Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

Abstract

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

Surgical treatment of spinal stenosis in achondroplasia: Literature review comparing results in adults and paediatrics

“…22 In thoracic spine, a kyphotic angle greater than 40 was suggested to be the threshold for spondylodesis when laminectomy was performed. 34 However, in a study of a case series of 20 adult patients, no correlation was found between the thoracolumbar kyphotic angle or size of the spinal canal and outcomes surgical decompression with laminectomy. 15 Overall, the post-operative complications rate can reach up to 40%, while subsequent surgery can reach up to 50%.…”

“…These include anatomic sequelae of the underlying dysplasia, such as severity or chronicity of congenital stenosis, increased lumbar lordosis, horizontal positioning of the sacrum, and increased thoracolumbar kyphosis, which may predispose this unique group of patients to this complication. 34 Comparing ultrasonic bone curette (BoneScalpel) in 10 patients versus high-speed drill in 20 patients in a retrospective review of 30 paediatric achondroplastic patients who were treated for spinal stenosis using showed a decreased number of durotomies and overall complications in the ultrasonic bone curette (BoneScalpel) cohort versus the high-speed drill cohort. Those results originate from a single study with small number of patients, therefore definitive conclusions cannot be made about the superiority and protective effect of the ultrasonic bone curette device over the high-speed drill.…”