Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences

Zanirato, Andrea; Damilano, Marco; Formica, Matteo; Piazzolla, Andrea; Lovi, Alessio; Villafañe, Jorge Hugo; Berjano, Pedro

doi:10.1007/s00586-018-5535-y

Cited by 84 publications

(66 citation statements)

References 112 publications

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“…14,16 The potential risks and complications are significantly amplified when the alternative to decompression includes long hardware constructs, with some series showing complication rates greater than 50%. 55 Based on the available literature, there is considerable variability in outcomes following decompression to address stenosis in the setting of degenerative scoliosis and spondylolisthesis. Several early studies have reported high rates of progressive deformity and failure of conventional laminectomy in patients with deformity and symptomatic stenosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Hasan¹,

McGrath²,

Sen³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe management of lumbar spinal stenosis (LSS) with concurrent scoliosis and/or spondylolisthesis remains controversial. Full-endoscopic unilateral laminotomy for bilateral decompression (ULBD) facilitates neural decompression while preserving stabilizing osseoligamentous structures and may be uniquely suited for the treatment of LSS with concurrent mild to moderate degenerative deformity. The safety and efficacy of full-endoscopic versus minimally invasive surgery (MIS) ULBD in this patient population is studied here for the first time.METHODSA retrospective analysis of prospectively collected data was conducted on 45 consecutive LSS patients with concurrent scoliosis (≥ 10° coronal Cobb angle) and/or spondylolisthesis (≥ 3 mm). Patient demographics, operative details, complications, and imaging characteristics were reviewed. Outcomes were quantified using back and leg visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 1 year.RESULTSA total of 26 patients underwent full-endoscopic and 19 underwent MIS-ULBD with an average follow-up period of 12 months. The endoscopic cohort experienced a significantly shorter hospital length of stay (p = 0.014) and fewer adverse events (p = 0.010). Both cohorts experienced significant improvements in VAS and ODI scores at all time points (p < 0.001), but the endoscopic cohort demonstrated significantly better early ODI scores (p = 0.024).CONCLUSIONSEndoscopic and MIS-ULBD result in similar functional outcomes for LSS with mild to moderate deformity, while the endoscopic approach demonstrates a favorable rate of complications. Further studies are required to better delineate the characteristics of spinal deformities amenable to this approach and the durability of functional results.

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Section: Discussionmentioning

confidence: 99%

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Hasan¹,

McGrath²,

Sen³

et al. 2019

Neurosurgical Focus

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“…The overall confidence in the results of the 28 reviews was rated as “low” in 2 SRs 9 , 10 and “critically low” in the rest 11 - 36 ( Table 3 ). Critical appraisal of each SR is found in Table S2 in the supplemental material.…”

Section: Resultsmentioning

confidence: 99%

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Dettori

Skelly

Brodt

2020

Global Spine Journal

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Study Design: A systematic cross-sectional survey of systematic reviews (SRs). Objective: To evaluate the methodological quality of spine surgery SRs published in 2018 using the updated AMSTAR 2 critical appraisal instrument. Methods: We identified the PubMed indexed journals devoted to spine surgery research in 2018. All SRs of spine surgical interventions from those journals were critically appraised for quality independently by 2 reviewers using the AMSTAR 2 instrument. We calculated the percentage of SRs achieving a positive response for each AMSTAR 2 domain item and assessed the levels of confidence in the results of each SR. Results: We identified 28 SRs from 4 journals that met our criteria for inclusion. Only 49.5% of the AMSTAR 2 domain items satisfied the AMSTAR 2 criteria. Critical domain items were satisfied less often (39.1%) compared with noncritical domain items (57.3%). Domain items most poorly reported include accounting for individual study risk of bias when interpreting results (14%), list and justification of excluded articles (18%), and an a priori establishment of methods prior to the review or registered protocol (18%). The overall confidence in the results was rated “low” in 2 SRs and “critically low” in 26. Conclusions: The credibility of a SR and its value to clinicians and policy makers are dependent on its methodological quality. This appraisal found significant methodological limitations in several critical domains, such that the confidence in the findings of these reviews is “critically low.”

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“…A recent systematic review of adult spinal deformity surgery reported a perioperative SSI rate (requiring surgical debridement) of 2.24% and wound dehiscence rate (requiring surgical closure) of 0.25%. 15 Given the paucity of evidence, the authors are unable to comment on the impact of cyanoacrylate dermal closure in instrumented thoracic and lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Cyanoacrylate Dermal Closure in Spine Surgery: Systematic Review and Pooled Analysis

Tan

Rutges

Marion

et al. 2019

Global Spine Journal

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Study Design: Systematic review. Objectives: Cyanoacrylate glue closure has been utilized for dermal closure in surgical incisions. Its safety and efficacy in spine surgery are not established. The authors perform a systematic review to determine the rate of surgical site infection (SSI), wound dehiscence, and wound erythema with cyanoacrylate dermal closure in spine surgery. Methods: A systematic review adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed utilizing the PubMed/MEDLINE, EMBASE, and Cochrane databases on patients undergoing spine surgery with cyanoacrylate dermal closure. Pooled analysis was performed with stratification of patients according to spinal level and the presence/absence of instrumentation. Risk-of-bias and methodological quality was appraised using 17 prespecified criteria. Results: Five articles (1 retrospective cohort study, 4 cases series) with a total of 1282 patients were included. A total of 967 patients, all diagnosed with degenerative spine disease, were suitable for pooled analysis. In 290 patients who underwent anterior cervical discectomy and fusion, and in 23 patients with posterior cervical decompression (without instrumentation), there was 0% rate of SSI, wound dehiscence, and erythema. In 489 patients who underwent lumbar microdiscectomy, there was 0.41% rate of SSI, 0.20% rate of wound dehiscence, and 0.20% rate of wound erythema. In 165 lumbar laminectomy patients, there was a 1.82% rate of SSI, 0.61% rate of wound dehiscence, and 0% rate of wound erythema. Conclusion: Cyanoacrylate dermal closure for the aforementioned procedures is associated with low rates of wound complications (SSI, dehiscence, and erythema). Further studies should be performed, especially in nondegenerative surgery, instrumented thoracic and lumbar spine surgery.

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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences

Cited by 84 publications

References 112 publications

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Cyanoacrylate Dermal Closure in Spine Surgery: Systematic Review and Pooled Analysis

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