Complications of adult spinal deformity surgery: A literature review

Abstract

Purpose: Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery. Methods: A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications. Results: A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%. Discussion: Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications. Conclusion: Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.

Segmentation of spinal computed tomography to produce biomechanically accurate patient-specific surgical models

“…A major factor in consideration of nonoperative vs operative treatment is the fact that ASD surgical interventions have varying rates of complications [4] that manifest themselves as a variety of undesirable and costly outcomes, including infection, implant/fusion failure, and/or revision surgery. Treatment planning is known to improve patient outcomes and reduce complications, and treatment planning is entirely patient and surgeon specific.…”

Can Pelvic Incidence Change After Lumbo-Pelvic Fixation for Adult Spine Deformity, and Would the Change be Affected by the Type of Pelvic Fixation?

“…Worse deformity causes more prominent symptoms, with symptomatic ASD occurring in as much as 68% of patients after the age of 60 3,4 . When surgery is indicated, it aims to correct and/or prevent the progression of the deformity and to decompress the associated spinal stenosis 5,6 …”

“…Mechanical complications are the most common, followed by neurologic complications. Robust pelvic fixation was shown to play an integral goal in achieving fusion in the lumbo-pelvic junctional area, subject to heavy shear stress 6 . Modern iliac screws (IS) and S2-alar-iliac screws (S2AI) used as means of lumbo-pelvic fixation were associated with reduced rates of pseudarthrosis in the lumbosacral area in patients with ASD 11 .…”

“…3,4 When surgery is indicated, it aims to correct and/or prevent the progression of the deformity and to decompress the associated spinal stenosis. 5,6 ASD surgeries are associated with a high rate of complications reaching 30%-38% of cases in several series. [7][8][9][10] Mechanical complications are the most common, followed by neurologic complications.…”

“…Robust pelvic fixation was shown to play an integral goal in achieving fusion in the lumbo-pelvic junctional area, subject to heavy shear stress. 6 Modern iliac screws (IS) and S2-alar-iliac screws (S2AI) used as means of lumbo-pelvic fixation were associated with reduced rates of pseudarthrosis in the lumbosacral area in patients with ASD. 11 Currently, both approaches represent the most popular surgical means of lumbo-pelvic fixation in clinical practice.…”