E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Long-term Complications and Outcomes Following Pedicle Subtraction Osteotomy for Adult Spinal Deformity: Minimum 5-Year Follow-Up Data
Sunho Kim✉ ,
Seung-Jae Hyun ,
Jae-Koo Lee ,
Ki-Jeong Kim
Seung-Jae Hyun ,
Jae-Koo Lee ,
Ki-Jeong Kim
Neurosurgery, Seoul National University Bundang Hospital
DOI: 10.5137/1019-5149.JTN.51289-26.3
Accepted: 17/09/2026
Article in Press
Corresponding Author:
Sunho Kim (raizingof@gmail.com)
Abstract
Aim
This study aimed to clarify the rates and characteristics of complications in patients who underwent pedicle subtraction osteotomy (PSO) with a minimum follow-up period of 5 years.
Material and Methods
This single-center retrospective study analyzed 53 consecutive patients who underwent PSO for adult spinal deformity between 2012 and 2017. Twenty-five patients with a minimum 5-year follow-up period were enrolled. Patients with incomplete radiographic or medical records or inadequate follow-up were excluded. Patient demographics, operative details, complication types, preoperative and postoperative radiographic parameters, global sagittal parameters, and Scoliosis Research Society-22 revised (SRS-22r) scores were collected. Complications were analyzed according to postoperative period: 0–2.5 years, 2.5–5 years, and >5 years. An additional subgroup analysis was performed to evaluate radiographic outcomes between patients with mechanical failure (MF) and those without mechanical failure (no-MF).
Results
Thirty-three complications were reported in 18 patients. The overall complication rate was 72.0% (18/25), and most complications occurred within the first 2.5 years after surgery (26/33 [78.8%]). After 2.5 years postoperatively, 4 complications (12.1%) occurred during the 2.5–5-year period and 3 complications (9.1%) occurred after 5 years. In subgroup analysis, MF occurred in 16 of 25 patients (64.0%). A gravity line–hip axis (GL-HA) offset lower than −50 mm was a significant risk factor for MF between the groups (P=0.039; mean, −59.8 mm [MF] vs. −20.9 mm [no-MF]), whereas no significant differences were observed in the other radiographic parameters. SRS-22r scores improved from 2.4 preoperatively to 3.6 postoperatively in the overall cohort.
Conclusion
The incidence of complications after PSO was highest within the first 2.5 years after surgery and decreased thereafter. In addition, subgroup analysis showed that a GL-HA offset more negative than −50 mm was significantly associated with MF.
This study aimed to clarify the rates and characteristics of complications in patients who underwent pedicle subtraction osteotomy (PSO) with a minimum follow-up period of 5 years.
Material and Methods
This single-center retrospective study analyzed 53 consecutive patients who underwent PSO for adult spinal deformity between 2012 and 2017. Twenty-five patients with a minimum 5-year follow-up period were enrolled. Patients with incomplete radiographic or medical records or inadequate follow-up were excluded. Patient demographics, operative details, complication types, preoperative and postoperative radiographic parameters, global sagittal parameters, and Scoliosis Research Society-22 revised (SRS-22r) scores were collected. Complications were analyzed according to postoperative period: 0–2.5 years, 2.5–5 years, and >5 years. An additional subgroup analysis was performed to evaluate radiographic outcomes between patients with mechanical failure (MF) and those without mechanical failure (no-MF).
Results
Thirty-three complications were reported in 18 patients. The overall complication rate was 72.0% (18/25), and most complications occurred within the first 2.5 years after surgery (26/33 [78.8%]). After 2.5 years postoperatively, 4 complications (12.1%) occurred during the 2.5–5-year period and 3 complications (9.1%) occurred after 5 years. In subgroup analysis, MF occurred in 16 of 25 patients (64.0%). A gravity line–hip axis (GL-HA) offset lower than −50 mm was a significant risk factor for MF between the groups (P=0.039; mean, −59.8 mm [MF] vs. −20.9 mm [no-MF]), whereas no significant differences were observed in the other radiographic parameters. SRS-22r scores improved from 2.4 preoperatively to 3.6 postoperatively in the overall cohort.
Conclusion
The incidence of complications after PSO was highest within the first 2.5 years after surgery and decreased thereafter. In addition, subgroup analysis showed that a GL-HA offset more negative than −50 mm was significantly associated with MF.
Keywords
Pedicle subtraction osteotomy
Adult spinal deformity
Complication
Mechanical failure
Gravity line-hip axis