Multiple vertebral osteotomies in the treatment of rigid adult spine deformities

Study Design. Retrospective review of the clinical and radiographic results in adult revision spine deformity surgery using the techniques of osteotom ies to effect spine balance and curve correction. Objectives. To assess the efficacy of multiple vertebral osteotomies in cor rection of rigid spine deformities in adult patients undergoing revision su rgery. Method. The records and radiographs of 27 adult patients with idiopathic sc oliosis who underwent revision surgery requiring anterior release (discecto my and/or osteotomy) and posterior osteotomy to correct rigid spinal deform ities were retrospectively reviewed. Results. All 27 patients were available for follow-up evaluation. Fifteen p atients had anterior discectomies followed by posterior osteotomies, wherea s 12 had anterior and posterior osteotomies in staged or sequential (same d ay) fashion. Diagnosis was idiopathic scoliosis for the index operation. At revision, the primary deformity was flatback deformity in 10 patients and pseudarthrosis with progressive deformity in 17 patients. Eleven patients h ad predominant sagittal decompensation, 11 patients had multiplanar decompe nsation, and five patients were balanced. The average number of osteotomies performed anteriorly was 4.3 levels (range, 1-8) and the average number of osteotomies posteriorly was 4.6 levels (range, 1-10). There were a total o f nine complications in eight patients including three pseudarthroses (11%) , five hardware failures (19%), and one transient neurologic deficit (4%). There were no deep wound infections, deep vein thromboses, pulmonary emboli , or deaths. The average scoliosis correction was 40% (range, 5-81%), where as the average sagittal balance was corrected 6.5 cm (range, -5-29.5 cm), o n average, and coronal balance was corrected 2.5 cm (range, 1-6 cm), on ave rage. Conclusion. This study demonstrates multiple vertebral osteotomies (anterio r and/or posterior) in the management of rigid adult spine deformities and deformity correction with an acceptable complication rate. Use of vertebral osteotomies for patients undergoing revision spine surgery is a safe and r easonable approach to obtain an arthrodesis.