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OBJECTIVE  Posterior column osteotomy (PCO) has been known to provide an angular change (AC) of approximately 10° in sagittal plane deformity. However, whether PCO can actually obtain an AC of ≥ 10° depending on the particular level in the lumbar spine and which factors can effect a gain of ≥ 10° AC after PCO remain to be elucidated. The aim of this study was to identify the factors that effect a gain of ≥ 10° AC through PCO by comparing radiographic measurements between an AC group and a control group before and after adult spinal deformity (ASD) surgery.    METHODS  Forty consecutive patients who underwent multilevel PCOs for ASD at a single institution between 2012 and 2016 were included in this study. PCO was performed in 142 disc space levels in the lumbar spine. The authors defined the disc space level that obtained ≥ 10° AC in the sagittal plane by PCO as the AC group and the remaining patients as controls. The modified Pfirrmann grade, surgical level, implementation of the transforaminal lumbar interbody fusion (TLIF), and radiographic measurements were compared between the groups.    RESULTS  There were 67 levels in the AC group and 75 in the control group. Multivariate analysis identified the surgical level at L4–5 (OR 3.802, 95% CI 1.127–12.827, p = 0.031), performing TLIF with PCO (OR 3.303, 95% CI 1.258–8.674, p = 0.015), and a preoperative kyphotic disc space angle (OR 1.397, 95% CI 1.231–1.585, p &lt; 0.001) as the factors that significantly effected ≥ 10° AC in the sagittal plane after PCO.    CONCLUSIONS  In ASD surgery, PCO cannot always achieve ≥ 10° AC in the sagittal plane. The factors that effected ≥ 10° AC in PCO for ASD were surgical level at L4–5, performing TLIF with PCO, and the preoperative kyphotic disc space angle.

Factors for the acquisition of 10° angular change at the lumbar spine through posterior column osteotomy in adult spinal deformity surgery