Closing a Three-Column Osteotomy with a Construct-To-Construct Closure: Case Series and Technical Note With Intraoperative Pictures and Videos.

Background and objectives: When performing a 3-column osteotomy (3CO) in adult spinal deformity surgery, osteotomy closure carries major risk. The construct-to-construct closure technique has been previously described as a safe means to close a 3CO. We sought to provide an in-depth description of the construct-to-construct closure technique through a case series using illustrations and intraoperative pictures and videos for spine surgeons looking to incorporate this technique.

Methods: A retrospective, single-surgeon case series was undertaken of 3COs using the construct-to-construct closure technique. A detailed description of the technique with corresponding illustrations was provided. For each case, a summary with key intraoperative pictures and videos was included. Descriptive statistics were performed.

Results: Seven patients (mean age: 57.1 ± 10.2 years; 57% females) underwent a 3CO with mean follow-up of 12 months at the following levels: L4, T11, L3, T10, T10-12, T12, and L2. Construct-to-construct closure was used in all cases with a mean correction of 36.3° ± 5.8° (range 28°-47°). Neuromonitoring data were stable in 5 cases, but a significant decrease in data was seen during osteotomy closure in 2 cases. In the 2 cases where data were lost, the correction was quickly released in a controlled manner and the postoperative neurological examination was stable to improved. No cases of screw pullout, screw plowing, or subluxation occurred.

Conclusion: The current case series provides an in-depth description of the construct-to-construct closure technique to close a 3CO and is accompanied by illustrations and intraoperative pictures and videos.