192. Revision Rates Following Primary Adult Spinal Deformity Surgery: 667 Consecutive Patients Followed Up to 21-Years Postoperatively

Pichelmann, Mark; Lenke, Lawrence G.; Good, Christopher R.; O'Leary, Patrick

doi:10.1016/j.spinee.2008.06.230

Cited by 45 publications

(77 citation statements)

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“…10,19,[21][22][23]25,29 Factors associated with higher complication rates include comorbidities, age, smoking, osteoporosis, long fusions, and excessive blood loss. 7,15,16,26 Glassman et al 19 demonstrated that major complications in their cohort led to worse outcomes, as evidenced by lower 12-Item Short-Form Health Survey scores at 1 year postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

134

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Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

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Section: Discussionmentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

134

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“…The reoperation rate for adult spinal deformity varies from 6% to 60%, 7,10,14,21,25,30 with an increased trend toward reoperation in patients 60 years or older. 9,12 We report an unplanned reoperation rate of 25% in patients undergoing pelvic fixation (8.6% for S2AI screws vs 35% for iliac bolts).…”

Section: Failure-free Ratementioning

confidence: 99%

“…1 Frequent causes of reoperation in this patient population include wound infection/breakdown, implant failure, pseudarthrosis, and removal of instrumentation because of pain. 21,25,29,30 From a patient's standpoint, the high rates of complications and reoperation associated with lumbar deformity surgery are an important factor to be considered in the initial decision to proceed with surgery.…”

mentioning

confidence: 99%

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mazur¹,

Ravindra²,

Schmidt³

et al. 2015

SPI

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OBJECT S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques. METHODS The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors. RESULTS Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation. CONCLUSIONS Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.

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“…Estudo recente revelou que 9% dos pacientes operados por deformidades são submetidos à pelo menos uma revisão cirúrgica, sendo que 1,5% são submetidos a mais que uma revisão 3 . As razões mais comuns são: pseudo-artrose (41,4%), progressão da curva (20,7%), infecção (1,5%) e mais raramente o déficit neuroló-gico ( 0,2%) [3][4][5][6] . A fixação pedicular tem uma série de vantagens para correção das deformidades em relação aos outros métodos de fixação da coluna vertebral, porém o potencial das complicações são mais graves [4][5][6][7][8][9] .…”

Section: Introductionunclassified

“…As razões mais comuns são: pseudo-artrose (41,4%), progressão da curva (20,7%), infecção (1,5%) e mais raramente o déficit neuroló-gico ( 0,2%) [3][4][5][6] . A fixação pedicular tem uma série de vantagens para correção das deformidades em relação aos outros métodos de fixação da coluna vertebral, porém o potencial das complicações são mais graves [4][5][6][7][8][9] . O uso da fluoroscopia no auxílio da fixação das deformidades vertebrais têm acurácia relativa, em especial, nas reabordagens de escoliose, podendo ter altas taxas de violação pedicular [10][11][12] .…”

Section: Introductionunclassified

Estudo de acurácia em cirurgia assistida por navegação na revisão cirúrgica de deformidade vertebral

Jacob¹,

Galves²,

Santos³

et al. 2011

Coluna/Columna

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RESUMOObjetivo: Avaliar as vantagens da cirurgia com navegação na revisão cirúrgica de deformidades vertebrais, verificando a acurácia deste método. Método: Foram revisados cincos pacientes com deformidades vertebrais que tiveram intercorrências na primeira cirurgia. Esses pacientes foram submetidos a um estudo de tomografia computadorizada (TC) com cortes de 2mm da coluna vertebral antes da segunda cirurgia. Nos cinco pacientes submetidos a reabordagem cirúrgica procedeu-se a instrumentação posterior com auxílio da navegação. Foram 84 parafusos pediculares implantados, sendo que 33 destes parafusos foram assistidos por computação. A navegação foi empregada nos níveis da deformidade vertebral onde a anatomia apresentava-se alterada inviabilizando o correto uso dos parâmetros anatômicos para inserção de parafusos pediculares. Nos demais níveis onde era possível a correta identificação desses parâmetros anatômicos foi utilizada a técnica padrão. A TC pós-operatória foi realizada para aferição do posicionamento dos parafusos pediculares. Avaliamos os resultados obtidos no posicionamento com e sem o uso da navegação. O tempo de fluoroscopia e o tempo da cirurgia também foram comparados com o padrão ouro da literatura. Resultados: Dos 33 parafusos implantados com navegação observou-se uma acurácia de 94%, com uma taxa de violação pedicular de 6%. Conclusões: O uso da navegação é importante nas revisões cirúrgicas das deformidades vertebrais com anatomia alterada, influenciando no bom resultado final da cirurgia.Descritores: Cirurgia assistida por computação; Reoperação; Escoliose. RESUMENObjetivo: Evaluar las ventajas de la cirugía con navegación en reoperación por deformidades vertebrales, verificando la precisión de este método. Método: Fueron revisados cinco pacientes con deformidades vertebrales que tuvieron complicaciones en la primera cirugía. Esos pacientes fueron sometidos a un estudio de tomografía computada (TC) con cortes de 2 mm de la columna vertebral antes de la segunda cirugía. En los 5 pacientes sometidos al reabordaje quirúrgico se procedió a instrumentación posterior con auxilio de la navegación. Fueron 84 tornillos pediculares implantados, siendo que 33 de éstos fueron asistidos por computación. La navegación fue empleada en los niveles de la deformidad vertebral en donde la anatomía se presentaba alterada impidiendo el uso correcto de los parámetros anatómicos para inserción de tornillos pediculares. En los demás niveles en donde era posible la correcta identificación de esos parámetros anatómicos se utilizó la técnica estándar. La TC postoperatoria fue realizada para medición del posicionamiento de los tornillos pediculares. Evaluamos los resultados obtenidos en el posicionamiento con y sin el uso de la navegación. El tiempo de fluoroscopía y el tiempo de la cirugía también fueron comparados con la regla áurea de la literatura. Resultados. De los 33 tornillos implantados con navegación se observó una precisión de 94%, con una tasa de violación pedicular del 6%. Conclusiones: El uso de la navegac...

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192. Revision Rates Following Primary Adult Spinal Deformity Surgery: 667 Consecutive Patients Followed Up to 21-Years Postoperatively

Cited by 45 publications

References 0 publications

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Estudo de acurácia em cirurgia assistida por navegação na revisão cirúrgica de deformidade vertebral

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