients), thoracolumbar T10-L2 (55 patients), and lumbar L3-S1 (nine patients). The level of apex and BMI were independent risk factors for neurologic complications: TH apex (OR: 101.30, 95{\%} CI: 1.420-infinite; p=.037); BMI (OR: 1.92, 95{\%} CI: 1.110-infinite; p=.026). Conclusions Posterior vertebral column resection for severe spine deformity is technically demanding and carries a substantial risk. The apex is a variable that influences the occurrence of neurologic complications, and the presence of a TH apex in particular could be a preoperative risk factor for neurologic complications.",
keywords = "Kyphoscoliosis, Kyphosis, Neurologic complications, Pediatric deformity, Vertebral column resection osteotomy",
author = "Cristina Sacramento-Dom{\'i}nguez and Mitsuru Yagi and Jennifer Ayamga and Nemani, {Venu M.} and Harry Akoto and Rufai Mahmud and Wulff, {Irene A.} and Munish Gupta and Papadopoulos, {Elias C.} and Ferran Pellis{\'e} and Francisco S{\'a}nchez-P{\'e}rez-Grueso and Hess, {William F.} and Kim, {Han Jo} and Richard Hodes and Oheneba Boachie-Adjei",
year = "2015",
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TY - JOUR

T1 - Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?

AU - Sacramento-Domínguez, Cristina

AU - Yagi, Mitsuru

AU - Ayamga, Jennifer

AU - Nemani, Venu M.

AU - Akoto, Harry

AU - Mahmud, Rufai

AU - Wulff, Irene A.

AU - Gupta, Munish

AU - Papadopoulos, Elias C.

AU - Pellisé, Ferran

AU - Sánchez-Pérez-Grueso, Francisco

AU - Hess, William F.

AU - Kim, Han Jo

AU - Hodes, Richard

AU - Boachie-Adjei, Oheneba

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background Posterior vertebral column resection (PVCR) is a challenging but effective technique for the correction of complex spinal deformity. However, it has a high complication rate and carries a substantial risk for neurologic injury. Purpose The aim was to test whether the apex of the deformity influences the clinical outcomes and complications in patients undergoing PVCR. Study design A historical cohort was recruited from a single center and evaluated preoperatively, postoperatively, and at final follow-up. Patient sample Ninety-eight hyperkyphotic patients undergoing PVCR were included. Inclusion criteria consisted of kyphoscoliosis and hyperkyphosis surgically treated with PVCR as a primary or revision procedure. Outcome measures The outcome measures included a number of neurologic complications. Methods Receiver operator characteristic (ROC) curve analysis and Youden index (J) were used to estimate the optimum cut-off to predict neurologic complications for each potential risk factor. In three ROC analyses, we included separately body mass index (BMI), kyphosis degree, and age as independent variables and neurologic complications as the dependent variable. Logistic regression was used to estimate the odds ratios (ORs) and construct 95% confidence intervals (CIs). Results Among the 98 patients, the etiologies were: post infectious (50), congenital (31), and others (17). The averages were: age 14±6.5 years, BMI 20±10 kg/m2, American Society of Anesthesiologists 3±0.7, forced vital capacity 76±23%, fusion levels 10±3, estimated blood loss 1,319±720 mL, surgical time 375±101 minutes, and preoperative localized kyphosis 104±30°. Thirty-three patients had abnormal preoperative neurologic status. Major complications occurred in 46 patients (neurologic in 25). The apex of kyphosis was proximal thoracic T1-T5 (five patients), thoracic (TH) T6-T9 (17 patients), thoracolumbar T10-L2 (55 patients), and lumbar L3-S1 (nine patients). The level of apex and BMI were independent risk factors for neurologic complications: TH apex (OR: 101.30, 95% CI: 1.420-infinite; p=.037); BMI (OR: 1.92, 95% CI: 1.110-infinite; p=.026). Conclusions Posterior vertebral column resection for severe spine deformity is technically demanding and carries a substantial risk. The apex is a variable that influences the occurrence of neurologic complications, and the presence of a TH apex in particular could be a preoperative risk factor for neurologic complications.

AB - Background Posterior vertebral column resection (PVCR) is a challenging but effective technique for the correction of complex spinal deformity. However, it has a high complication rate and carries a substantial risk for neurologic injury. Purpose The aim was to test whether the apex of the deformity influences the clinical outcomes and complications in patients undergoing PVCR. Study design A historical cohort was recruited from a single center and evaluated preoperatively, postoperatively, and at final follow-up. Patient sample Ninety-eight hyperkyphotic patients undergoing PVCR were included. Inclusion criteria consisted of kyphoscoliosis and hyperkyphosis surgically treated with PVCR as a primary or revision procedure. Outcome measures The outcome measures included a number of neurologic complications. Methods Receiver operator characteristic (ROC) curve analysis and Youden index (J) were used to estimate the optimum cut-off to predict neurologic complications for each potential risk factor. In three ROC analyses, we included separately body mass index (BMI), kyphosis degree, and age as independent variables and neurologic complications as the dependent variable. Logistic regression was used to estimate the odds ratios (ORs) and construct 95% confidence intervals (CIs). Results Among the 98 patients, the etiologies were: post infectious (50), congenital (31), and others (17). The averages were: age 14±6.5 years, BMI 20±10 kg/m2, American Society of Anesthesiologists 3±0.7, forced vital capacity 76±23%, fusion levels 10±3, estimated blood loss 1,319±720 mL, surgical time 375±101 minutes, and preoperative localized kyphosis 104±30°. Thirty-three patients had abnormal preoperative neurologic status. Major complications occurred in 46 patients (neurologic in 25). The apex of kyphosis was proximal thoracic T1-T5 (five patients), thoracic (TH) T6-T9 (17 patients), thoracolumbar T10-L2 (55 patients), and lumbar L3-S1 (nine patients). The level of apex and BMI were independent risk factors for neurologic complications: TH apex (OR: 101.30, 95% CI: 1.420-infinite; p=.037); BMI (OR: 1.92, 95% CI: 1.110-infinite; p=.026). Conclusions Posterior vertebral column resection for severe spine deformity is technically demanding and carries a substantial risk. The apex is a variable that influences the occurrence of neurologic complications, and the presence of a TH apex in particular could be a preoperative risk factor for neurologic complications.

KW - Kyphoscoliosis

KW - Kyphosis

KW - Neurologic complications

KW - Pediatric deformity

KW - Vertebral column resection osteotomy

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