Major Complications in Revision Adult Deformity Surgery

Cho, Samuel K.; Bridwell, Keith H.; Lenke, Lawrence G.; Yi, Jin Seok; Pahys, Joshua M.; Zebala, Lukas P.; Kang, Matthew M.; Cho, Woojin; Baldus, Christy

doi:10.1097/brs.0b013e3182217ab5

Cited by 175 publications

(50 citation statements)

References 16 publications

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“…Schwab et al [17] reported major perioperative complication rate in the order of 8.4 %. Cho et al [18] reported major complications in 34.3 % of the patients undergoing revision deformity surgery. While most of the literature reports an average complication rate of about 40 %, the overall surgeon reported complication rate in the SRS registry remains around 13.4 % [5].…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience

et al. 2013

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Purpose This study analyses the complications of spinal deformity surgery in adults to highlight pre-disposing factors. Methods The clinical records and imaging were reviewed for 48 consecutive patients, 12 males and 36 females, with a mean age of 64 (31-86), who had surgery for spinal deformity. Mean follow-up time was 36 months (24-60). Patient data recorded were age, diagnosis and co-morbidities; deformity assessment: curve type, sagittal and coronal balance, Cobb angle. Operation details: number of instrumented levels, duration and intra-operative complications. Outcome: complications, re-operations, balance and Cobb angle. Results 28 patients (58 %) had at least 1, 15 patients (27 %) had 2 and 5 patients (9.5 %) had more than 2 comorbidities. Average time between 1st presentation and operation was 13 months (1-41). The mean number of levels fused was 10.8 (4-23). In addition to posterior pedicle screw instrumentation, 40 patients had chevron osteotomies and 8 had pedicle substraction osteotomies. Posterior interbody fusions were performed at one level in 17 of which 7 had 2 level fusion. Two patients had combined anterior and posterior approaches. Fusion to the pelvis was performed in 19 patients. There were a total of 27 major and minor complications in 19/48 (39.5 %) patients. Late complications included 5 patients who had revisions for proximal junctional kyphosis, 1 patient had revision for pseudoarthrosis and 4 patients had removal of mal-positioned screws. Conclusions Factors associated with high complication rate in adult spinal deformity surgery are age, co-morbidities and severe sagittal imbalance at the time of presentation.

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Section: Discussionmentioning

confidence: 99%

Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience

et al. 2013

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“…6,7,10–12,15 The combination of an aging population and increasing number of spine fusion procedures results in an increasing number of patients with adult deformities, as well as an increasingly complex revision burden. 13,14 With the rising revision burden, the diagnosis of fixed sagittal malalignment is increasingly common.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study

Kelly

Lenke

Shaffrey³

et al. 2014

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Object The goal in this study was to evaluate the risk factors for complications, including new neurological deficits, in the largest cohort of patients with adult spinal deformity to date. Methods The Scoli-RISK-1 inclusion criteria were used to identify eligible patients from 5 centers who were treated between June 1, 2009, and June 1, 2011. Records were reviewed for patient demographic information, surgical data, and reports of perioperative complications. Neurological deficits were recorded as preexisting or as new deficits. Patients who underwent 3-column osteotomies (3COs) were compared with those who did not (posterior spinal fusion [PSF]). Between-group comparisons were performed using independent samples t-tests and chi-square analyses. Results Two hundred seven patients were identified—75 who underwent PSF and 132 treated with 3CO. In the latter group, patients were older (58.9 vs 49.4 years, p < 0.001), had a higher body mass index (29.0 vs 25.8, p = 0.029), smaller preoperative coronal Cobb measurements (33.8° vs 56.4°, p < 0.001), more preoperative sagittal malalignment (11.7 cm vs 5.4 cm, p < 0.001), and similar sagittal Cobb measurements (45.8° vs 57.7°, p = 0.113). Operating times were similar (393 vs 423 minutes, p = 0.130), although patients in the 3CO group sustained higher estimated blood loss (2120 vs 1700 ml, p = 0.066). Rates of new neurological deficits were similar (PSF: 6.7% vs 3CO: 9.9%, p = 0.389), and rates of any perioperative medical complication were similar (PSF: 46.7% vs 3CO: 50.8%, p = 0.571). Patients who underwent vertebral column resection (VCR) were more likely to sustain medical complications than those treated with pedicle subtraction osteotomy (73.7% vs 46.9%, p = 0.031), although new neurological deficits were similar (15.8% vs 8.8%, p = 0.348). Regression analysis did not reveal significant predictors of neurological injury or complication from collected data. Conclusions Despite higher estimated blood loss, rates of all complications (49.3%) and new neurological deficits (8.7%) did not vary for patients who underwent complex reconstruction, whether or not a 3CO was performed. Patients who underwent VCR sustained more medical complications without an increase in new neurological deficits. Prospective studies of patient factors, provider factors, and refined surgical data are needed to define and optimize risk factors for complication and neurological deficits.

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“…The phenomenon of ''older'' age being associated with higher risk of complication has been described in trauma [29], degeneration [28], revision [30], or tumor [7] series. Similarly, the current study showed that older age was an independent risk factor for two or more complications.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization

Tang

et al. 2015

Eur Spine J

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Major Complications in Revision Adult Deformity Surgery

Cited by 175 publications

References 16 publications

Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience

Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience

Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study

Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization

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