Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients.

PURPOSE: To evaluate and compare early radiographic and clinical outcomes of lower cervical and upper thoracic three-column osteotomies (3CO) for cervicothoracic kyphosis correction.

METHODS: Patients who underwent 3CO at the cervicothoracic junction at two institutions were retrospectively reviewed. Patients were divided into two groups: lower cervical osteotomy (LCO) and upper thoracic osteotomy (UTO: T1-T5). Operative data, radiographic alignment, peri-operative complications, and clinical outcomes were compared between the groups.

RESULTS: Forty-eight patients [male: 24; female: 24; average age 61 years (range 18-92 years); mean follow-up: 22 months] met inclusion criteria. A total of 24 pedicle subtraction osteotomies and 24 vertebral column resections were performed. Compared to UTO, LCO operative time was significantly shorter, average ICU and hospital stays were significantly longer, and the average pre-operative cervical sagittal vertical axis (SVA) and kyphosis were significantly greater (p < 0.05). For both groups, there was significant improvement in cervical SVA, cervical lordosis, segmental angle, Neck Disability Index (NDI), SRS Activity, and pain visual analog score (p < 0.05). Reoperation rates were similar between the groups (LCO: 33.3 %; UTO: 18 %, p = 0.28). Significantly, more patients required tracheostomy/gastrostomy tubes after LCO (3 vs. 0 in the UTO group, p = 0.03).

CONCLUSIONS: Three-column posterior osteotomies at the cervicothoracic junction restored regional sagittal alignment and improved quality of life in this series of patients with rigid cervicothoracic deformity, albeit with high complication rates. Lower cervical osteotomies provided greater cervical SVA correction and were shorter operations, although they were associated with more complications and longer hospital and ICU stays compared to upper thoracic osteotomies.