Trends and complications of three-column osteotomy in treating adult spinal deformity in elderly patients: A retrospective analysis.

Abstract

Sagittal imbalance linked to adult spinal deformity negatively affects quality of life and can be treated with 3CO techniques. While effective, these methods are invasive and can lead to high complications. Since 2010, a more patient-focused approach has grown in popularity, but its effects on elderly patients remain unclear. This retrospective study aimed to investigate the trend of three-column osteotomy (3CO) utilization in posterior long-segment fusion among different age groups. We also sought to determine the safety profile of 3CO by analyzing postoperative complications in the elderly population. The study assessed postoperative complications and long-term outcomes for elderly patients aged 70 and above who underwent 3CO as part of a posterior spinal instrumented fusion from 2010 to 2020 using multivariable logistic regression. A total of 2091 patients were identified for analysis. The Mann-Kendall trend test revealed a significant downward trend in 3CO interventions after 2017. Elderly patients demonstrated higher rates of medical complications compared to younger cohorts but had lower rates of surgical complications and reoperations. This pattern persisted even after adjusting for baseline comorbidity profiles. At the five-year mark, elderly patients (ages 70-84) exhibited reoperation rates similar to the middle-aged group (ages 55-69) but notably lower than those in patients younger than 55 years. Aside from an increased risk of medical complications following 3CO, older patients were not at an increased risk of surgical complications, including pseudarthrosis, proximal junctional failure, and reoperation.