Neurologic Adverse Events Following Three-Column Osteotomy for Adult Spine Deformities: A Prospective Multicenter Study

Prospective, multicenter study. To compare and characterize complications in adult spinal deformity (ASD) patients with and without three-column osteotomy (3CO). Although 3CO is associated with increased risk of neurologic adverse events, no study has, to our knowledge, compared and characterized sensory and motor neurologic complications in ASD patients with versus without 3CO. Demographics, surgical characteristics, and neurologic complications were collected for 553 ASD patients. Lower extremity motor scores (LEMSs) were compared at baseline and postoperatively. Multivariate analysis was performed to identify risk factors associated with neurologic adverse events. Among 553 ASD patients, 130 (23.5%) underwent 3CO. More patients with 3CO were revision patients (67.7% vs . 35.0%; P <0.001), presented with sagittal deformity (43.9% vs . 31.0%; P =0.008), and had longer operative times (455.6 vs . 407.3&#xa0;min; P =0.001) and greater estimated blood loss (EBL) (1650 vs . 1000&#xa0;mL; P <0.001) than patients without 3CO. The incidence of neurologic adverse events was greater among patients with versus without 3CO (23.1% vs . 15.4%; P =0.04). Multivariate analysis revealed that older age [odds ratio (OR) 1.288 per 10-year increase, 95% CI: 1.060-1.565, P =0.01] and longer operative time (OR: 1.088, 95% CI: 1.001-1.004, P =0.01) were significant predictors of neurologic adverse events. No between-group difference in LEMS was observed at six-week (49.0 vs . 49.0; P =0.90) or one-year (49.4 vs . 49.3; P =0.71) follow-up. By one-year follow-up, 20.5% of 3CO patients and 21.6% of patients without 3CO had residual motor deficit. Compared with patients who did not undergo 3CO, more patients with 3CO had prior instrumentation, presented with sagittal deformity, had longer operative time and greater EBL, and were more likely to have a neurologic adverse event. At one-year follow-up, there was no significant difference in LEMS between the two groups. Level III.