Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity

Lenke, Lawrence G.; Newton, Peter O.; Sucato, Daniel J.; Shufflebarger, Harry L.; Emans, John B.; Sponseller, Paul D.; Shah, Suken A.; Sides, Brenda; Blanke, Kathy

doi:10.1097/brs.0b013e318269fab1

Cited by 200 publications

(169 citation statements)

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“…2,8,13,[16][17][18]27 Daubs et al evaluated patients undergoing spinal deformity surgery and found a major complication rate of 20%. 8 Auerbach et al found that major complications occurred in 35% of patients, and 53.9% of the complications resolved within 4 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…20,25 The complication rate for patients undergoing 3CO surgery has been reported to be up to 59%. 2,13,16,17,27 Risk factors for developing major complications have been identified as advanced age, sagittal deformity, preoperative kyphosis, long fusion constructs, 3 or more medical comorbidities, excessive blood loss, and revision surgery. 2,[6][7][8]11,13 While the incidence and risk factors for complications after 3CO have been defined, these definitions have come from primarily single-center studies with small patient populations.…”

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confidence: 99%

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Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Bianco

Norton

Schwab

et al. 2014

FOC

107

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Object Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Bianco

Norton

Schwab

et al. 2014

FOC

107

View full text Add to dashboard Cite

show abstract

“…Vertebral column resection has now been reported to have a 30 % incidence of intraoperative changes of neuromonitoring during surgery and 3 % of postoperative neurologic deficit [2,3]. These numbers are probably underestimated.…”

Section: Spinal Deformity Surgery Commentarymentioning

confidence: 99%

Expert’s comment concerning Grand Rounds case entitled “Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period” (by Hui-Ren Tao et al. doi:10.1007/s00586-012-2519-1)

Levin

Arlet

2012

Eur Spine J

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“…The adult deformity population is characterized by a higher rate of comorbidities, such as diabetes mellitus, coronary heart disease and others. Therefore, significant blood loss during open spine surgery [1][2][3] contributes to the relatively high complication rate of up to 30 % following osteotomies [4]. Because the osteotendinous complex of the spinal column serves as a dynamic stabilizer [5], disruption during exposure might contribute to a higher risk of adjacent level diseases [6,7].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous three column osteotomy for kyphotic deformity correction in congenital kyphosis

et al. 2013

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Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity

Abstract: A total of 147 consecutive pediatric VCRs performed by 7 surgeons demonstrated excellent radiographical correction. However, these complex reconstructions were associated with a 59% complication rate, thus emphasizing the challenging nature of these patients and procedures.

Cited by 200 publications

References 15 publications

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Expert’s comment concerning Grand Rounds case entitled “Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period” (by Hui-Ren Tao et al. doi:10.1007/s00586-012-2519-1)

Percutaneous three column osteotomy for kyphotic deformity correction in congenital kyphosis

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