Primary Versus Revision Surgery in the Setting of Adult Spinal Deformity

Diebo, Bassel G.; Passias, Peter G.; Marascalchi, Bryan J.; Jalai, Cyrus M.; Worley, Nancy; Errico, Thomas J.; Lafage, Virginie

doi:10.1097/brs.0000000000001114

Cited by 64 publications

(47 citation statements)

References 46 publications

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“…In general, revision surgeries are not associated with improved pain scores and have a higher rate of comorbidities including increased bleeding, infections, acute respiratory distress syndrome, and longer hospital stays and even have higher mortality rates than the primary surgeries 43. Careful consideration of the type of therapy most appropriate for the treatment of FBSS is dependent on the etiology of the pain, likelihood that the intervention will succeed and the associated risks with the procedure.…”

Section: Management Of Fbssmentioning

confidence: 99%

Failed back surgery syndrome: current perspectives

Baber¹,

Erdek²

2016

JPR

171

146

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The treatment of failed back surgery syndrome (FBSS) can be equally challenging to surgeons, pain specialists, and primary care providers alike. The onset of FBSS occurs when surgery fails to treat the patient’s lumbar spinal pain. Minimizing the likelihood of FBSS is dependent on determining a clear etiology of the patient’s pain, recognizing those who are at high risk, and exhausting conservative measures before deciding to go into a revision surgery. The workup of FBSS includes a thorough history and physical examination, diagnostic imaging, and procedures. After determining the cause of FBSS, a multidisciplinary approach is preferred. This includes pharmacologic management of pain, physical therapy, and behavioral modification and may include therapeutic procedures such as injections, radiofrequency ablation, lysis of adhesions, spinal cord stimulation, and even reoperations.

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Section: Management Of Fbssmentioning

confidence: 99%

Failed back surgery syndrome: current perspectives

Baber¹,

Erdek²

2016

JPR

171

146

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“…In a study of 10,912 patients from the National (Nationwide) Inpatient Sample (NIS) database who underwent all types of spinal fusions, the incidence of procedure-related complications was approximately 30% higher for patients who underwent revision surgery than for primary cases. 6 This study also suggested that patients undergoing revision surgery are at specific increased risk of complications involving the nervous system, hematoma formation, vascular injury, nerve puncture, wound dehiscence, infection, and acute respiratory distress syndrome. 6 Similarly, in a study of ASD patients who underwent surgery for adult scoliosis, revision patients were found to have a higher overall complication rate than primary patients (58.2% vs 45.2%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…6 This study also suggested that patients undergoing revision surgery are at specific increased risk of complications involving the nervous system, hematoma formation, vascular injury, nerve puncture, wound dehiscence, infection, and acute respiratory distress syndrome. 6 Similarly, in a study of ASD patients who underwent surgery for adult scoliosis, revision patients were found to have a higher overall complication rate than primary patients (58.2% vs 45.2%, respectively). 5 Results from other studies have suggested that there are no differences in morbidity and complication risk between primary and revision surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies compare revision and primary cases regardless of specific surgical approaches and procedures performed. For example, Diebo et al compared revision cases of patients who underwent combined anterior-posterior fusion with 6 In addition, variables such as comorbidities, nutritional status, age, and frailty are likely significant contributors to morbidity and are not consistently included in past studies. However, even when authors attempt to concentrate on a homogeneous cohort of patients, the data among different independent studies remain inconclusive.…”

Section: Discussionmentioning

confidence: 99%

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Does prior spine surgery or instrumentation affect surgical outcomes following 3-column osteotomy for correction of thoracolumbar deformities?

Lau¹,

Chan²,

Deverin

et al. 2017

Neurosurgical Focus

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OBJECTIVEAdult spinal deformity (ASD) develops in the setting of asymmetrical arthritic degeneration, and can also be due to iatrogenic causes, such as prior surgery. Many patients who present with ASD have undergone prior spine surgery with instrumentation. Unfortunately, contemporary studies that evaluate the effect of prior surgery or instrumentation on perioperative outcomes, readmission rates, and need for reoperation are lacking.METHODSAll ASD patients who underwent a 3-column osteotomy performed by the senior author at the authors’ institution for correction of thoracolumbar spinal deformity between 2006 and 2016 were identified. The authors compared surgical outcomes between primary (first-time) and revision cases. Further subgroup analysis was conducted to investigate the effect of the number of prior surgeries (0, 1, 2, 3, 4, and 5 or more) and the presence of spinal instrumentation on outcomes. Multivariate analysis was used to adjust for relevant and significant confounders.RESULTSA total of 300 patients were included; 38.3% of patients were male. The overall perioperative complication rate was 24.7%, and the mean length of hospitalization was 8.2 days. The 90-day readmission rate was 9.0%, and the overall follow-up reoperation rate was 26.7%. There were no significant differences in complication rates (26.6% vs 24.0%, p = 0.645), length of hospitalization (8.7 vs 7.9 days, p = 0.229), readmission rates (11.4% vs 8.1%, p = 0.387), or reoperation rates (26.6% vs 26.7%, p = 0.984) between primary and revision cases. There was no significant difference in wound complications (infections/dehiscence) requiring reoperation (5.1% vs 6.3%, p = 0.683). Subgroup analysis conducted to evaluate the effect of the number of prior spinal surgeries or the presence of spinal instrumentation did not reveal significant differences for the aforementioned surgical outcomes. In adjusted multivariate analysis, there were no significant associations between history of prior surgery (number of prior surgeries and prior instrumentation) and all of the surgical outcomes of interest.CONCLUSIONSThe findings from this study suggest that patients who have undergone prior spine surgery with or without instrumentation are not at increased risk for perioperative complications, need for readmission, or reoperation following 3-column osteotomy of the thoracolumbar spine.

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“…2 On the other hand, given that the NIS is only an inpatient database, complications that may occur outside the hospital are not captured. Despite these limitations, various studies have examined short-term outcomes after scoliosis surgery using the NIS, 4,13,14,21 and most of their findings have been consistent with other multicenter collaborations, particularly in regard to rates of perioperative complications. Nonetheless, the findings in the present study may lead to future multicenter prospective studies on the matter, with longer-term follow-ups and patientreported outcomes.…”

Section: Discussionmentioning

confidence: 99%

Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals

Ramos¹,

Jain

Kebaish

et al. 2016

SPI

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OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82–0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.

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Primary Versus Revision Surgery in the Setting of Adult Spinal Deformity

Cited by 64 publications

References 46 publications

Failed back surgery syndrome: current perspectives

Failed back surgery syndrome: current perspectives

Does prior spine surgery or instrumentation affect surgical outcomes following 3-column osteotomy for correction of thoracolumbar deformities?

Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals

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