Radiographical and Implant-Related Complications in Adult Spinal Deformity Surgery

Sorocéanu, Alexandra; Diebo, Bassel G.; Burton, Douglas C.; Smith, Justin S.; Deviren, Vedat; Shaffrey, Christopher I.; Kim, Hee Jin; Mundis, Gregory M.; Ames, Christopher P.; Errico, Thomas J.; Bess, Shay; Hostin, Richard A.; Hart, Robert A.; Schwab, Frank J.; Lafage, Virginie

doi:10.1097/brs.0000000000001020

Cited by 143 publications

(68 citation statements)

References 44 publications

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“…Surgery for adult spinal deformity (ASD) has increased in magnitude and complexity, and often deformities require three-column osteotomies (3COs) such as pedicle substraction osteotomy (PSO) or vertebral column resection (VCR) [1][2][3][4][5][6][7]. While operative management is known to be associated with greater quality-adjusted life years than non-operative treatment [8], complication rates of up to 50% have been reported in this patient population [1,2,7,[9][10][11][12][13][14][15]. Apart from one recent study [14], most of the data came from retrospective cohorts with poorly defined inclusion criteria and lacked validated assessment systems.…”

Section: Introductionmentioning

confidence: 99%

Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

et al. 2018

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Purpose Accurate information regarding the expected complications of complex adult spinal deformity (ASD) is important for shared decision making and informed consent. The purpose of the present study was to investigate the rate and types of non-neurologic adverse events after complex ASD surgeries, and to identify risk factors that affect their occurrence. Methods The details and occurrence of all non-neurologic adverse events were reviewed in a prospective cohort of 272 patients after complex ASD surgical correction in a mulitcentre database of the Scoli-RISK-1 study with a planned followup of 2 years. Logistic regression analyses were used to identify potential risk factors for non-neurologic adverse events. Results Of the 272 patients, 184 experienced a total of 515 non-neurologic adverse events for an incidence of 67.6%. 121 (44.5%) patients suffered from more than one adverse event. The most frequent non-neurologic adverse events were surgically related (27.6%), of which implant failure and dural tear were most common. In the unadjusted analyses, significant factors for non-neurologic adverse events were age, previous spine surgery performed, number of documented non-neurologic comorbidities and ASA grade. On multivariable logistic regression analysis, previous spine surgery was the only independent risk factor for non-neurologic adverse events. Conclusions The incidence of non-neurologic adverse events for patients undergoing corrective surgeries for ASD was 67.6%. Previous spinal surgery was the only independent risk factor predicting the occurrence of non-neurologic adverse events. These findings complement the earlier report of neurologic complications after ASD surgeries from the Scoli-RISK-1 study.Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key points 1. Non-neurologic adverse events after complex adult spinal deformity surgical correction in a prospective cohort of 272 patients (Scoli-RISK-1 study) were reported.2. 184 of the 272 patients experienced a total of 515 non-neurologic adverse events for an incidence of 67.6%.3. The most frequent non-neurologic adverse events were surgically-related (27.6%), of which implant failure and dural tear were most common.4. On multivariable logistic regression analysis, previous spine surgery was the only independent risk factor for non-neurologic adverse events. Kenny Yat Hong Kwan et al. (2018) Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study. Eur Spine J;1. The incidence of non-neurologic adverse events for patients undergoing corrective surgeries for ASD was 67.6%.2. Previous spinal surgery was the only independent risk factor predicting the occurrence of non-neurologic adverse events.3. These findings complement the earlier report of neurologic complications after ASD surgeries from the Scoli-RISK-1 study. Kenny Yat Hong Kwan et al. (2018) Non-neurologic adverse events after complex adult spinal deformity surgery: results fr...

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Section: Introductionmentioning

confidence: 99%

Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

et al. 2018

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“…To more fully explore in impact of obesity on the entire spine, Teraguchi et al [24] investigated the prevalence and distribution of intervertebral disc degeneration over the entire spine and found the age and obesity were associated with the presence of disc degeneration in all areas of the spine, indicating that obesity places stress across multiple regions of back. BMI and obesity have also been identified as a risk factor for adjacent segment diseases and post-operative complications among patients undergoing lumbar fusion for degenerative spine diseases [30,31,32,33,34,35,36,37,38,39,40]. Weight control before and after the surgery was observed to reduce the incidence of adjacent segment disease and improve the fusion surgery outcome [41,42].…”

