{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:40:58Z","timestamp":1790095258427,"version":"4.0.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Recent debate has arisen between whether to use a three-column osteotomy (3CO) or multilevel low-grade (MLG) techniques to treat severe sagittal malalignment in adult spinal deformity (ASD) surgery. The goal of this study was to compare the outcomes of 3CO and MLG techniques performed in corrective surgeries for ASD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>ASD patients who had a baseline PI-LL &gt; 30\u00b0 and 2-year follow-up data were included. Patients underwent either 3CO or MLG (thoracolumbar posterior column osteotomies at \u2265 3 levels or anterior lumbar interbody fusion at \u2265 3 levels with no 3CO). The segmental utility ratio was used to assess relative segmental correction (segmental correction divided by overall correction in lordosis divided by the number of thoracolumbar interventions [interbody fusion, thoracolumbar posterior column osteotomies, and 3CO]). The paired t-test was used to assess lordotic distribution by differences in lordosis between adjacent lumbar disc spaces (e.g., L1\u20132 to L2\u20133). Multivariate analysis, controlling for age, sex, BMI, osteoporosis, baseline pelvic incidence, and T1 pelvic angle, was used to evaluate the complication rates and radiographic and patient-reported outcomes between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 93 patients were included, 53% of whom underwent MLG and 47% of whom underwent 3CO. The MLG group had a lower BMI (p &lt; 0.05). MLG patients received fewer previous fusions than 3CO patients (31% vs 80%, p &lt; 0.001). MLG patients had 24% less blood loss but a 22% longer operative time (565 vs 419 minutes, p = 0.008). Using adjusted analysis, the 3CO group had greater segmental and relative correction at each level (segmental utility ratio mean 69% for 3CO vs 23% for MLG, p &lt; 0.001). However, the 3CO group had lordotic differences between two adjacent lumbar disc pairs (range \u22120.5\u00b0 to 9.0\u00b0, p = 0.009), while MLG was more harmonious (range 2.2\u00b0\u20136.5\u00b0, p &gt; 0.4). MLG patients were more likely to undergo realignment to age-adjusted standards (OR 5.6, 95% CI 1.2\u201346.4; p = 0.033). MLG patients were less likely to develop neurological complications or undergo reoperation (OR 0.4, 95% CI 0.1\u20130.9; p = 0.041). Adjusted analysis revealed that MLG patients more often met a substantial clinical benefit in the Oswestry Disability Index score (OR 5.3, 95% CI 1.1\u201326.8; p = 0.043).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>MLG techniques showed better utility in lumbar distribution and age-adjusted global correction while minimizing neurological complications and reoperation rates by 2 years postoperatively. In selected instances, these techniques may offer the spine deformity surgeon a safer alternative when correcting severe adult spinal deformity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.1.spine23802","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T21:54:06Z","timestamp":1710539646000},"page":"677-683","source":"Crossref","is-referenced-by-count":9,"title":["Comparison of multilevel low-grade techniques versus three-column osteotomies in adult spinal deformity surgery: does harmonious correction matter?"],"prefix":"10.3171","volume":"40","author":[{"given":"Peter G.","family":"Passias","sequence":"first","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler K.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"},{"name":"Department of Orthopaedic Surgery, University of Texas Health San Antonio, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamshaid M.","family":"Mir","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan A.","family":"Lebovic","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Dave","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Tretiakov","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Joujon-Roche","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailey","family":"Imbo","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Krol","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane","family":"Owusu-Sarpong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaleen","family":"Vira","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Banner University\/University of Arizona Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brigham and Women\u2019s Hospital\/Harvard Medical Center, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University Medical Center, Providence, Rhode Island; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University Medical Center, Providence, Rhode Island; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Acta Orthop Traumatol Turc","first-page":"57","article-title":"Adult spinal deformity: a very heterogeneous population of patients with different needs","volume":"50","author":"Acaro\u011flu RE","year":"2016","unstructured":"Acaro\u011flu RE, Dede \u00d6, Pellis\u00e9 F,  Adult spinal deformity: a very heterogeneous population of patients with different needs. 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