{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:29:26Z","timestamp":1781612966939,"version":"3.54.5"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A multi-institutional retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate risk factors of mechanical failure in three-column osteotomy (3COs) in patients with adult spinal deformity (ASD), focusing on the osteotomy level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 111 patients with ASD who underwent 3COs with at least 2\u00a0years of follow-up. Radiographic parameters, clinical data on early and late postoperative complications were collected. Surgical outcomes were compared between the low-level osteotomy group and the high-level osteotomy group: osteotomy level of L3 or lower group (LO group, n = 60) and osteotomy of L2 or higher group (HO group, n = 51).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 111 patients, 25 needed revision surgery for mechanical complication (mechanical failure). A lower t-score (odds ratio [OR] .39\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002) and being in the HO group (OR 4.54,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03) were independently associated with mechanical failure. In the analysis divided by the osteotomy level (LO and HO), no difference in early complications or neurological complications was found between the two groups. The rates of overall mechanical complications, rod failure, and mechanical failure were significantly higher in the HO group than in the LO group. After propensity score matching, mechanical complications and failures were still significantly more observed in the HO group than in the LO group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01 and .029, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A lower t-score and osteotomy of L2 or higher were associated with increased risks of mechanical failure. Lower osteotomy was associated with better correction of sagittal balance and a lower rate of mechanical complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682231196449","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T01:07:38Z","timestamp":1692407258000},"page":"498-505","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["The lower Osteotomy Level is Associated With Decreased Revision Surgery Due to Mechanical Complications After Three-Column Osteotomy in Patients With Adult Spinal Deformity: A Multi-Institutional Retrospective Study"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8057-7237","authenticated-orcid":false,"given":"Atsuyuki","family":"Kawabata","sequence":"first","affiliation":[{"name":"Tokyo Medical and Dental 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University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Matsukura","sequence":"additional","affiliation":[{"name":"Tokyo Medical and Dental University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Oyaizu","sequence":"additional","affiliation":[{"name":"Tokyo Medical and Dental University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6200-0100","authenticated-orcid":false,"given":"Takashi","family":"Hirai","sequence":"additional","affiliation":[{"name":"Tokyo Medical and Dental University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4195-2545","authenticated-orcid":false,"given":"Hiroyuki","family":"Inose","sequence":"additional","affiliation":[{"name":"Tokyo Medical and Dental 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