Section: Introductionmentioning

confidence: 99%

Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis

Sheng

Feng

Zhang

et al. 2017

IJERPH

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Background: The link between body weight status and spinal diseases has been suggested by a number of cross-sectional and cohort studies with a limited range of patient populations. No population-representative samples have been used to examine the link between obesity and spinal diseases. The present study is based on a nationally representative sample drawn from the Medical Expenditure Panel Survey. Methods: Using the cross-sectional sample of the 2014 Medical Expenditure Panel Study, we built four weighted logistic regression analyses of the associations between body weight status and the following four spinal diseases: low back pain, spondylosis, other cervical disorders and intervertebral disc disorder (IDD). Each respondent’s body weight status was used as the key independent variable with three categories: normal/underweight, overweight, and obese. We controlled for marital status, gender, age, smoking status, household income, health insurance coverage, educational attainment and the use of health services for other major categories of diseases. Results: A total sample of 23,048 respondents was used in our analysis. Overweight and obese respondents, as compared to normal/underweight respondents, were more likely to develop lower back problems (Overweight: logged odds = 0.218, p < 0.01; Obese: logged odds = 0.395, p < 0.001) and IDD (Overweight: logged odds = 0.441, p < 0.05; Obese: logged odds = 0.528, p < 0.001). The associations between bodyweight status and spondylitis were statistically insignificant (Overweight: logged odds = 0.281, p = 0.442; Obese: logged odds = 0.680, p = 0.104). The associations between body weight status and other cervical disorders (Overweight: logged odds = −0.116, p = 0.304; Obese: logged odds = −0.160, p = 0.865) were statistically insignificant. Conclusions: As the first study using a national sample to study bodyweight and spinal diseases, our paper supports the hypothesis that obesity adds to the burden of low back pain and IDD. Longitudinal and interventional studies are needed to understand the specific mechanisms behind these positive associations.

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“…Although several recent series have highlighted the correlation between sagittal balance and spinopelvic parameters and self-reported outcomes, both before 48–50 and after surgical treatment for patients with ASD, 50,51 due to the novelty of such concepts, the incorporation of the preoperative evaluation of such parameters is still not reflected in the reported outcomes available in the literature as a whole. In objective terms, the largest prospective multicenter study involving both operative and nonoperative treatment of patients with ASD has demonstrated that a pelvic tilt (PT) of 22° or more, an sagittal vertical axis of 47 mm or more, and pelvic incidence minus lumbar lordosis (PI − LL) of 11° or more can be used as key threshold values for identifying patients with severe disability (ODI > 40).…”

Section: Conclusion and Implications For Future Researchmentioning

confidence: 99%

Effectiveness of Operative and Nonoperative Care for Adult Spinal Deformity: Systematic Review of the Literature

Teles

Mattei

Righesso

et al. 2017

Global Spine Journal

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Study Design:Systematic review.Objective:There is a need for synthesizing data on effectiveness of treatments for patients with adult spinal deformity (ASD) due to its increasing prevalence and health care costs for these patients. The objective of this review was to estimate the effectiveness of surgery versus nonoperative care in patients with ASD.Methods:A systematic review of articles in published in English using PubMed between 2005 and 2015. Surgical and nonsurgical series that reported baseline and follow-up health-related quality of life measures of patients with ASD with a minimum 2 years of follow-up were selected. Independent extraction of articles by 2 authors using predefined data fields, including risk of bias assessment.Results:Surgery significantly reduces disability, pain, and improves patients’ quality of life. The average postoperative improvement in Oswestry Disability Index was −19.1 (±9.0), Numerical Rating Scale back pain −4.14 (±1.38), Numerical Rating Scale leg pain −3.36 (±1.33), Short-Form Health Survey 36-SF36-Physical Component score 11.2 (±5.07), and Short-Form Health Survey 36-Mental Component score 9.93 (±4.96). The complication rate ranged from 9.52% to 81.52% (mean = 39.62%), and the need for revision surgery ranged from 1.72% to 40.0% (mean = 15.71%). The best existing evidence about nonoperative care of ASD is provided from observational studies with very high risk of bias. Quantitative analyses of nonsurgical cohorts did not demonstrate significant changes in quality of life of patients after 2 years of observation.Conclusions:This data may assist clinicians to counsel patients, as well as to inform health care providers and policymakers about what to expect from the treatment for ASD.

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Radiographical and Implant-Related Complications in Adult Spinal Deformity Surgery

Abstract: 3.

Cited by 143 publications

References 44 publications

Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis

Effectiveness of Operative and Nonoperative Care for Adult Spinal Deformity: Systematic Review of the Literature

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