Ten-year follow-up report of corrective fusion with 3-column osteotomy in adult patients with spinal deformities: a retrospective case series

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Abstract
Purpose While 3-column osteotomy (3-CO) is associated with high reoperation and complication rates, long-term outcomes remain unreported. Evaluating long-term outcomes after adult spinal deformity (ASD) surgery with 3-CO is crucial to improving clinical management. In this study, we investigated 10-year postoperative outcomes of corrective fusion surgery with 3-CO in adult patients with spinal deformities, focusing on alignment changes, patient-reported outcomes, and reoperation incidence. Methods Data were retrospectively retrieved from a single-center database of ASD surgeries. This retrospective case series included 84 patients (73 women) who underwent posterior 3-CO fusion for ASD between 2010 and 2014. Spinopelvic parameters were measured using standing whole-spine radiographs obtained from the preoperative period through 10 years postoperatively. Patient-reported outcomes were assessed at the same intervals. Surgical details, complications, and reoperations were recorded. Results The mean age at surgery was 67.1 years. Among 49 patients with follow-up beyond 10 years, all radiographic parameters significantly improved postoperatively, although the pelvic tilt, thoracic kyphosis, and sagittal vertical axis progressively increased over time. The Oswestry Disability Index (%) improved significantly from 45.7 preoperatively to 31.2 at 2 years, 29.0 at 5 years, and 28.4 at 10 years, showing sustained benefit. The most frequent perioperative complication was postoperative delirium, observed in 10 patients. Reoperation was required in 41 patients (52.4%) for a total of 54 procedures. Conclusion Ten-year outcomes of adult patients with spinal deformities treated with 3-CO fusion were relatively favorable. Global alignment improved postoperatively but gradually declined, while patient-reported outcomes improved and were maintained for 10 years.

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