{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T21:16:20Z","timestamp":1773609380118,"version":"3.50.1"},"reference-count":39,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (&gt; 22\u00b0), sagittal vertical axis (&gt; 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (&gt; 11\u00b0). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1\u20136) or thoracolumbar (T9\u2013L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 \u00b1 12.4 years (range 20\u201382 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6% for the SRS-22 pain score MCID to 24.4% for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3% to 62.3% and from 16.2% to 47.8%, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6% vs 41.9%, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.12.spine141031","type":"journal-article","created":{"date-parts":[[2015,6,19]],"date-time":"2015-06-19T14:08:16Z","timestamp":1434722896000},"page":"340-348","source":"Crossref","is-referenced-by-count":27,"title":["The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients"],"prefix":"10.3171","volume":"23","author":[{"given":"Shayan","family":"Fakurnejad","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;\u00a0"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas C.","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;\u00a0"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Rocky Mountain Hospital for Children, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of California, San Francisco;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine141031","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1097\/BRS.0b013e31824fffde","article-title":"Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures","volume":"37","author":"Auerbach","year":"2012"},{"key":"b2-spine141031","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.nec.2012.12.008","article-title":"Classifications for adult spinal deformity and use of the Scoliosis Research Society-Schwab Adult Spinal Deformity 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